Understanding Dialysis in Delhi – Types, Process, Cost & FAQs Explained.pdf

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1. UnderstandingDialysisinDelhi–Types,
Process,Cost&FAQsExplained
Thekidneysperformessentialfunctions:theyfilterwasteproducts(likeurea,creatinine),
manageelectrolytebalance(sodium,potassium,etc.),regulatewaterremoval(fluidbalance),
andhelpmaintainacid-basebalance.Whenkidneysfail(duetochronickidneydisease(CKD)
oracutekidneyinjury),thesetaskscannotbeadequatelyperformed.Aswastesbuildupand
excessfluidaccumulates,thebodybecomesexposedtotoxicsubstancesanddangerous
imbalances.
Dialysisisarenalreplacementtherapy(RRT)thattakesover(atleastpartially)thefiltration
roleoffailingkidneys.Itdoesnotfullyreplicateallkidneyfunctions(forexample,producing
hormoneslikeerythropoietin),butithelpsmaintainlifeandhealthuntilkidneysrecover(rare
inCKD)oruntilatransplantisavailable.Whenconsideringlong-termtreatment,patientsand
familiesoftenevaluatedialysiscostinDelhi,asexpensescanvarybasedonthetypeof
dialysis,hospitalfacilities,andtreatmentfrequency.
Dialysisisofteninitiatedwhenkidneyfunctionfallsbelowapproximately10–15%ofnormal
(stage5),orwhensymptomsofuremia,fluidoverload,ordangerouselectrolyte
abnormalitiesappear.

2. HowDialysisWorks:PrinciplesandPhysiology
Dialysisusestheprinciplesofdiffusion,osmosis,andultrafiltrationacrossasemipermeable
membranetoremovesolutesandfluidfromtheblood.Belowisasimplifiedviewofthe
process:
1.Bloodaccessandextracorporealcircuit(inmanytypes):Bloodisdrawnfromthe
body(typicallyviaavascularaccess)andpassedalongonesideofasemipermeable
membrane(e.g.insidehollowfibers).
2.Dialysate(dialysisfluid)flowsontheoppositesideofthatmembrane,oftenina
counter-currentflowtomaximizeconcentrationgradients.Wastesolutes(urea,
creatinine,potassium,etc.)diffusefromtheblood(higherconcentration)intothe
dialysate(lowerconcentration).
3.Ultrafiltration/fluidremoval:Byapplyingapressuregradient(hydrostaticpressureor
negativepressure),excesswatermovesacrossthemembranefromthebloodsideto
thedialysateside.Thisishowfluidoverloadismanaged.
4.Thecleanedbloodisthenreturnedtothepatient,whiletheuseddialysate(now
containingwasteandextrafluid)isdiscarded.
5.Inperitonealdialysis,thepatient’sownperitoneum(liningoftheabdominalcavity)
servesasthesemipermeablemembrane;dialysateisinstilledintotheperitonealcavity
andlaterdrained,carryingawaywasteandfluid.
Blood is
cleaned of
toxins
Body
experiences
improved
health
Continued
Therapy
Dialysis
Initiation
Dialysis
continues as
needed
Kidney
Failure
Kidneys lose
function
Symptom
Relief
The Dialysis Cycle
Therapy starts
to filter blood
Toxins
accumulate in
the body
Waste
Buildup
Filtration
Process

3. Becausedialysisisnotcontinuous(exceptinsomeintensivecaresettings),itmustbe
scheduledatintervalstopreventwasteaccumulationbetweensessions.Types/ModalitiesofDialysis
Thereareseveralwaystoclassifydialysis—bylocation(in-centervshome),bymodality
(hemodialysisvsperitoneal),orbyspecialvariants(continuoustherapies,nocturnaldialysis,
etc.).Belowisabreakdown:1.Hemodialysis(HD)
Definition&principle:Bloodisdrawnoutofthebody,circulatedthroughadialyzer(artificial
kidney)whereitisfiltered,thenreturned.
