A clutch of private players are revolutionising the renal care industry in the country

Kamal D Shah, a chemical engineer and a former employee of Apple, was living a life of bliss until bad news came calling. To be precise, it was not a single piece of news but a series of events that unfolded, starting 1997. It began with his kidneys, with both showing signs of damage. He was put on hemodialysis for a-year-and-a-half. His mother gave him a kidney, but the transplant wasn’t successful.

A few years later, Shah was caught in the dreaded December 2004 tsunami while holidaying in Mahabalipuram with friends. Though he escaped, the incident took a toll on his body, causing severe kidney infection and resultant complications. Since then, Shah has been on daily dialysis at home.

But unlike most patients with a similar condition, Shah did not retire from an active life and went on to set up a dialysis care chain — Hyderabad-based NephroPlus — with Vikram Vuppala, a healthcare strategy consultant with McKinsey in the US. Later, Sandeep Gudibanda, an engineer-turned-entrepreneur, joined them.

Even as data indicates an acute shortage of medical infrastructure for dialysis and renal care, a new business segment is shaping up in India’s healthcare sector. In the past three to four years, several chains have come up offering quality dialysis facilities and related services. There are currently three or four such organised chains, while more are waiting in the wings with various business models.

There is little doubt that the potential for an organised renal care market is immense. There are millions of people in the country whose lives depend on dialysis. In fact, so serious is the current state of affairs that the Supreme Court, on November 26, 2013, sought a response from the central and state governments on the status of dialysis and renal care infrastructure in the country. The court’s action came in response to a public interest litigation (PIL) filed by advocate Sanjeeb Panigrahi.

A Crying Need
“The size of the dialysis market in India is about $350 million and is growing at 20-25 per cent annually. Unfortunately, about 3.5 lakh people in India reach the final stage of kidney disease every year,” says Shriram Vijayakumar, founder and chief executive of DaVita NephroLife, which has already set up 14 centres.

For a population of 120 crore, India has under a thousand nephrologists. “Various estimates put the number of people with chronic kidney-related diseases at around two crore and, of this number, around 60-80 lakh are on dialysis. The problem is that just 15-20 per cent of them survive as most patients discontinue dialysis and medication mainly on account of the poor quality of the dialysis and high costs,” says Shrirang Bichu, associate professor and consultant nephrologist at Apex Kidney Care.

Mukesh Shete, a leading nephrologist and co-promoter of Apex Kidney Care, says there is an immediate need to start more dialysis units as a patient of acute kidney failure has to undergo a minimum of 12 hours of dialysis a week in three sessions, until he gets a donor.

“In Mumbai, there are only 50 machines with public hospitals and another 1,200 machines with private hospitals and charity organisations. This year, 150 more will go to the public sector, but that is way short of the requirement, which is about 15,000 machines,” says Jatin Kothari, consultant nephrologist and transplant physician at Hinduja Hospital.

Viswanath Billa, consultant nephrologist and transplant physician, says that the quality of dialysis care in the country is pathetic and way below global standards. Lack of quality equipment maintenance and trained paramedical and support staff are other reasons why patients develop infections during dialysis.

“In the US, a session of dialysis costs $250, whereas in India, it is about $20-$25 (Rs 1,200 to Rs 1,800) a session. That said, in the developed world the entire cost is taken care of by the government and the patients’ insurance provider,” says Billa.

Despite hundreds of cases of kidney failure in India, only around 5,000 transplants are conducted in the country annually. This is mainly due to the lack of matching organs of patients’ relatives and a complex regulatory process that stretches over 12-15 months.

Changing Business Model
While India is not lacking in potential for healthcare players in the kidney care segment, multinational healthcare chains are still reluctant to tap the market. The reason: it is not really a profitable business for corporate hospitals as dialysis costs in India remain low, says Billa.

Patients on dialysis need constant monitoring. Besides, the process of delivering high-quality dialysis requires constant attention to everything from water quality, machinery, training, documentation, infection control and clinical outcomes. Dialysis alone has over a hundred processes and protocols that need continuous monitoring, making renal care supremely complex and expensive and, thereby, rendering the Indian market unrewarding.