ESRD concerns

This letter is in response to the article written by Paolo Romero last Dec. 28.

End Stage Renal Disease (ESRD) or permanent kidney failure is one of the most catastrophic complications of lifestyle diseases like diabetes and hypertension. Based on the Philippine Renal Disease Registry Annual Report in 2013, the number of new patients diagnosed with this condition who need to start permanent dialysis is about 12,000 per year. More than 20,000 patients are on maintenance dialysis at present all over the country. This is an alarming number considering the medical and financial implications of lifelong dialysis. While patients are waiting for a kidney transplant, which remains the best treatment for kidney failure, they are placed on either two forms of dialysis, hemodialysis (HD) or peritoneal dialysis (PD).

In PD, a special dextrose-solution is placed in one’s abdominal cavity, where it stays for about 6 to 8 hours. During this time, all the poisons and excess fluid are moved from the patient’s blood to the solution, then the solution is drained, and another fresh solution is placed inside the abdominal cavity. This is called a PD exchange. Both modalities result in a similar survival, however, PD has several unique advantages:

• A home-based therapy:

• Allows a patient to eat and drink more; and

• Provides continuous dialysis 24/7 just like the normal kidney.

Patients or their care-givers are trained to do their PD exchanges in the comfort and convenience of home. Thus the patient’s schedule and lifestyle are less restricted. PD exchanges are done daily, thus a patient can eat and drink more than a patient on HD which is done 2 to 3 times a week. HeaJth economics-wise, PD is easily accessible and more affordable for both the patient and dialysis provider. There is no need for expensive machines and water treatment facilities that are required in setting up an HD center. Patients only need access to the PD solutions and accessories and is done by the patient at home.

NKTI has a thousand patients maintained on PD, with an average of 30 new patients initiated on PD each month. Because PD is performed by the patients themselves at home, patients and their caregivers undergo special training to ensure that PD is performed properly and safely. Patients are seen regularly in the clinic or visited by the PD nurses at home to ensure that they are compliant with their PD prescription and technique.

We understand and agree with the good Congressmen when they expressed their concerns about the financial burden of dialysis and its sustainability among these patients. Certain issues though deserve clarification. As the leading service provider for kidney diseases, NKTI considers the welfare of its patients as its top priority. In 2004, the NKTT started its PD First Policy and provided training for other hospitals to perform this life-saving treatment. In 2014, NKTl implemented the PHIC PD benefit reimbursement. These programs have been put in place to fully maximize the benefits provided by PhilHealth which is a reimbursable amount of P180,000.

Patients have the option of receiving the PHlC reimbursement as a check for P 3,500 or receiving the equivalent number of bags of PD solutions every six days. Although this is not a full subsidy, the PHIC benefit in a year for adequate PD is 75% compared to only 25% subsidy when patients are on hemodialysis (HD). This is for patients on the standard PD prescription of three 2-Liter bags per day. Patients who require additional PD bags, based on the nephrologist’s medical assessment, that is not covered by PhilHealth are immediately referred to PCSO. Guarantee letters from PCSO are presented by the patients to PCSO’s designated distributor that presently does not include NKTI.

The costs of the PD solutions when purchased by patients at the NKTl are net of senior citizen, person with disability and government employee’s discount. This amounts to P178.80 that includes I PD bag and I Disinfection Cap. In order to implement the Philhealth benefit, the NKTl has employed additional personnel to ensure patient services are adequately delivered and an additional warehouse space had to be allocated to provide storage for PD supplies.

We always encourage our patients to avail of the case rate benefit of Philhealth during the patient orientation on the support systems offered to patients under NKTI. We refer patients to PCSO and detail the specific needs of patients, so that there is no duplication of assistance, and to ensure that patients receive the proper care that they require, be it medications, PO solutions, or other services. 

Since Nov. 21 , 2014, due to the shortage of PD solutions brought about by port congestion, there has been no enrolment of new patients for PD. We have formally written and requested assistance from DOH and the Port Authority to prioritize the release of PO supplies, since these are life-saving medications. In order to ensure that each PD patient is served, we have asked patients to pick up their PD supplies from NKTI weekly, instead of every 2 weeks. We want to ensure that all our current patients are provided with the PD solutions that they require. We share the concerns of the people’s representatives and will continue to look for ways to make PD more accessible and provide assistance to our PD patients. — JOSE DANTE P. DATOR, MD, Executive Director, National Kidney and Transplant Institute