Research indicated that the high cost of kidney dialysis had a negative impact on the fathers’ employment and earning abilities in 50% of the cases. However, another reason why Indian children on dialysis not finishing their education may have an intellectual cause. Research done by the American National Institute of Health (NIH) indicates that children in the last stage of chronic kidney disease (having CKD 5) tend to have cognitive and learning disabilities which affect their ability to learn, perform well on tests, do homework and assignments well, and advance in their education. These children tend to score slightly lower on standardized IQ tests, indicating that they possessed lower IQs than normal children.
Another key factor contributing to lower educational opportunities and the fact that children on kidney dialysis tend to stay out of school in India is the lack of universal health insurance coverage. The health insurance sector is still largely an untapped market, even if it is rapidly expanding and growing. Since most of the children needing kidney dialysis live in rural areas where health insurance coverage is at best sporadic, the children's’ families are forced to pay for most of the dialysis costs out of their personal funds. This leaves them with less financial resources to send these children to school because even public schools in India are not completely free. Statistics compiled in 2018, the latest year available for such data, indicate that 60 million households are pushed below the poverty line every year because of out of pocket expenses (OOPE) arising from costs from kidney dialysis and other medical treatments for their children.
Families of children living in rural areas also lack the financial help from the government needed to help lessen their overall OOPE burden. This forces them to cut back on other family expenditures that may not be deemed as necessary. Education for their children on dialysis may be one of these expenditures. Another important factor keeping rural children on kidney dialysis out of the classroom may be attributed to the fact that the rural poor spend twice as much on out of pocket expenses than their richer urban counterparts.