Dialyzer Reuse

Although on dialysis for sometime, still lot of patients are clue less about the best practices about reusing of a dialyzer. This results in two options -

• Deferring the decision to the doctor or technician
• Only using dialyzers one time

In the case of the first one, many patients just go by the number of reuses with the thought that the lesser the number of reuse the better dialysis they get. On the contrary, every dialysis effects the dialyzer little differently. Now a days there are dialyzer reprocessing machines which throw up technical specifications which can be used to determine if the dialyzer is good for reuse. Sometimes they might last for 20 reuses and on other times they might not be good even after 2. Hence, getting fixed on the number of dialyzers is not the right decision.

In case of the second option, the quality question doesnt arise. But its like paying high unnecessarily. The classic analogy I think of is HD televisions. Lot of people buy 32 inch HD television at a premium. But the funny thing is that at around a distance of 8-10 feet, our eyes can not actually distinguish between pixels that small and hence 32 inch HD is not different from any normal TV. What I am getting at is paying the premium is unnecessary as the gain in quality of picture is just in technicality and not in reality!

Hence many times a reused dialyzer is as good as a new one for the purpose of dialysis and hence paying a premium for a new dialyzer is not required. But before re usage make sure that all the guidelines of reusage are followed and hopefully its not done manually but using a reprocessing machine which can exactly tell if the dialyzer is good enough for reuse.

Here are few FAQs about reuse from davita's site (one of the biggest chain of dialysis centers in the world)
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What are the advantages of reuse?

Reuse can be helpful to the patient and to the planet.
Patient advantages of reuse Since each dialyzer is inspected by a reuse technician, the technician can note any blood clots in the dialyzer and alert a renal nurse. Blood clots could mean you are not getting enough heparin, which is a medicine given before and throughout hemodialysis. Heparin thins the blood to allow it to pass easily through the dialyzer and prevent it from clotting, which would reduce the dialyzer’s ability to remove wastes and fluid. Blood clots in the dialyzer may make your dialysis session less effective and can lower your Kt/V.
Environmental advantages of reuse Dialyzer reuse helps to reduce negative environmental consequences in several ways. On average, it only takes 9.6 reuse dialyzers to treat one patient for one year, versus an average of 153 single-use dialyzers. The reuse of all dialyzers in a single year would eliminate the production of up to 46 million dialyzers and reduce the amount of medical waste ending up in landfills by more than 62 million pounds.
Dialyzer reuse also reduces the amount of harmful toxins created by waste processing. In order to be properly disposed of, dialyzers first have to go through a decontamination process requiring they either be incinerated or microwaved before being sent to landfills. When dialyzers are incinerated, the process produces emissions and ash that have negative health effects on the surrounding communities. While the microwave process does not produce harmful toxins, it does nothing to reduce the amount of medical waste that ends up in landfills.
By choosing dialyzer reuse, you can dramatically reduce the negative impact on the environment. Dialyzer reuse reduces your carbon footprint, helps relieve America of its dependence on crude oil, sends less non-biodegradable waste to landfills and ultimately benefits the dialysis patient by keeping costs lower without compromising clinical outcomes.

What are the disadvantages of reuse?

If proper procedures are followed for inspecting, cleaning and disinfecting your dialyzer, you should have no problems. If the reuse procedure is not followed properly you may have problems with your Kt/V levels or a physical reaction. However, these problems are rare, and because you are being closely monitored during treatment, if these issues arise, they can be resolved quickly.

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So go ahead and talk to your doctors and technicians about reusage of your dialyzers. Necessary quality need not be out of the reach of your pocket.

That feeling of first time!

Apart from a few procedural delays which we will sort out soon, we came out of our first out patient dialysis unscathed . Infact feels nice to hear from patients that this is really nice center and we should do some advertising to get more patients! Direct customer feedback is the best data.

