Researchers establish India’s first national standard for survival of hemodialysis patients

A new national survey provides new information on survival rates and associated factors for patients undergoing hemodialysis across India.

of studywas announced in Lancet Community Health – Southeast AsiaUsing anonymized individual-level data from 193 dialysis centers nationwide that are part of the NephroPlus network, we investigated survival rates for patients undergoing hemodialysis treatment. The study evaluated a cohort of 23,601 patients from April 1, 2014 to June 30, 2019, of whom 29% were women.

Researchers established nationally representative survival rates for hemodialysis treatment in India, quantified variation in survival rates across facilities, and measured the extent to which this variation was explained by facility-level characteristics. The purpose was to.

The main findings of the study are:

• For the entire cohort, the raw 180-day survival rate was 71%, suggesting that approximately 7 in 10 patients survived beyond 6 months.
• After accounting for facility-level and patient-level factors, the model-predicted 180-day survival rates ranged from 83% to 97%. The average center survival rate was 90%.

Center-level characteristics include characteristics such as number of beds, number of staff, and whether the center is urban or semi-urban. rural area; individual (patient)-level characteristics include age, gender, education, smoking status, method of payment for treatment, and comorbidities.

Even after accounting for differences in patient case mix, mortality rates were 32% higher in rural centers than in urban centers. However, the authors cautioned that other patient characteristics not captured in the database may partially explain the higher mortality rates in rural centers.

Patient characteristics associated with survival:

• Mortality rate of affected people is low higher education or more monthly household income
• Patients who do not pay out-of-pocket for treatment have a lower mortality rate than those who pay out-of-pocket.
• Diabetic patients have a high mortality rate
• Mortality is higher in patients whose vascular access is other than arteriovenous fistula or graft

Professor Vivekanan Jha, Executive Director of India George Institute for Global Health and Past President of the International Society of Nephrology, emphasized the far-reaching significance of the research and said, “The national dialysis program and state government subsidies “Access to dialysis has improved.” Millions of Indians now have access to this life-saving treatment.

“We urge governments to consider expanding coverage to include support for the prevention of kidney disease and improved long-term management of major complications associated with dialysis, such as cardiovascular disease and mineral bone disease. We strongly urge you to do so, and we also request that you use it in conjunction with dialysis therapy.” Enrollment in the national dialysis program.”

Commenting on these findings, Dr Karinna Hockham of the George Institute for Global Health said, “This is a significant study, both in terms of scale and geographic scope, to investigate survival outcomes for patients undergoing hemodialysis in India.” “This is the largest study to date.” The power to investigate population health outcomes using regularly collected health data. Information is provided on the types of data that should be collected for a comprehensive understanding of the factors that influence survival after dialysis. ”

Dr. Arpita Ghosh, senior research fellow and statistician at the George Institute for Global Health, said: “We sought to measure the extent to which variation in survival rates between facilities can be explained by facility-level factors. “I tried it. It was an important learning experience.” To ensure that you have an effective quality improvement system, exercise thinking about the type of information that should be collected in a national dialysis registry. ”

Hemodialysis is an important medical procedure used to treat people with conditions such as: kidney failure. When the kidneys are no longer able to effectively filter waste and excess water from the blood, hemodialysis steps in to perform this important function.

India has one of the highest numbers of long-term dialysis patients in the world, with an estimated 175,000 patients in 2018. The number of dialysis patients is on the rise. Among all the procedures covered under the Ayushman Bharat scheme, the government spends the most money on dialysis procedures.

Despite this burden, there is limited data on clinical outcomes for dialysis patients in India. Previous studies have been small, single-center, or more than 10 years old. Prior to this study, there were no national standards for survival for hemodialysis patients, and no studies had investigated differences in survival between dialysis facilities.

As access to dialysis expands in India, continuous and collaborative quality improvement efforts will play a critical role in ensuring patients receive the best possible outcomes during treatment. Become. Central to this is the collection of standardized prospective data on dialysis outcomes and other key characteristics to enhance accountability and identify areas for improving care.

By establishing national benchmarks for survival and identifying key factors influencing survival, this study paves the way for targeted interventions and improved care. dialysis Patients all over the country.