Sheer providence made Kamal D. Shah end up as one of the co-founders of NephroPlus, a chain of kidney care clinics. On dialysis for 21 years, this inspiring man is a saviour for kidney patients.
In conversation with A. Radhakrishnan, he tells us how dialysis patients too can live a completely normal life.
How did you grapple with dialysis?
Having completed my Chemical Engineering in 1997, I got admission into a U.S. university to pursue my Masters.
Scheduled to fly out in a couple of weeks, I took some mandatory vaccinations. Within a couple of days, I developed symptoms like nausea, vomiting which worsened. Our family physician prescribed some tests which showed that the kidney function had been impaired.
My serum creatinine, a measure of kidney function with a normal value of 0.5 to 1.2 mg/dL, was 7 mg/dL! On a nephrologist’s advice, I underwent a session of dialysis urgently the next day at a hospital. That was the first time in my life that I heard the word ‘dialysis’.
Was there a history of dialysis in your family? What was your initial state of mind when kidneys failed?
No, there was no family history of kidney disease. My nephrologist said my kidney disease was an ‘acute’ condition but my kidney function would revive within 7-10 days. So, considering it as a temporary setback, I looked forward to my Masters. Of course, that never happened.
How did NephroPlus come about?
While actively involved with a software company, I had co-founded in 2000, I also began writing a blog – www.kamaldshah.com on my journey with kidney disease, which became fairly popular among the nephrology community and patients.
I got an email from Vikram Vuppala, a strategy consultant in the U.S., who had stumbled upon my blog, while researching about dialysis in India and wanted to be a healthcare entrepreneur in India. I found great opportunity in his suggestion that we work to change the way dialysis was done in India. Sandeep Gudibanda whom he met at an ISB workshop also joined us, and we started NephroPlus.
What is the presence of NephroPlus in India and the world? Its nearest competitor in India?
With initial funding coming from Vikram’s own funds and his friends and family members, we set up the first centre, a small five machine centre in Hyderabad.
The entire experience and focus was designed with the patient in mind. As I was swimming every morning, working the full day, travelling and having fun, I believed every dialysis patient could lead a completely normal life too. We needed to change the way patients and the world looked at those undergoing dialysis, not as ‘patients’ (the word brings to mind a sick, bedridden person), but as normal individuals. So firstly, we decided to call our patients ‘guests’.
Today NephroPlus dialysis network is India’s largest and the world’s seventh with about 200 centres, its competitors in India being Fresenius, Apex, 7Med etc.
How do your co-founders manage roles?
All the three co-founders have clear and distinct roles. Initially Vikram was of course overall in-charge and looked after funding and finances. Sandeep managed Business Development while I looked after Clinical Quality and Patient Services. All important decisions were taken in tandem, and later we hired more specialised management team members.
Why does kidney failure happen? Why is it on the rise? How many dialysis patients are there in India?
Kidney failure happens due to various causes, but diabetes and hypertension are the top two in India. The incidence is on the rise due to our generation’s faulty lifestyles. Increase in stress levels, consumption of processed foods, abuse of antibiotics and painkillers, etc., all contribute.
Shockingly, of an estimated one lakh dialysis patients in India, only about 15% are fortunate to get dialysis. The rest 85% unfortunately don’t, due to lack of access or affordability.
What is it like to undergo long-term kidney dialysis? How many dialysis sessions do you totally conduct every day pan India?
Long term kidney dialysis can be a huge burden in several ways – financial, mental, and physical. Many people’s lives are turned upside down usually with such a diagnosis.
We conduct about 5,000 dialysis sessions across the country every day.
Talk about your specialised patient-friendly services and unique concepts?
Our core thrust being ‘Guest care comes first’, we have come up with several initiatives like Aashayein (a one day educational cum fun event for those on dialysis – both within and outside NephroPlus), Dialysis Olympiad (an Olympics style games event for those on dialysis), and Holiday Dialysis (a programme where those on dialysis along with their families can enjoy a hassle-free holiday where everything is taken care of by us).
Our Aashayein Kidney Foundation covers those who cannot afford certain ancillary expenses like injections, lab tests, procedures etc.
How pronounced are the chances of patients undergoing dialysis running a fairly high risk of HIV and hepatitis C infections? What about bacterial infections and hygiene?