Before the dialysis was started, we seemed to be more tensed than the patient! But the experienced patients are so calm that you don't feel like its a big deal. The blood comes out of the body, gets cleared of toxins and goes back in - six times during one dialysis session. 

On a different account, budding entrepreneurs looking for seed funding should look for CGTMSE loan scheme of SIDBI and SBI. There are pros and cons of the scheme -

Pros

• No collateral required
• Low interest rates
• Good moratorium period

Before you start jumping up and down thinking they are better than VCs, here are the cons -

• Lot of bureaucracy
• Very rigid, once you have given them the project report, you have to file quotations for any capital investment and if you get a better deal later its no good; they only will pay for the vendors you get the initial quotations
• They only give debt for capital investment

If you need investment for non capital expenditure like advertisement, marketing then they are no good. VC money is good in several ways as they give you the flexibility to spend it in the best possible way. And they are patient with the returns. Hence, depending on your project CGTMSE might or might not be a good option for you.

The humble beginings

1st day is always fun at work. For us it meant a little bit more and hence we went ahead and took pictures to remember this day. Here is a guided tour of the album.

The picture on the left is of our reception. This is what the patient sees straight ahead as soon as he enters. 

The co-owner with his workhorses!
I can vouch GP tried hard but as you all know his problems with keeping a smiling face :). The machines are dialogue + from B Braun (A German company). For the uninitiated these are the latest line of machines from one of the leading suppliers of dialysis machines in India. We hope to run them round the clock some day!

A long shot into the dialysis unit.

Here it begins

After a long and arduous journey we come to our first milestone. We start the operations of our first center tomorrow. Along the way there are several memories which will be etched in our brains for a long long time. Although there is a sense of satisfaction but when I look back I can see so many things which we could have done in a better way. So many days of angst could have been wiped out with some good planning at our end.

The best part of the journey so far, has been the interactions we have had with several people - doctors, distributors, vendors, investors to politicians and other entrepreneurs. Each one had a part to play in our overall business plan as it is right now. I cant help but smile at our immaturity when I see our very first business plan. Right now we have much better insight into what are the gaps in the present system and how can we fill them but as confident as I might be I am sure I will laugh at them again 1 year or so down the lane.

What I am getting on to is - you can plan as much as you can but until you actually jump in and start doing the things that you planned, you will never have a good business plan to execute.

To a new start tomorrow!

Finalists at Economic Times' "Power of Ideas"

It always feels great when an idea on which you’ve been working on dedicatedly for a long time is appreciated and validated by the external world. We have been fortunate enough to recognized for our thinking at multiple forums since the time we started working on our idea for making dialysis affordable and accessible. Here are some of the accolades we have collected over the journey so far:

Winners – Master Plan 2010, IIM Ahmedabad’s Annual Business Plan Competition

Finalists – Power of Ideas 2010, Economic Times

Finalists – Vulture’s Nest 2010, IIT Bombay’s VC Pitch Competition

Semi-Finalists – Piramal Prize 2010

Not only have each of these competitions helped us to sharpen our thinking, they provided us with a platform to meet people who are now mentors, friends, and inspiration to us. In our experience, succeeding in a good quality business plan competition is not just about winning. It is about how hard were you pushed to the wall to think innovatively and come out with something that can fundamentally change the nature of the game. Yes it is tough to be under fire in front of an audience and it hurts to some extent when you ideas (on which you’ve spent months) are being ridiculed within seconds. But the bright side of it all is the rigor of thinking it induces within you and how it strengthens your resolve to make you idea work – come rain or shine.

We strongly recommend the budding entrepreneurs like us to make the best use of such platforms. Go out there and tell the world without fear what great ideas & dreams you have. Because no one ever thought of a great idea while sitting in a closed room. Because if you think that people can steal your idea by merely listening to it, the idea is probably not even worth a dime. 