Access:Togetenoughbloodflow,avascularaccessmustbecreated.Thecommontypes
include:
•Arteriovenous(AV)fistula:Surgeonconnectsanarterytoavein(usuallyinthearm),
whichpermitshighbloodflowovertime.
•AVgraft:Synthetictubebridgingarteryandvein,usedwhenveinsarenotsuitablefor
fistula.
•Venouscatheter(temporary):Insertedintoacentralvein(neck,chest)when
immediatedialysisisneeded.
Blood Access
Blood is drawn from the
body.
Cleaned blood is
returned to the patient.
Cleaned Blood
Return
Dialysate flows on the
opposite side.
Dialysate
Disposal
Dialysate Flow
Excess water moves to
the dialysate.
Fluid Removal
The Dialysis Cycle
Used dialysate is
discarded.
Waste diffuses into the
dialysate.
Waste Diffusion

4. Settings:
•In-centerhemodialysis:Patientsvisitadialysiscenter(hospital,standaloneunit)3
timesperweek,eachsessionlasting3–4hours(ormore,dependingonprescription).
•Homehemodialysis:Thepatientorcaregiveristrainedtorundialysisathome.This
allowsmoreflexibility,possiblemorefrequentornocturnalsessions.
•Nocturnalhemodialysis:Dialysisisdoneovernightoverlongerdurations(e.g.6–8
hours),eitherin-centerorathome,whichcanimproveclearanceandreduceside
effects.Variants/advancedapproaches:
•High-fluxvslow-fluxdialyzers:High-fluxmembranespermitremovaloflarger
molecules(e.g.β₂-microglobulin)butrequireefficientmachinesetup.
•Hemodiafiltration&hemofiltration:Thesecombinediffusionandconvection,adding
replacementfluidtoenhanceremovalofmedium-sizedtoxins.(Ofteninintensiveor
specializedsettings.2.PeritonealDialysis(PD)
Definition&principle:Dialysateisinstilledintotheperitonealcavity(abdomen).Waste
solutesandfluidcrossfromblood(throughperitonealmembrane)intothedialysate.Aftera
dwelltime,thefluidisdrained.TypesofPD:
•ContinuousAmbulatoryPeritonealDialysis(CAPD):Exchangesbyhandduringwaking
hours(often3–5exchangesperday).Nomachinerequired.
•ContinuousCyclingPeritonealDialysis(CCPD)/AutomatedPD(APD):Machine
(cycler)performsexchanges,oftenovernightwhilethepatientsleeps.
•IntermittentPD:Lesscommonlyusedvariant,sometimesinhospitalsettings;usesa
machinebutlessfrequentlythanCCPD.3.ContinuousRenalReplacementTherapies(CRRT)
Primarilyusedinintensivecaresettingsforcriticallyillpatients(oftenwithunstable
hemodynamics).Theseareslower,continuousdialysis/filtrationtherapies(e.g.,continuous
venovenoushemofiltration,hemodiafiltration).Becausethepatientistypicallyunstable,these
arenotoutpatientoptions.4.ChoosingaModalityWhichtypeisbestdependson:•Patient’sresidualkidneyfunction•Medicalconditions(heartdisease,abdominalsurgeries,vascularaccessissues)•Lifestylepreferences(desireforflexibility,travel,homesetup)•Supportsystem/caregiveravailability•Cost,availability,infrastructure•RiskofinfectionsorcomplicationsPatientscansometimesswitchmodalitiesifneeded.
ReadMore:BalancingLifeandTreatment:ManagingWorkandSocialActivitiesWhileon
DialysisHowAVFistulaImprovesQualityofLifeforDialysisPatient

5. DialysisCostinDelhi&India:WhattoExpect
Costisoftenamajorconsiderationforpatientsandfamilies.InIndiaandDelhi,costsvary
dramaticallybytype,facility(government,private,standalone),subsidies,andwhethera
packagedealisavailable.Delhi/IndiaCostEstimates
•InDelhi,hemodialysisisreportedtocostintherangeof₹2,100to₹6,300persession
(forprivatecenters)onPractolistings.Practo
•PeritonealdialysisinDelhiisreportedly₹5,250to₹8,400persession(Practo)(though
PDsessionsarelessfrequent,butconsumablesandsetupaddup.
