Dialysis in India: Key Findings from a Nationwide Study

Patients and Prevalence

  • India has one of the world’s highest numbers of chronic dialysis patients: ~175,000 in 2018.
  • Dialysis use is increasing due to:
    • National Dialysis Service (launched 2016) improving access.
    • Development of affordable dialysis systems.
    • Rising incidence of end-stage renal disease.

Dialysis Basics

  • Dialysis removes waste and fluids kidneys can’t eliminate.
  • It balances blood chemistry by regulating toxins.
  • Without dialysis, complete kidney failure is fatal.

Types of Dialysis

  • Hemodialysis (HD): Blood is filtered by a machine (3 times/week, 3-4 hours each).
  • Peritoneal Dialysis (PD): Blood is cleaned within the body using the abdomen as a filter.

Mortality Rates

  • 180-day survival estimates vary between dialysis centers (83% – 97%).
  • Rural centers have a 32% higher mortality rate than urban centers.

Factors Affecting Mortality

  • Vascular Access:Catheter access is linked to higher mortality compared to fistula/graft.
  • Financial Coverage:Government/insurance coverage lowers mortality compared to out-of-pocket payment.
  • Underlying Conditions:Diabetes is associated with higher mortality.
  • Center-Level Factors:Staffing, care processes, and patient volume influence survival rates.


  • Ongoing quality improvement programs are crucial as dialysis access expands.
  • National collaborative efforts are needed to improve healthcare infrastructure and care delivery.
  • Establishing national standards for dialysis outcomes is essential.
  • Understanding the combined effects of center and patient characteristics on outcomes is vital.


India’s Agni-5 MIRV Missile: A Leap in Nuclear Deterrence


  • Successful test of Agni-5 MIRV marks a milestone for India’s nuclear defense against China.

Agni-5 Missile

  • Longest-range Indian missile tested (>5,000 km).
  • Significance lies in its:
    • Range
    • Integration with MIRV technology (multiple warheads)

MIRV Technology

  • Originated in the US (1970s) with Intercontinental Ballistic Missiles (ICBMs).
  • Carries 3-4 warheads targeting separate locations.
  • Increases potential targets and challenges missile defense.
  • Launched from land or sea (submarines) for wider reach.

Strategic Importance and Challenges

  • Designed to counter advancements in Chinese missile programs, not solely for offense.
  • MIRVs are harder to defend against due to multiple warheads.
  • Agni-5 puts China on notice of India’s growing nuclear deterrence.
  • Deploying MIRVs requires complex solutions for:
    • Miniaturized warheads
    • Advanced guidance systems
    • Reliable re-entry vehicles


  • MIRVs remain vital for strategic nuclear forces globally, highlighting the complexities of nuclear disarmament and non-proliferation.
  • Agni-5 development strengthens India’s:
    • Strategic autonomy
    • Position as a regional and global power
    • Credibility of “No First Use” policy with a stronger second strike capability
  • Agni-5 reflects India’s progress in missile technology and independent development of sophisticated weaponry.


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