About 30% of dialysis patients in India are infected with Hepatitis C, Hepatitis B and HIV infections. Causes include improper protocols followed by the dialysis staff, movement of patients from a centre where protocols are not followed and blood transfusions.
Bacterial infections are also possible especially related to catheters as access for dialysis. This can be prevented by proper precautions by the dialysis patient and the dialysis staff.
Do you have an anti-infection kit for patients?
We have a “Zero Infection Point” kit or ZIP kit for every guest that is ID’d by the guest, and has everything needed for starting and closing a dialysis session. This goes a long way in preventing cross infections with viruses. Along with our SOPs (standard operation procedures) for starting and closing and indeed, every aspect of the dialysis centre is a key part of our emphasis on guest-centric care and ensuring that those on dialysis get the best possible treatment, with assured safety.
How much do online support groups help patients?
Online support groups can be an invaluable source of support for kidney patients. But they can never be a substitute for a doctor. Every individual is different and what works for one may not necessarily work for another. So, while it is fine to look to online groups for emotional and social support, these groups must never be relied upon.
In India, what are the options for doing dialysis at home? How much does it cost to start dialysis treatment in India and the recurring expenditure after the treatment starts? What has your experience been like?
In India, dialysis at home can be done in two ways – Hemodialysis and Peritoneal Dialysis. You can take content for this from this link:
Though the cost info is old, you can use the following:
Initial cost of Home Hemo: 6L for the machine plus 1L for RO plus 1L for plumbing and wiring. (approx)
Monthly cost depends a lot on how many sessions, how long is each session and the type of dialyser used and whether the dialyser is reused or not. It can range from 20K to 40K per month.
Best part of daily nocturnal home hemo: No diet and fluid restrictions, dialyse at your own convenience.
Compare Peritoneal Dialysis and Hemodialysis. What are the downsides for PD?
Check link below to consider aspects while deciding on modality to adopt: http://www.dialysis.org.in/2010/06/pd-versus-hd.html
These are only two types. In these two there are sub-types based on the frequency and duration etc.
I would not recommend any dialysis over the other. The reason is purely clinical and personal. I personally prefer PD but I know several people who prefer HD. It is like asking which flavour of ice cream is the best.
What is the standard of nephrologists in India and why do they generally frown on Ayurveda for kidney issues?
Nephrologists in India are on par with the best in the world. However India has only 1500 nephrologists for a population of 1.4 billion, a ratio much lower than that compared with several countries.
They frown on Ayurveda because this treatment can be risky and can cause more harm than good at times. Several quacks abound and sometimes prescribe dangerous, heavy metal-laced concoctions which can cause severe problems.
How important is water to a patient?
Water is a basic necessity for any living being whether human or animal. Thirst is a primordial instinct and to ask patients to refrain from drinking water is to ask them to not do something that is ingrained in every cell of the human body. That is why many dialysis patients find it very difficult to control the amount of fluid taken in.
However, it is important to restrict it because of the various harmful consequences of fluid overload especially on the heart.
What kind of diet should be followed to keep potassium at a desired level for a patient undergoing dialysis treatment?
Potassium is very dangerous as excess levels in the blood can cause cardiac complications and can sometimes be fatal as well. To control it, foods high in potassium must be restricted like coconut, fruits like banana, mango, chikoo and vegetables like tomato, potato, spinach, etc.
How long does a person live on dialysis?
People can live for decades on dialysis. The important thing is to adhere to your dialysis prescription, make sure you restrict your diet and fluid as advised and have a positive mind. Also make sure you keep busy (work full time or part time if possible) and exercise regularly (check with the Doctor on what is a safe exercise regimen).
How do you face patient complaints?
Being a large network, there are bound to be complaints. I genuinely try my best to ensure that all are addressed speedily. Thankfully, I have a very motivated and capable team that also takes resolution of these complaints in a timely manner very seriously.
What do you think of the state of private health care in the country?
Private healthcare in the country, despite its problems, is the only way India can achieve the vision of healthcare for all. The government simply does not have the resources or the ability to provide it for the massive population we have.
The best way is through Public Private Partnership (PPP) projects, where the provider is the private entity and the payer is the government. That said, adequate checks and balances need to be put in place to ensure that fraud is eliminated and delays and corruption from the government in payments are removed.