•AccordingtoHexaHealth,dialysisinDelhitypicallycostsbetween₹2,500to₹5,000
persession(average~₹3,750)
•AccordingtoaNationalUniversity(NU)Hospitalsblog,inmajorIndiancitiesincluding
Delhi,persessioncostis₹1,500to₹3,500,withmonthlycosts(forthefullschedule)
goingupaccordingly.
•Ingovernmenthospitals(e.g.AIIMS),ratesaremuchlower:AIIMSNewDelhi’srevised
ratelistshowsHaemodialysisat₹500persession.
•InabroaderIndianstudy,costofeachHDsessionrangesfrom₹150(ingovernment
hospitals)to₹2,000(insomecorporatehospitals)dependingonregion,
infrastructure,etc.Themonthlycost(privatehospitalaverage)was~₹12,000in
•Fortis(inNCRregion)offersapackageof30dialysissessions(withF6dialyser)for
about₹72,360,whichworksoutto~₹2,412persession.
Thus,ifyougotoaprivatecenterforstandardhemodialysis3×perweek,costscanaddup
to₹18,000to₹40,000permonth(ormoredependingonextras,complications).Importantcaveats:
•Theseareproceduralcosts;additionalcosts(labtests,medications,vascularaccess
surgeries,hospitalizations,transport)mayaddsubstantially.
•Ingovernmentorsubsidizedcenters,thecostmaybefarlowerorfreeunder
schemes.•Somecentersofferpackages(e.g.30sessions)atadiscountedrate.
CRRTHemodialysisPeritoneal DialysisRequires vascular
access and frequent
sessions, but offers
flexibility with home
options.
Used in intensive care
for critically ill patients
with unstable
hemodynamics.
Uses the peritoneal
membrane for filtration,
suitable for those
preferring machine-free
options.
Which dialysis modality is best for the patient?

6. ImpactofGovernment&PublicPrograms
•Delhigovernmentisexpandingdialysisservicesandadding150newmachinesacross
sixgovernmenthospitalstoimproveaccess,especiallyforlow-incomepatients.
•UnderschemeslikethePradhanMantriNationalDialysisProgramme(PMNDP)andPPP
dialysismodels,economicallyweakerpatientsmayreceivefreeorsubsidizeddialysis.
•Eligibilitycriteria(residency,income,possessionoffoodsecuritycard)comeintoplay
forfree/subsidizeddialysisundergovernmentschemesinDelhi.
