SAT-134 SOCIOECONOMIC STATUS AND TREATMENT OUTCOMES OF HOSPITALIZED PATIENTS WITH CHRONIC KIDNEY DISEASE IN NIGERIA - THE BURDEN OF THE DISEASE

Abstract

Patients with chronic kidney disease (CKD) often require hospitalization for deterioration or disease complication. This hospitalization represents an addition to the high burden of CKD especially in the developing countries. Early recognition with targeted pre-emptive treatment measures of the factors responsible for admission should reduce the frequency or duration of hospitalization in these patients. This prospective study evaluated hospitalized CKD patients with emphasis on patients' admission records, treatment given, duration and estimated cost of hospitalization. Patients were followed up to end point which was either discharge home or death. Socioeconomic class was defined in accordance with the modified Kuppuswamy scale. One hundred and sixty five patients (101 males and 64 females) were studied; 68% were in the low socioeconomic class (SE) while 7.3% fell in the high socioeconomic class; the remaining were in the middle SE class. Ninety five (57.6%) patients’ responsibility for cost of hospitalization was borne by relations other than biological parents, while in 22.4% of patients the cost was borne by self. Biological parents were responsible for cost of hospitalization in 8.5% of patients. In 5 (3.0%) of patients cost of hospitalization was borne by a government agency/employer. The two major etiological diagnosis of CKD in these patients were hypertensive nephropathy (56.3%) and combined diabetic/hypertensive nephropathy (20.8%). Ten causes were identified as reasons for admission; in some patients multiple reasons were responsible. The causes were, in order of frequency: severe uremia (61%), severe anemia (48.8%), fluid retention (39.6%), pulmonary edema (22.5%), and severe hypertension (21.3%), UTI (9.8%), febrile episodes (9.1%), heart failure (8.5%), gastroenteritis (6.1%) and dehydration (1.8%). Hospitalization duration was ≤ 7days in 68 (44.2%) patients, 8-21 days in 73 (47.4%) patients and more than 28 days in 6 (3.9%) patients. During admission, 122 (74.0%) patients had hemodialysis treatment, 95 (57.6%) had blood transfusion, and 54 (32.7%) had IV fluid infusion for rehydration. The outcome of hospitalization was favorable in 120 (72.7%) patients who improved and were discharged home, while it was unfavourable in 22 (27.3%) who either deteriorated and were discharged or died during hospitalization. Some mandatory treatment procedures like dialysis, blood transfusion, and intravenous fluid rehydration significantly added to the cost of hospitalization. Majority of patients with CKD in Nigeria are in the low socioeconomic class. The outcome of hospitalization in the patients was favorable in majority of the patients studied. However, as the cost of hospitalization represents an addition to the high burden of CKD on these patients’ resources, prompt attention to the identified causes of admission would go a long way in reducing this burden.