Abstract
Background: Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. Methods: A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. Results: Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. Conclusion: Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
Highlights
Chronic kidney disease is an evolving health problem worldwide
This review explores how financial hardship was studied in previous studies and the relationship between financial hardship and symptom burden among patients receiving maintenance dialysis
Studies were included in the analysis if they (1) involved patients who were diagnosed with end-stage kidney disease (ESKD) and received any modality of maintenance dialysis; (2) examined the relationship between financial hardship and any individual symptoms and/or symptom burden; (3) reported an association between financial hardship and symptom burden in the results section; and (4) had the full text available in English
Summary
Chronic kidney disease is an evolving health problem worldwide. Because its global prevalence is increasing, major increases in costs related to treatment and productivity loss are projected [1]. 700 million cases were reported in 2017, contributing to. Stage-five chronic kidney disease, or end-stage kidney disease (ESKD), has a significant impact on healthcare systems, as well as the affected individuals. 2% to 3% of healthcare expenditure is directed toward the management of ESKD in many developed countries, and the demand for dialysis is expected to double by 2030 [2]. Patients with ESKD often experience financial hardship due to treatment costs and income loss related to decreased productivity [3]
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