A BASSI1, O JOHN1, R JOSHI2, S KOTWAL2, S SINGH1, B ESSUE2, S JAN2, M GALLAGHER2, J KNIGHT2, V JHA1,2,3
1The George Institute for Global Health, University of New South Wales, New Delhi, India, , , 2The George Institute for Global Health, Sydney, University of New South Wales, Sydney, Australia, 3The George Institute for Global Health, University of Oxford, Oxford, UK.
Background: Outcomes among end stage kidney disease (ESKD) patients initiated on hemodialysis in India are unknown. There is a need to collect systematic information on factors that can improve treatment outcomes.
Aim: We report baseline socio-demographic characteristics, out-of-pocket expenditure and quality-of-life of patients on hemodialysis in a prospective cohort study.
Methods: The subjects were recruited between 1/11/2016 and 31/03/2018 across 18 sites in 10 states in India. Routine medical records were utilized for demographic and clinical information, with additional data from patient interviews. Quality of Life (QOL) was assessed using Euroqol-5D-3L®.
Results: A total of 981 subjects (324 female) were enrolled. Median age at enrollment was 52.5 years (female 51.8 years; male 57.3 years). Nearly 60% (female 72.9% and males 52.3%) of the subjects had school education or less. More than 80% of the female subjects were housewives and 41% of the male subjects were either retired or not working. Median monthly family income was reported as US$ 601. Only one-quarter of the subjects had health insurance. About 64% and 52% of the subjects had a history of hypertension and diabetes, respectively.Median monthly out-of-pocket expenditure was US$ 486 for uninsured subjects vs. US$ 187 for insured subjects. More than 8% of the subjects had to change their occupation due to kidney disease and treatment schedules. Median distance travelled to the dialysis unit was 24 kilometers. Over 20% of the patients reported severe anxiety and depression.
Conclusions: Our study found high dialysis-related out-of-pocket expenditure, particularly in those who were uninsured. A large number of subjects were unable to continue their jobs. Follow-up data will provide much-needed information for planning of treatment options for ESKD.
Dr Kotwal is a nephrologist at Prince of Wales Hospital in Sydney Australia and a post-doctoral research fellow at the George Institute of Global Health. Her main area of interests lie in the use of linked health data and evidence implementation research.
She has a background in epidemiology, biostatistics and the analysis of linked health data. She has designed and led multiple data linkage projects across Australia and has experience in analysis of large observational registry and administrative datasets.