Dr. Georgi Abraham, Consultant Nephrologist & Transplant Physician, Madras Medical Mission, Chennai spoke about the status of peritoneal dialysis (PD) in India and its relevance during the COVID-19 pandemic as part of an ongoing series of webinars organised by MOHAN Foundation. The webinar was held on 21st May 2020. Dr. Georgi is a pioneer in peritoneal dialysis in India. He was one of the first nephrologists to introduce continuous ambulatory peritoneal dialysis (CAPD) as far back as 1991 using the O-set CAPD system. He founded the Peritoneal Dialysis Society of India in 1997.
The audience comprised the staff of MOHAN Foundation, members of patient support groups such as Transplant Recipients’ Indian Organisation – Meant to Provide Hope (TRIOMPH) and Kidney Warriors Foundation, and members of Network & Alliance of Transplant Coordinators (NATCO).
Dr. Georgi recognised early on that PD was a feasible option for patients who might want to undergo dialysis at home, but many nephrologists in India did not offer the option because of financial implications, lack of training in PD, and fear of infection (peritonitis). Dr. Georgi reiterated that three modes of renal replacement therapy (HD, PD, renal transplant) were available to patients depending on the situation. He said that given that the COVID-19 pandemic was not going to go away anytime soon, and that there could be similar viruses in the future, it would be better to focus on PD. Centre HD is facing a number of challenges in the current scenario – patients being dialysed in a closed room for 4 -5 hours, patients travelling from the community 2 – 3 times a week from ‘different’ areas or inability of patients to come to the HD centre, staff health being affected and the unit shutting down. A study published by Maurizio Gallieni et al on April 17, 2020 from Lombardy, Italy showed that in the first 50 days they had 12/215 (5.6%) COVID-19 cases among HD patients, none in PD.
Dr. Georgi and his team have shared their experience and expertise in PD with countries in Africa and the Middle East. One of the innovations by Dr. Georgi and Dr. Satish Prabu was an affordable and customised option for PD patients - the “peel-away sheath kit” called the Georgi and Satish permanent PD catheter. There is an Indian manufacturer for CAPD fluid now so the cost has come down. Recently CAPD was included in the Pradhan Mantri National Dialysis Programme under the Pradhan Mantri Jan Arogya Yojana, although the focus is on HD. It is time now to ensure that all potential PD candidates are identified, assessed, and offered PD.