… the service will be offered in addition to the existing hemodialysis treatment

Health: The Thimphu referral hospital will introduce peritoneal dialysis as part of the nephrology unit expansion plans given the increasing number of renal failure and related cases.

Medical superintendent Dr Gosar Pemba said that the hospital is looking at improving the overall nephrology unit and not just dialysis. “To introduce peritoneal dialysis, the nephrologist along with some nurses would be sent for training to India,” he said.

However, introduction of peritoneal dialysis depends on fund availability especially for human resource development, as the hospital does not receive a separate budget for training. “Infrastructure is not much of an issue,” he said.

“Eventually it involves cost,” Dr Gosar Pemba said. Peritoneal dialysis was introduced in the Thimphu referral hospital in the past but was discontinued for reasons that the present management is unaware of.

Dr Gosar Pemba said that patients would be able to do peritoneal dialysis on their own while the hospital would provide them with the fluid.

Dialysis treatment is a process that does the job of a kidney in voiding body waste, by pumping a patient’s blood into the machine, filtering the toxic substances and pumping it back into the body. Renal failure patients in Bhutan receive hemodialysis at present.

Health officials said that peritoneal dialysis gives continuous dialysis compared to hemodialysis, which causes dialysis disequilibrium such as headache and nausea given the intermittent character of the treatment. Besides, patients who have no access to put in dialysis cathedral also qualify for peritoneal dialysis. The process is cheaper than hemodialysis.

In peritoneal dialysis, a cathedral is inserted into the stomach and it requires exchange of the dialysis solution. After the dialysis has taken place, the dialysis may be left out again and repeated. A patient may also be able to use fewer medications and eat a less restrictive diet than one can with hemodialysis.

Records indicate a steady increase in people suffering from renal failure cases over the years. Dialysis units of Thimphu, Gelephu and Mongar hospitals recorded 146 new cases last year from 119 the previous year. So far this year, the three hospitals recorded 40 new cases, which translate to about 15 cases in less than three months.

From eight cases in 1998, today there are about 149 patients on dialysis at the three hospitals. Limited dialysis machines and increasing renal failure patients, according to health officials, is a major issue.

The issue further compounded with just a lone nephrologist in the country today. When the nephrologist is on leave, all the services have to stop, said health officials.

There are 10 machines in Thimphu.  Each dialysis procedure lasts four hours, and it takes an hour to prepare the machine. Ideally, health officials said, a patient need to receive dialysis treatment two to three times a week to be adequately dialysed.  However, with just 10 machines, some patients receive dialysis treatment only about once a week.  If inadequately dialysed, a patient’s survival rate decreases, said health officials.

Bhutan Kidney Foundation’s executive director Tashi Namgay said the peritoneal dialysis would help patients who cannot avail kidney transplant for various reasons such as their age or other medical conditions and working people to receive dialysis at their homes or work places.

“In other regions, I have seen even illiterate people conducting it themselves,” he said, while expressing concerns over transportation of the fluid especially in rural places. “But we should be able to find a possible alternative.”

The construction of an additional 22-bed dialysis unit for out patients below the Thimphu referral hospital is expected to ease pressure at the existing dialysis unit.

Dr Gosar Pemba said that the new dialysis unit would immensely benefit the hospital and patients. “The existing unit would be used for inpatients while the new dialysis unit would cater to out patients,” he said.

When the reverse osmosis machine at the dialysis unit breaks down, he said the unit has to close down until the machine is repaired as no dialysis can take place. With two dialysis units, if one of the machines breaks down, patients can receive dialysis in one of the units. When the machine in Gelephu and Mongar breaks down, patients are sent to Thimphu to continue their dialysis.

Kinga Dema