Diabetes epidemic spurs Fresenius

India’s diabetes epidemic has triggered surging demand for dialysis as the disease destroys many sufferers’ kidneys, leaving them with only months to live without treatment.

Fresenius Medical Care AG, the world’s biggest provider of kidney dialysis, said sales of blood-filtering products in India have grown more than 30% annually since 2006. Apollo Hospitals Enterprise and Fortis Healthcare India, the country’s biggest private-hospital operators, are opening dialysis centres nationwide as the number of Indians with diabetes is predicted to reach 101 million by 2030.
The Indian market for kidney-care products and services may grow to $152 million next year from $97 million in 2007, researcher Global Markets Direct forecast in 2008.

“New machines are coming up in every nook and corner of the country,” Jayant Singh, head of the medical technologies practice at Frost & Sullivan’s India unit, said.

The number of people lining up at hospitals to get dialysis, a procedure in which waste is removed from the blood, is increasing almost 30% each year, Singh said. About 52,000 Indians receive long-term dialysis in the country, said Georgi Abraham, professor of medicine at the Pondicherry Institute of Medical Sciences.

The global dialysis market was valued at $69 billion in 2010, Fresenius Medical said in its latest annual report. Dialysis equipment and solutions total $11.7 billion. The products include dialysers, dialysis machines, concentrates and dialysis solutions.

“The Indian market in Asia looks increasingly promising in the medium term,” Fresenius Medical said in the report, released in June. The Bad Homburg, Germany-based company had the largest share of the overall dialysis products market in 2010, at about 33%, followed by Baxter International Inc, of Deerfield, Illinois, and Gambro AB, of Stockholm.

 “We expect the growing importance of the Chinese and Indian markets to accelerate our growth over the next few years,” the company said in the report.

New Delhi-based Fortis plans to open 50 dialysis clinics, mostly in residential neighborhoods in cities and towns, over the next two years, said Varun Sethi, chief executive officer of the company’s Renkare dialysis unit. The first opened in New Delhi’s Greater Kailash neighborhood this month with seven booths, including a private suite.

Patients can watch television while tubes connected to their arm circulate blood through a dialysis machine. The service costs about `30,000 a month for 12 visits, Sethi said.

“There’s a huge demand for dialysis centres, but only those who can afford it get it,” said Abraham at the Pondicherry Institute.

There are two ways to clean blood. Hemodialysis, the most common one, involves circulating blood through an artificial filter to remove impurities. In peritoneal dialysis, a fluid- filled cavity in the abdomen relies on osmosis to extract impurities and excess water from the blood.

A patient on peritoneal dialysis needs at least 6 to 8 litres of the fluid for a day’s treatment. A 2-liter pack from Baxter costs Rs 189, according to Vijay Kumar, whose 18-year-old son Piyush has been on dialysis since 2004.

 “It is very expensive, but the only advantage is that he can do it here at home,” said Kumar, who runs a logistics business in Banaras in north India. Monthly expenses for the treatment, including drugs needed to prevent anemia, come to more than `24,000, he said. Patients who aren’t insured can buy the machine outright, pay in installments, or rent it from the company, said Frost & Sullivan’s Singh.

Sales of dialysis machines and consumables made by Fresenius, Gambro and Baxter in India are growing 13% to 15% a year, compared with 20% in China, where government initiatives have boosted treatment, Singh said.

Entry-level hemodialysis machines made by Gambro sell for $8,000 to $12,000 a unit, and the company is developing cheaper units, said Stuart Paul, the Swedish company’s president for the Americas and the Asia-Pacific region. Gambro is India’s second-biggest seller of hemodialysis machines, he said.

 “Increases in the wealth of the patients is making these machines more affordable, but cost is still a big challenge in India,” Paul said.

A year of dialysis and medication for a patient with chronic kidney disease in India can range from `60,000 at a subsidised provider to more than `700,000 for the home-based treatment, said

Abraham at the Pondicherry Institute.
While that’s less than the cost of more than $30,000 in the US, the price is still a barrier for most patients in India, where a majority of people live on less than $2 a day.

 “This is a very expensive disease, and we feel really helpless for patients from rural towns and villages,” said Priya Patil, a physician at Sir JJ Hospital in Mumbai.

Kidney diseases are a “death sentence” for the poor, she
said. Bloomberg