Thus,althoughprivatedialysiscostsarehigh,governmenteffortsareimprovingaccessto
low-costorfreedialysisinpublicfacilities.Contact:BestNephrologistinDelhikidneyspecialisthospitalindelhiPracticalWorkflow&PatientJourneyinDialysis
Here’showatypicalpatientjourneymightunfold,withtheprocess,preparations,and
monitoring:1.Diagnosis&evaluation
•Anephrologist(kidneyspecialist)assesseskidneyfunction(eGFR,creatinine,
urea,electrolytes)•Alsoevaluatescomorbidities(heartdisease,bloodpressure,vascularstatus)•Decideswhentostartdialysis(basedonsymptoms,labvalues)2.Vascularaccesscreation(forHD)•Ifchoosinghemodialysis,thesurgeonmayneedtocreateanAVfistulaorgraft•Fistulamaytakeweekstomaturebeforeuse•Temporarycathetermaybeusedinitiallyifurgentdialysisisneeded3.Patienttraining&baselineworkup•Baselinelabs(CBC,electrolytes,hepatitisscreening,viralmarkers)•Assessmentforanemia,bonemineraldisease,nutrition•Patient/familytraininginhygiene,vascularaccesscare,diet,fluidrestrictions4.Dialysisprescriptions&schedules•Basedonbodysize,residualkidneyfunction,targetclearances•In-centerHDisoften3×perweekfor3–4hours•Ifhomeornocturnaldialysis,schedulesareadapted5.Duringadialysissession
•Thepatientisseated(orsupine),needlesinsertedintoaccess(arterial/venous
sides) •Bloodpumpedthroughdialyzer,dialysatecirculates,wastes&fluidremoved
•Monitorscheckbloodpressure,flowrates,patientsaremonitoredfor
complications
•Aftercompletion,needlesareremoved,bleedingisstopped,vitalsignsare
checked6.Post-dialysismonitoring&follow-up•Vitalsigns,labtests•Monitorforhypotension,cramps,disequilibriumsyndrome
•Medicationadjustments(e.g.phosphatebinders,erythropoietin,
antihypertensives)•Nutritionalassessment•Monitorvascularaccessfunction,complications7.Ongoingcare&adjustments•Periodicreviewofdialysisadequacy(e.g.Kt/V,URR)•Adjustdialysatecomposition,sessionlength/duration•Monitorforcardiovascularcomplications,bone-mineraldisease,anemia•Infections,hospitalizations,accessrevisions8.Potentialtransitiontotransplant(ifeligible)•Somepatientsondialysismaybecandidatesforkidneytransplant.•Dialysismaycontinuewhileawaitingtransplant.
Risks,Complications&Challenges

7. Dialysisisalife-sustainingtherapy,butitisnotwithoutpotentialcomplicationsand
challenges.Patientsmustbemonitoredcarefully.•Hypotension/lowbloodpressureduringdialysis(duetorapidfluidremoval)•Musclecramps,headache,nausea•Infections:Accesssiteinfections,catheterinfections,peritonitis(inPD)•Bleeding/vascularaccessthrombosis/stenosis•Electrolyteshifts,particularlypotassium,calciumimbalances•Dialysisdisequilibriumsyndrome(rare,fromrapiddropinurea)•Cardiovascularstrain(fluidshifts,changesinbloodpressure)
•Peritonealdialysis-specificcomplications:cathetermalfunction,hernia,glucoseload
issues•Amyloidosisinlong-termdialysis(duetoβ₂-microglobulinaccumulation)•Reducedqualityoflife,fatigue,diet/fluidrestrictions
Closemonitoringandamultidisciplinaryteam(nephrologist,dialysisnurses,dietitians)are
crucialtomitigatetheserisks.ComparativeSummary:HDvsPDDialysisinDelhi:SpecialConsiderations&Landscape
•Aspartofexpandingpublichealthservices,Delhigovernmentisincreasingitsdialysis
capacityingovernmenthospitals,especiallytoassistlow-incomepatientsunder
PMNDPandPPPmodels.
•Ingovernmenthospitals(likeAIIMS),thecostisoftensubsidized;AIIMScharges₹500
perHDsessioncurrently.AIIMS
•Privatehospitalsandstandalonecentersmaychargemuchhigher,dependingonthe
dialyzermodel,watertreatment,staffing,andoverheads.
•Patientsmustcheckeligibilityforfree/subsidizeddialysisundergovernmentschemes,
whichmayrequireproofofresidence,income,andfood-securitycards.
•Somecentersoffer“packages”(e.g.30sessions)atadiscountedper-sessionrate,
whichmayreducetheburden.
•Thecapacitygapisreal:demandfordialysisoftenoutstripsthemachineavailability,
leadingtowaittimesinsomepubliccenters,especiallyforsubsidizedslots.