If Nano comes for 1 Lakh why not a dialysis machine

One of the major reason for costly dialysis therapy is the expensive dialysis machines. Given the fact that most of the science of dialysis depends on the dialyzer (the filter membrane that acts as artificial kidney), we do not understand why the cost of machine is so high. Also presently all dialysis machines in India are imported. Such expensive technologies with not great servicing can not penetrate India - who will take an expensive machine to rural India if it can not easily be serviced. A study on lack of infant incubators in Africa pointed to the same two reasons - 1) Expensive machine 2) lack of service.

The lack of service bit can be solved by having a good servicing team in India. On the machine front though we have to develop these machines in India. In really simplified terms - the machine is just a pump. It takes blood out of the body, passes it through the dialyzer and pumps it right back in. Infact we have heard more than one account of situations where dialysis machines were actually run by hands when there was no power in hospitals. Its other features also do not have any technology that is out of reach here in India.

I think its a matter of inspiration and will. In a country where a Nano can be made in "not possible range" of 1 lakh why cant we make a cheap dialysis machine. After all a Nano has 4 wheels, and so has a dialysis machine! :)

Information on dialysis; new technologies

While doing some research found few links with really good articles on the upcoming research in the field of dialysis.

On wearable kidney, water less dialysis - http://www.sciencedaily.com/releases/2008/07/080710153015.htm

Peritoneal based wearable kidney - http://www.universityworldnews.com/article.php?story=20081106154225422

Some encouraging news for dialysis patients who are employed by central government in India -
http://www.medindia.net/news/Azad-to-Inaugurate-Standalone-Dialysis-Unit-at-CGHS-Clinic-in-Delhi-73108-1.htm

If you ever had acute kidney failure you should be very careful about your kidney and maybe enroll yourself in a chronic kidney disease management program. - http://www.medindia.net/news/Study-Says-Acute-Kidney-Injury-Patients-More-Likely-to-Need-Dialysis-Within-5-Years-58161-1.htm

Why Dialysis

Every time we walk into a meeting with a hospital head, nephrologist, investor or vendor, the first question we get asked is why this field. We thought lets answer this question here so that we can refer all of the above mentioned people to this blog and save our energy.

The answer is serendipity. We both were looking for technologies that we can commercialize in India. We visited IIT Bombay and met professors to know about their research. It was here that we chanced upon Dr. Jayesh Bellare, professor in chemical engineering department at IITB. He has developed technology to develop dialyzers (the filters which do the job of kidney during dialysis) in India.

Our first thought was to sell these cheap dialyzers in India. But soon we realized that with the economy of dialysis this is not viable as the major cost of dialysis services lie somewhere else and reducing the cost of dialyzer doesn't lead to a competitive  advantage.

That is when we decided to enter the "dialysis service delivery" business as this is where the gap lies. This was one year ago and our ideas have undergone lot of revisions. Now we understand that the dialysis service not only needs to be more cost effective but also scalable.  In its present form it will not be able to penetrate smaller cities in India. So we are planning to invest in right technologies to do the above two and hence make dialysis more accessible to Indian population.

The Goal

Kidney disease is an ever growing epidemic in India given its large population of diabetics and heart patients. It is estimated that there are more than 1 million patients in India who have completely lost all kidney function. However, no more than 5% of these patients have any access to treatment given a lack of relevant support system. The solution demands innovative ways of delivering an expensive treatment modality like dialysis in a cost-effective manner. That’s where Sparsh comes into the picture.

Sparsh Nephrocare was founded with a single minded focus – “to make dialysis treatment more affordable and accessible to kidney failure patients”. Our aim is to provide best quality dialysis treatment to patients, especially in cities/towns where the availability of treatment is a major concern. Through our cost-effective and no-frills approach, we hope to make the treatment available to masses and reach a patient base far larger than that of any other service provider.

We at Sparsh are committed to the welfare of our patients. We understand that high quality treatment doesn’t always have to be expensive and beyond the reach of patients. We also believe that world-class treatment can be provided in functional and frill-free facilities which compromise only on cost and not on quality.