The burden of kidney disease in Pakistan is among the highest in the world with the number of patients estimated to be above 20 million. Among the several contributors to this high incidence in the country are high-salt, oily and sugary diets, dry weather, low water intake, hypertension, excessive use of certain medicines such as painkillers, high cholesterol levels and diabetes.

Those with end-stage kidney disease face irreversible damage to renal function and need replacement therapy which can be in the form of kidney transplant or dialysis. As their kidneys cannot naturally perform the function of purifying blood of toxins and waste material, this is done through dialysis if patients do not go for kidney transplant.

The second option — that of kidney transplant — is a complicated and costly affair; and that is why very few kidney patients are able to benefit from this option. The regulation of organ transplantation process has become stricter and quite often leads to delay and difficulties in finding donors.

In Pakistan, there is no national registry of end stage kidney disease patients so their exact number is not known but it is a fact that the dialysis facilities are extremely limited. Even if these are available, not everybody can afford the treatment. There are some welfare organisations/hospitals that cover the total or partial cost of deserving patients’ treatment but their scale of operations is small and the number of patient intakes is low. Governments in the past have been announcing free dialysis facilities for the deserving and withdrawing them abruptly, mostly because of shortage of funds and wrong calculations. However, there are many public sector hospitals that subsidise the cost of dialysis if not able to offer it for free.

The plight of kidney failure patients could be seen during the onslaught of Covid-19 and the peak during the last wave when it became extremely difficult for them to visit health facilities. In Pakistan, the dialysis method in use is called hemodialysis. In this method, the blood of a patient is withdrawn and purified artificially in the dialysis machine before being pumped back to the body. Essentially, the function of a kidney is outsourced to the dialysis machine.

During the high incidence period of Covid-19, the dialysis facilities remained unavailable to patients in need. On one hand, the machine operators were reluctant to attend to the patients; and on the other, patients and caretakers stayed away from health facilities out of fear of being infected by the virus. Long gaps in dialysis sessions adversely affected patients’ health and increased their pain.

The case of Khalid Hussain who would often accompany his ailing uncle to the dialysis facility is reflective of the difficulties faced by patients with badly-damaged kidney. He says he has to take his uncle thrice a week for dialysis which takes 4 to 5 hours on average.

“If we add travel and waiting time, this period extends to 7 to 8 hours,” he says.

This disrupts their daily routine and costs them dearly in terms of time and money. Sometimes, they have to miss a session or two because of shortage of dialysis machines as some of them are dedicated for the use of hepatitis patients only.

This situation calls for formation of a comprehensive strategy at national level without which it is unlikely to improve.

The portable device will not only decrease the cost of treatment but also allow the patients more freedom to continue with their everyday life and work routine.

As some respite, however, a Lahore-based biomedical startup company called Byonyks has developed Pakistan’s first portable and affordable dialysis machine that does not involve extraction of blood of the patient. This type of dialysis is called Automated Peritoneal Dialysis (APD) in which a fluid is injected into the stomach of the patient where a membrane in the Peritoneal/Abdominal Cavity works as a filter and removes unwanted contents from the blood, says Farrukh Usman, CEO, Byonyks.

With the help of APD, one can benefit from the therapy while sleeping in the comfort of one’s home without the need to go to a traditional dialysis centre. As the process is completed during the night, the daily routine of the patients and their attendants is not affected.

Usman says Byonyks is introducing its product keeping in view affordability factors for those who cannot afford the cost of traditional dialysis. He hopes that this machine “proves to be the world’s most affordable APD machine”. The development of the machine was aided by IGNITE Research and Development Fund of the Ministry of Information Technology and Telecommunication, and it has undergone successful test and trials.

The portable device will not only decrease the cost of treatment but also allow the patients more freedom to continue with their everyday life and work routine. Furthermore, the APD device does not require a dialysis technician to be present while the process is underway.

Usman had assembled a team between the US and Pakistan comprising renowned names from the biomedical and technology fields to establish Byonyks, a biomedical device engineering startup that is designing affordable healthcare technology for those that do not have access to it. Byonyks has availed several opportunities to build a professional relationship with international investors and doctors present at the world-renowned seminars and conferences such as Arab Health Dubai, OPEN USA, professional nephrology associations

As per the information shared by the Byonyks team:

Patients can perform dialysis in the comfort of their homes and while sleeping.

The APD device prevents transmission of blood borne infections such as Hepatitis C and AIDS/HIV as the blood is not exposed to any of the components of the machine.

The machine provides safety against arrhythmias, blood pressure fluctuations, feeling of being drained or exhausted at the end of the treatment in many patients due to fluid removal in a short period of time during hemodialysis session.

Some patients will continue with livelihoods during daytime as it is a nighttime therapy.

The machine will not need any technician or nurse for supervision during therapy at home and especially when used in ICU setting.

The machine does not require heavy infrastructure like water treatment plants for a home hemodialysis setup, therefore it will be immediately available anywhere across Pakistan.

The machine is environment-friendly.

The patients will be free to travel locally and internationally with these APD machines which are portable.

Fouad Bajwa, an IT expert and Bynoyks team member, says they are working on a three-tier pricing system under which the machine will be sold in the US and EU market for $5000, to Pakistani high-income groups for $3000 and for those from financially-distressed communities at 50 per cent discount.

In addition to this, he says, that the company will also support some charities and non-profit organisations by providing them a few free machines. The rental model price will be Rs 10,000 paid on a monthly basis for those who cannot buy it instantly.

The author is a staff reporter and can be reached at shahzada.irfan@gmail.com