SAT-039 Socio-Demographic Characteristics, Out of Pocket Expenditure, Quality of Life and Six Months Treatment Outcomes of Haemodialysis Patients in India

Abstract

Haemodialysis is the primary form of renal replacement modality in India. In the absence of a national registry, systematic evaluation of outcomes for those starting dialysis are not available. The socio-demographic predictors of poor clinical outcomes have received limited attention thus far. The Dialysis Outcomes in India study is following a cohort of incident dialysis patients to evaluate the impact of socio-demographic and economic factors on clinical outcomes among end-stage kidney disease (ESKD) patients initiated on haemodialysis in India. Here we present the results from the baseline socio-demographic, clinical characteristics, Quality of Life (QoL) and six months clinical outcomes. A total of 1000 participants were recruited between Nov 2016 and Mar 2018 in 16 facilities across nine states in India. A web-based secure data collection tool was developed using open source tools. We used routine medical records for the collection of demographic and clinical information. Structured interviews were conducted to collect socio-economic parameters, including out-of-pocket expenditure (OoPE), with QoL measured using Euroqol-5D-3L®. Median age (IQR) of enrolled participants was 58 (48-66) years, 29% were female. One-fifth of the participants were graduates (female 15 % and males 85%), and 80% of the participants had at 12 years of education or less (female 88% and males 75%). A history of hypertension was reported in 68% of participants [duration 5 (3-10) years], and diabetes in 50% [duration 10 (5-15) years]. Majority (80%) of the female participants worked within the home, and 44% of the males were either retired or not working. Nine percent of the participants reported that they had to change their occupation due to kidney disease and treatment schedules. Median monthly family income was reported as US$ 500 (586). Median distance traveled to the dialysis unit was 10 (5-20) kms. The median monthly OoP expenditure was US$ 360±220 for uninsured participants and US$ 180±140 for insured participants. A feeling of severe anxiety/depression was reported by 15% of the patients and 16% reported severe problems related to activities of daily living. At the six months interim analysis, 73% remain on haemodialysis, 10% of the participants have died, 6% have withdrawn from dialysis, 4% have received a transplant, and 1.5% have switched to peritoneal dialysis.Tabled 1Table 1: Six months treatment outcomesOutcomesTotal (n=1000)Female (n=294)Male (n=706)Continuing Dialysis727 (72.7%)218 (74.1%)509 (72.1%)Kidney Transplant43 (4.3%)5 (1.7%)38 (5.4%)Peritoneal Dialysis14 (1.4%)7 (2.4%)7 (1%)Conservative Therapy37 (3.7%)7 (2.4%)30 (4.3%)Withdrew Dialysis63 (6.3%)19 (6.4%)44 (6.2%)Death99 (9.9%)33 (11.2%)66 (9.4%)Lost to Follow-up17 (1.7%)5 (1.7%)12 (1.7%) Open table in a new tab Our study had 100% follow up compliance at six months and noted high dialysis-related OoP expenditure, particularly in those who were uninsured. Low levels of health insurance coverage represent a major challenge for policymakers in mitigating the economic burden of dialysis treatment. A high number of participants quitting their job or reducing working hours highlights the challenges related to maintaining employment for patients undergoing dialysis. The complete follow-up data will provide much-needed information for improvement of dialysis services in India.