Myths about peritoneal dialysis pervade the medical community itself, especially in rural areas where specialists remain scarce.
Published Oct 14, 2025 | 7:00 AM ⚊ Updated Oct 14, 2025 | 7:00 AM
Representational image.
Synopsis: India’s kidney failure crisis burdens rural patients with costly hospital dialysis trips. Peritoneal dialysis, a home-based alternative, is underused despite advantages. Barriers include funding gaps, missing networks, and medical misconceptions. Researchers urge inclusion in public health schemes, local manufacturing, and education to expand access, reduce costs, and improve lives, offering a model for universal kidney care.
Kidney patients in India make pilgrimages to hospitals two to three times weekly for dialysis, bleeding savings on transport before treatment even begins. Yet, a home-based alternative exists that less than 5 percent of the country’s dialysis patients receive, despite five states now reimbursing it under public health schemes.
More than 200,000 Indians develop end-stage kidney disease annually—the final phase of chronic kidney failure when organs cannot filter waste from blood. These patients need transplants or regular dialysis to survive. Transplants reach only a fraction who need them, making dialysis the lifeline for most.
The burden weighs heaviest in villages and small towns. Patients travel hours to dialysis centres, lose workdays, and watch children miss school while families drain savings on transport.
“India faces a kidney failure emergency, yet most rural patients still have no access to dialysis,” said Dr Vivekanand Jha, Executive Director at The George Institute for Global Health India.
A 2006 study found 226 cases of end-stage kidney disease per million population. With diabetes and hypertension surging since then and an ageing population, experts believe the burden has multiplied several-fold, though current data remains absent.
Hospital-based hemodialysis dominates Indian kidney care. Blood flows through machines that filter waste before returning to the body. Patients visit centres repeatedly each week for sessions lasting hours. Government schemes including the Pradhan Mantri National Dialysis Programme and Ayushman Bharat now subsidise these sessions for low-income groups.
Yet 95 percent of patients who access treatment undergo this centre-based approach. The system strains under demand with limited machines and distance creating barriers. Women face particular challenges travelling repeatedly, while children struggle maintaining education.
Peritoneal dialysis uses the abdomen’s lining to filter blood. Patients insert fluid through a tube into their abdominal cavity, where the peritoneum acts as a natural filter. Waste passes into the fluid, which patients drain and replace at home.
The method preserves dignity, allowing children to attend school without interruption and adults to continue working while families avoid enormous transport expenses. Despite these advantages, the treatment has stagnated at under 5 percent of dialysis patients for a decade.
A new study in Kidney International Reports examines why India has failed to expand access and proposes solutions.
Thailand, Hong Kong, and Mexico adopted “peritoneal dialysis-first” policies, recognising home-based treatment could deliver care where building hospital infrastructure proves difficult or expensive. The UK, Australia, and New Zealand actively promote it as a preferred option.
Researchers applied the Programme Sustainability Assessment Tool—a framework previously used for tobacco control, obesity prevention, and diabetes management. These evaluations consistently identified three critical elements: partnerships between organisations, political support from decision-makers, and ongoing outcome assessment.
The team found India’s peritoneal dialysis ecosystem fragile across nearly every measure.
Political inertia: The Ministry of Health issued guidelines for establishing peritoneal dialysis services in 2020. Most states ignored them. Only Andhra Pradesh, Telangana, Tamil Nadu, Kerala, and Chhattisgarh have taken pilot steps. Decision-makers remain unaware of the treatment’s potential, and without champions in state governments, guidelines gather dust.
Funding gaps: Pradhan Mantri Jan Arogya Yojana reimburses hospital-based hemodialysis but excludes peritoneal dialysis costs. The insurance scheme covers only inpatient procedures, not home-based care. Patients need fluid bags regularly, catheters, and training—none receiving reimbursement. The very populations who could benefit most—rural residents, low-income households, geographically isolated communities—cannot afford out-of-pocket costs.
Financial modelling shows a peritoneal dialysis-first policy could actually reduce costs through large-scale procurement and efficient distribution. The numbers support expansion, but the funding framework blocks it.
Missing networks: Hemodialysis operates through established public-private partnerships where private providers run centres under state contracts, maintaining supply chains and training staff. Peritoneal dialysis lacks this ecosystem, depending on individual champion doctors rather than systematic networks.
The study calls for structured partnerships where existing hemodialysis providers expand to include home dialysis training, fluid distribution, and patient follow-up.
Information vacuum: No national peritoneal dialysis registry exists. Policymakers cannot access data on patient outcomes, complication rates, or user experiences. Without disaggregated data by geography, gender, and economic status, disparities remain invisible and officials operate blind.
Medical misconceptions: Myths about peritoneal dialysis pervade the medical community itself, especially in rural areas where specialists remain scarce. Patients default to hemodialysis because doctors express skepticism or don’t mention home dialysis as an option.
Skills Gap: District hospitals lack trained personnel. Surgeons need catheter placement skills, physicians require initiation and troubleshooting knowledge, and nurses must teach patients safe home procedures. Secondary facilities possess neither staff nor competencies, forcing even patients preferring home dialysis toward centre-based treatment.
A single model cannot work across India’s diversity. Tribal regions face different challenges than coastal areas. Flood-prone zones require distinct solutions from drought-affected districts.
Stigma surrounds catheters in some communities. Misconceptions about self-care persist. Housing conditions and literacy levels vary dramatically, with some populations mistrusting medical interventions they cannot see healthcare workers perform directly.
Researchers recommend audio-visual educational materials in local languages, assisted peritoneal dialysis models where community health workers support patients, and engaging self-help groups to build trust.
Researchers recommend immediate inclusion of peritoneal dialysis under Pradhan Mantri Jan Arogya Yojana with full coverage of consumables, training, and telehealth support. States should develop implementation blueprints tailored to local conditions, and a national registry with equity-focused metrics should track progress.
“Families should not be pushed into catastrophic costs because insurance does not cover home-based care,” Dr Jha said.
“National guidelines for implementing peritoneal dialysis programme have already been developed. All that remains is inclusion of peritoneal dialysis packages under Pradhan Mantri Jan Arogya Yojana.”
Incentivising local manufacturing of dialysis fluids and equipment could lower costs and ensure supply security for remote regions. Structured partnerships could leverage existing infrastructure, while community education could shift perceptions.
If widely adopted, home-based dialysis could reduce hospital burden, lower family costs, and save lives in remote and low-income communities—potentially serving as a model for other countries seeking to make kidney care universally accessible. The approach requires careful planning, structural reforms, and political will to transform kidney care from a hospital-centric system to one that reaches patients where they live.
(Edited by Amit Vasudev)
