The burden of chronic kidney disease (CKD) increases globally and remains a significant public health concern in India as well. The rising prevalence of hypertension and diabetes, combined with delayed diagnosis and referral, contributes to a substantial burden of end-stage renal disease. The Pradhan Mantri National Dialysis Program (PMNDP) was launched in April 2016 under the National Health Mission to provide free dialysis services to socioeconomically vulnerable groups, especially below poverty line beneficiaries. In less than a decade, as of June 2025, PMNDP achieved national coverage across 751 districts, establishing 1704 dialysis centers and installing 10,183 hemodialysis machines. The program is implemented through in-house, public–private partnership, and hybrid models. A pan-India structured assessment across 101 centers and 1994 patients demonstrated improved coverage, functional infrastructure, and trained human resources. Cost protection through free dialysis has reduced the financial burden, though transportation remains a significant source of out-of-pocket expenditure. While operational performance indicators such as machine functionality, availability of reverse osmosis systems, and dialysis adequacy testing are satisfactory, systematic assessment of quality and outcome parameters remains inadequate or absent. Unlike established national renal registries in many developed countries, India lacks a national mechanism to capture dialysis outcomes such as mortality, infection rates, hospitalization, or vascular access patterns. Establishing a national registry and enabling centralized reporting are critical next steps to measure value, quality, and safety.
Subbarao et al. (Thu,) studied this question.