8. EpitomeKidneyUrologyInstitute&LionsHospitalstandsasoneofDelhi’sleadingcenters
foradvancedkidneyandurologicalcare.Renownedforitsexcellenceinnephrology,
urology,andkidneytransplantation,Epitomecombinescutting-edgetechnologywith
compassionatepatientcare.UndertheguidanceofhighlyexperiencedspecialistslikeDr.
VijayKher,theinstitutehasachievedremarkablesuccessinkidneytransplants,dialysis,and
minimallyinvasivesurgeries.Withstate-of-the-artdialysisunits,24x7emergencysupport,and
personalizedtreatmentplans,Epitomecontinuestosetnewbenchmarksinrenalhealthcare.
Itscommitmenttoaffordability,innovation,andethicalmedicalpracticesmakesitatrusted
nameamongpatientsacrossIndia.
EpitomeKidneyUrologyInstitute&LionsHospitalhasbuiltanimpressivetrackrecordin
kidneytransplantation.Todate,theirteamhassuccessfullyperformedover5,000kidney
transplants.UndertheleadershipofDr.VijayKherandthenephrology-team,thesesurgeries
havecateredtopatientsfrombothIndiaandabroad.Theyalsorunarobustsurgeryprogram
inurology(forkidneystones,minimallyinvasiveprocedureslikePCNL,URSL,etc.),though
specificnumbersforthosesurgeriesarenotpubliclydetailed.
FrequentlyAskedQuestions(FAQ)
Q1:Whenshoulddialysisbestarted?A:Dialysisistypicallystartedwhenkidneyfunctionis
severelyreduced(often<10–15%residualfunction)andsymptomsofuremia(nausea,fatigue,
fluidoverload,electrolytedisturbances)appear.Thedecisionalsodependsonpatient
conditionandlaboratoryresults.
Q2:HowmanytimesperweekdoIneeddialysis?A:Thecommonregimenforhemodialysis
is3sessionsperweek(each3–4hoursormore).Somepatientsmayneedmorefrequent
sessionsdependingonfluidaccumulation,residualkidneyfunction,andcomorbidities.In
peritonealdialysis,exchangesaredonedaily(CAPD)orovernight(APD)dependingon
schedule.
Q3:Candialysispatientstravelorliveanormallife?A:Yes,manypatientslivereasonably
normalliveswithdialysis.Travelispossible,thougharrangementsmustbemade(transportto
dialysiscenter,ensuringsterileenvironment).PDoffersmoreflexibilitysinceexchangescan
bedoneathome.Lifestyleadjustments(fluidanddietrestrictions)areneeded.
Q4:CanIgetakidneytransplantinsteadofdialysis?A:Yes,transplantisoftenthepreferred
long-termsolutionifthepatientiseligible(healthyenough,donoravailability).Manypatients
remainondialysiswhileawaitingtransplant.
Q5:Doesdialysiscompletelyreplacekidneyfunctions?A:No.Dialysismainlyremoves
wastesandexcessfluid.Itcannotfullyreplicateendocrineormetabolickidneyfunctions(e.g.
erythropoietinproduction,vitaminDactivation).Soadditionalmedicationsmaystillbe
required.
Q6:Whatarethesignsofcomplicationstowatchfor?A:
•Suddendropinbloodpressure,dizziness•Cramps,nauseaduringdialysis•Redness,swelling,painnearvascularaccessorcathetersite•Fever,abdominalpain(inPD)—possibleperitonitis•Prolongedbleedingfromneedles•ShortnessofbreathorfluidoverloadPatientsshouldpromptlyinformtheirdialysisunitordoctoriftheynoticethese.
Q7:Isperitonealdialysissaferorbetterthanhemodialysis?A:“Better”iscontext-dependent.
PDoffersmoreflexibilityandgentlermetaboliccontrol,buthashigherriskofperitonitisand
slowerclearance.HDismoreefficientandmorewidelyavailable,butismoredemandingon
vascularaccessandcancausehemodynamicstress.Thechoicedependsonpatientfactors,
lifestyle,andmedicaladvice.
