Two nephrologists from Belgium are in Thimphu for the purpose

Health: In view of the increasing referral costs and the rising chronic kidney disease (CKD) cases in the country, a local kidney transplantation programme and peritoneal dialysis would immensely benefit the country, say two visiting nephrologists from Belgium.

Having local infrastructure in place would not only save costs but also improve the quality of life for patients, according to the nephrologists who are currently providing free medical services at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu.

“This would also be beneficial in terms of health economics of nephrology care, as patients don’t have to travel far which is also costly,” Dr Tom Cornelis said.

While commending the knowledge on nephrology care and dialysis in Bhutan, Dr Tom Cornelis said there are issues with resources. Following wide ranging discussions with health officials, he said peritoneal dialysis and transplantation services was an important one.

Peritoneal dialysis differs from hemodialysis, which is clinical purification of blood with the help of a machine. With peritoneal dialysis, patients can administer the dialysis at home, work or while travelling by themselves. A patient may be able to use fewer medications and eat a less restrictive diet than one can with hemodialysis. The nephrologists said that the process is cheaper than hemodialysis.

“This could be a good initiative in addition to the existing hemodialysis treatment,” he said.

The nephrologists 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.

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, they said.

Dr Tom Cornelis said that another area of discussion was on starting a kidney transplantation programme in Bhutan.

He said it would be possible for the government to start a transplantation programme as local interest is available while knowledge can be gained by working together with countries where knowledge is available for peritoneal dialysis and transplantation with good context and partnerships.

The nephrologists said that introducing peritoneal dialysis and transplantation could even lead to a decrease in cost considering the high referral costs.

From eight cases in 1998, there are 149 patients on dialysis at the Thimphu, Gelephu and Mongar hospitals today. The health ministry spent about Nu 20.70 million (M) for 23 successful kidney transplants conducted in India last year.

The other nephrologist, Dr Suen Shets said that improving local facilities would help improve the quality of life of patients.

“Transplantation could be a long-term option, as it requires some more equipment and training but peritoneal dialysis can be done easily within a short time schedule,” he said.

He said that the hospital has plans to start kidney biopsy, which will help in the diagnosis of kidney disease. “If the biopsy can be done here, diagnosis can be made and they could be treated and prevented from coming to dialysis,” Dr Suen Shets said.

The nephrologists observed that kidney failure and end-stage renal diseases in Bhutan are due to diabetes and hypertension. They advised people to focus on better health and lifestyle to have a control over diabetes, blood pressure and weight gain through better diet besides increasing physical activity.

“Prevention is important as nobody would want to land up on dialysis, which is costly,” Dr Tom Cornelis said. “Patients at risk should get their blood checked so that they can be referred earlier to the nephrologist for early treatment.”

Dr Suen Shets also emphasised the importance of leading a healthy lifestyle consisting of a healthy diet with less salt and calories intake. “A proper diet is necessary to prevent not just kidney failure but cardiovascular diseases, strokes and diabetes as these diseases increase mortality,” he said.

The two nephrologists are expected to provide free consultation to more than 300 patients until April 21. The doctors are here as volunteers through His Majesty The King’s project. They first visited Bhutan in 2013 during which they visited the Thimphu referral hospital and the dialysis unit. It was then that they decided to come back and provide their services for free.

The Bhutan Kidney Foundation (BKF) and the Thimphu referral hospital is organising the consultation.

BKF’s executive director Tashi Namgay said that the services rendered by the nephrologists would compliment the services of the lone nephrologist in the country. “It is a good opportunity for kidney patients and there are many who want to consult these nephrologists,” he said.

Kinga Dema