India’s struggle with end-stage renal disease (ESRD) has reached a critical juncture, as the number of patients undergoing chronic dialysis continues to surge. The establishment of the National Dialysis Service in 2016, aimed at improving access to dialysis services, marks a significant step towards addressing this growing challenge. Despite these efforts, the journey to ensure equitable and quality dialysis care across the nation is far from over. Recent findings suggest a dire need for a national benchmark for survival amongst dialysis patients, highlighting the disparities in patient outcomes, particularly between urban and rural centres. A comprehensive study, involving over 23,600 patients within the NephroPlus network, reveals alarming disparities in survival rates, with mortality rates in rural centres being significantly higher than those in urban counterparts. This discrepancy underscores the broader issue of healthcare access and quality in rural India, where infrastructural and staffing challenges exacerbate the plight of patients.
The establishment of a national benchmark for dialysis outcomes is a commendable first step, but it is just the beginning of a long and arduous journey towards ensuring that every patient, irrespective of their geographic or socioeconomic status, receives the highest standard of care. The variability in survival rates across different centres calls for a concerted effort to standardize care processes and improve staffing and infrastructural facilities, especially in rural areas.The path forward necessitates a collaborative quality improvement system that spans the breadth of the country. Only through a concerted effort to understand and address the multilevel effects of centre- and patient-level characteristics on survival outcomes can we hope to mitigate the disparities that currently mar the landscape of dialysis care in India. As we stand on the brink of a potential healthcare crisis due to the increasing demand for dialysis, the time to act is now. Establishing national standards and benchmarks for dialysis outcomes is not just an administrative necessity but a moral imperative to ensure that the right to health and life is upheld for all patients battling ESRD in India.
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