Q8:Howlongcanapatientliveondialysis?A:Survivalvarieswidelybasedonunderlying
disease,comorbidities,age,andcarequality.Manypatientslivemultipleyearswithdialysis.
Somesurvive10+yearswithgoodmanagement.Transplantsgenerallyofferbetterlong-term
survivalwhenfeasible.
Q9:Whatnutritionalrestrictionsareneeded?A:
•Fluidrestriction:limitingfluidintaketopreventoverload•Salt(sodium)restriction

9. •Potassiumandphosphorusrestrictions(dependingonlabvalues)•Proteinintakemaybemoreliberal,asdialysiscausesproteinlosses•Dietarycounsellingisessentialandindividualized
Q10:Whatis“dialysisadequacy”andhowisitmeasured?A:Dialysisadequacyreferstohow
effectivelydialysisisremovingwastes.CommonmeasuresincludeKt/VandURR(urea
reductionratio).Ifadequacyisnotmet,theprescription(sessionlength,frequency,dialyzer
clearance)isadjusted.
Q11:CanIswitchdialysistypeslater?A:Yes.PatientsmayswitchfromPDtoHDorviceversa,
oralterschedules,subjecttomedicalevaluation.Lifestylechanges,complications,or
preferencemaypromptswitching.
Q12:WhatadditionalcostsshouldIplanforasidefromthedialysissessioncost?A:
•Vascularaccesssurgeryandmaintenance(AVfistula,graft)•Imagingandinterventionsforaccess(angioplasty,catheterrevisions)•Laboratorytests(monthly/weeklyelectrolytes,CBC,viralmarkers)•Medications(erythropoietin,iron,phosphatebinders,antihypertensives)•Hospitalization(forcomplications)•Transporttoandfromdialysiscenter•Consumables(e.g.dialyzers,tubing,dialysate)especiallyinhomedialysis
Tips&AdviceforPatients/Caregivers
•Choosetherightcenter:Qualityofwatertreatment,monitoring,staffexperience,
machinemaintenancematter.
•Askaboutpackages:Somecentersmaygivediscountedper-sessionratesifyou
prepayablockofsessions.
•Checkforsubsidiesorschemes:InDelhi,governmenthospitalsandPMNDP/PPP
schemesmayofferreducedorfreetreatmentforeligiblepatients.
•Maintainvascularaccesshealth:Avoidtraumatoarmwithfistula/graft;monitorfor
signsofinfectionorstenosis.
•Strictadherencetodietandfluidintake:Thisreducesburdenondialysisand
minimizescomplications.
•Stayconsistentwithsessions—skippingordelayingdialysiscanleadtoserious
complications.•Bevigilantforsignsofinfectionoraccessproblemsandreportthemearly.
•Engageinphysicalactivityandrehabilitation(asrecommended)tomaintainstrength
andqualityoflife.
•Considerhomedialysisiffeasible—itoffersflexibilityandbetterqualityoflifein
manycases.•Stayincontactwithtransplantprogram(ifeligible)topursuepossibletransplant.Conclusion&Recommendations
Dialysisisalife-sustainingtherapyforpatientswhosekidneyscannolongerperform
necessaryfiltrationandfluidregulation.InDelhi(andIndiagenerally),thecostofdialysiscan
besubstantialinprivatesettings,butsubsidizedorfreecareisincreasinglyavailableunder
governmentprograms.Patientsandfamiliesshouldunderstandhowdialysisworks,thetypes
available,therisksandbenefits,andhowtomanagelong-termcare.Disclaimer:
Theinformationprovidedinthisarticleisforeducationalandinformationalpurposesonly.It
shouldnotbeconsideredasubstituteforprofessionalmedicaladvice,diagnosis,or
treatment.Alwaysconsultaqualifiednephrologistorhealthcareproviderforpersonalized
guidanceregardingdialysis,treatmentoptions,andcosts.Pricesandservicesmentionedmay
varybyhospitalorcenterandaresubjecttochange.