SUN-180 SOCIO-DEMOGRAPHIC CHARACTERISTICS AND OUTCOMES AT 18 MONTHS OF A COHORT OF ESKD PATIENTS STARTING HEMODIALYSIS IN INDIA

Abstract

Hemodialysis (HD) is the dominant renal replacement therapy (RRT) in India. A national free dialysis programme was introduced in 2016, but the determinants of outcomes in dialysis in India have received limited attention. The Dialysis Outcomes in India study followed a cohort of incident dialysis patients to evaluate the impact of socio-demographic and economic factors on clinical outcomes. Here we describe the baseline socio-demographic and clinical characteristics associated with 18-month survival on hemodialysis. 1000 participants were recruited at 16 dialysis facilities across nine states in India. Demographic, clinical information, socioeconomic and quality of life parameters were collected in a web-based secure data collection platform. We examined the association of survival with age, gender, years of education, monthly household income, source of payment for dialysis, type of insurance coverage, vascular access, haemoglobin and intradialytic weight gain. Chi-square and Fishers exact T tests were used to test for associations and a p value of <0.05 was deemed significant. The median age (IQR) of the subjects was 59 (19) years, and 30% were female. 20% of the participants had education beyond primary school. One quarter 26% of the participants were graduates. 80% of the female participants worked within the home, while 44% of the male participants were either retired or not working. Of those who had a job, 9% had to change their occupation due to treatment. Median monthly family income was reported as US$ 500 (586). A history of hypertension was reported in 80% of participants [duration 5 (7) years], and diabetes in 54% [duration 10 (10) years]. Median distance traveled to the dialysis unit was 10 (16) kms. 60% of the participants funded dialysis out of pocket (OoP), 25% had government or an employer-based, while 10% had private insurance. The median monthly OoP expenditure was US$ 390±180 for uninsured participants and US$ 160±140 for insured participants. The dialysis outcomes at 18 months are described in Table 1. Survivors had shorter travel distance to dialysis center, higher household income and hemoglobin and lower interdialytic weight gain.Table 1Dialysis Outcomes at 18 MonthsOutcomes at 18 monthsTotal (n=1000)Continuing Dialysis368 (36.8%)Kidney Transplant111 (11.1%)Peritoneal Dialysis29 (2.9%)Conservative Therapy50 (5%)Withdrew Dialysis144 (14.4%)Death256 (25.6%)Lost to Follow-up42 (4.2%) Open table in a new tab In this national cohort of patients on HD, 37% continued on RRT at 18 months. Availing dialysis closer to home, adequate financial risk protection in terms of regular household income was associated with continuing on dialysis. Monitoring clinical and socio-economic outcomes in dialysis provides an opportunity to identify modifiable factors to improve quality of dialysis and inform policy around the national dialysis programme. Collection of outcomes data as part of the care workflow improves quality of data collection; we envisage institutionalization of the dialysis outcomes study towards establishment of a national dialysis registry in India.