POS-732 QUALITY OF LIFE AND ONE-YEAR SURVIVAL OF PATIENTS WITH KIDNEY FAILURE IN A RESOURCE LIMITED SETTING

Abstract

In 2017, 1.2million people died due to kidney failure making it the 12th leading cause of death globally. This position has risen from 17th over the past three decades. The global burden of kidney failure is most felt in Resource Limited Settings (RLS) such as Uganda in Sub-Saharan Africa (SSA). In most of SSA, patients never receive renal replacement therapy due to limited accessibility or proximity to these services and of those initiated onto dialysis, 85% will discontinue it due to cost limitations to maintain healthcare expenditure thus leading to premature death. The objective of this study was to determine the survival and changes in Quality of Life (QOL) of kidney failure patients receiving care in a tertiary hospital in Uganda over a one-year period. Patients aged ≥18 years with kidney failure were recruited from the renal outpatients’ clinic, hemodialysis unit and inpatient ward of tertiary hospital in Uganda, and followed up for 12months. Survival rates were calculated using the Kaplan Meier method and factors associated with survival analysed with the log rank test. Quality of life was calculated using the Kidney Disease and Quality of Life-Short Form (KDQOL-SF™) version 1.3 questionnaire. Scores less than 50 were considered to be indicative of poor QOL. Data was analysed for 335 patients recruited into the study. 216 (64%) patients were on Conservative Management (CM) while 119 (34%) were on Hemodialysis (HD). Overall, one-year survival was 26.6%; 95%CI (21.8 – 31.2). There was no statistically significant difference in median survival of patients on CM (7.6 months) in comparison to those on HD (8 months) (p-value 0.3984). Male sex and distance from the hospital were significantly associated with shorter survival HR 1.38 (CI 1.04-1.83) while belonging to a protestant faith improved survival HR 0.64 (CI 0.48-0.88). Quality of life scores changed significantly for 13 out of 19 subdomains of the KDQOL-SF™. Subdomain scores that changed the most included- Social support; 75.6 ±29.2 at baseline to 27.7 ±19.4 at one year (p-value <0.001), and Effects of kidney disease 54± 20 to 70± 23 (p-value <0.001). All three composite summary scores; -mental health, physical health and kidney disease specific, showed statistically significant increases but remained less than 50 throughout the one-year follow up. Survival is dismal for patients with kidney failure with no survival or QOL advantage offered by HD in comparison to CM in this setting. Male sex and residence far from the hospital were associated with reduced survival and protestant faith improved survival despite poor QOL scores and a marked decline in social support over the one-year period. To improve patient outcomes in RLS, health systems need to increase accessibility and affordability of specialist renal services including; trained human resources and renal replacement therapy options, as well as integrate spiritual support, financial literacy and social support services into existing care practices.