Many expenses from external factors arise from children needing dialysis treatment. These expenses often times add to the overall cost of the children's’ education, and discourage poor parents from sending their children to school especially if the extra expenses are unaffordable - most of these expenses are borne by the parents and the children's’ families. These expenses include tutors who may need to coach the children academically to compensate for loss in cognitive ability and function, and to compensate for missed school days resulting from dialysis and medical appointments. Also, since the academic abilities of many of these children are impaired because of their ESRD, the traditional academic path and professional white collar careers may not be a viable option for them. Many of these children need to attend vocational schools whose curriculum and educational objectives prepare them for such trades as plumbing, and carpentry. These vocational schools are expensive and may be out of budget for the children's’ families, especially those from poor rural areas.
These children may also need to be in special schools because of the special accommodations they require in school to learn which arise from their ESRD. These schools may be more expensive, and may be out of reach for most parents, especially those from rural areas. Also, since ESRD is a serious and potentially terminal illness, many of its young patients may suffer from severe depression and other mental illnesses as a result of their chronic kidney disease. These mental illness can severely limit their academic potential, and they may require expensive professional help in the form of therapists, psychologists, and other mental health professionals to be well enough mentally to excel in school. These expenses are borne by their parents and families, and may be unaffordable for those living in poor rural areas.
As is evident, when young children suffer from chronic kidney disease, the entire community suffers because these children are deprived of the opportunity to complete their education. Their families must often pay for their dialysis and other expenses resulting from treatment and the disease and may not have the financial resources to do so. A great many children are excluded from the classroom in India because of chronic kidney disease, and that number is growing as the disease spreads among all age groups and demographics in India.