Projects

India faces a kidney failure emergency. Contemporary data are not available; however, a 2006 analysis estimated the annual age-adjusted incidence of end-stage kidney disease to be 226 per million of the population.1 Since then, the numbers have increased substantially because of population growth, aging, and an increasing burden of CKD risk factors.2,3 Except for a small number who can receive a kidney transplantation and another group that would be suitable for conservative care, the vast majority will need dialysis. However, access to dialysis remains highly unequal. Most patients receive in-center hemodialysis (HD), supported through public-private partnerships under the Pradhan Mantri National Dialysis Program and the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (PM-JAY), for those with an income below a certain threshold, and private insurance or out-of-pocket payment for others.4 HD infrastructure is concentrated in urban centers, failing to adequately serve remote and socioeconomically disadvantaged populations. The overreliance on HD also ignores the needs of infants and children with kidney failure.