Kidney Week

Abstract: FR-PO809

Socioeconomic Determinants of Outcomes among Patients Receiving Hemodialysis in India

Session Information

• Standard Hemodialysis for ESRD - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Bassi, Abhinav, George Institute for Global Health, New Delhi, India

Abhinav Bassi,

• Jha, Vivekanand, George Institute for Global Health, New Delhi, India

Vivekanand Jha,

• Shah, Kamal D, NephroPlus Dialysis Centres, Hyderabad, India

Kamal D Shah,

• John, Oommen, The George Institute for Global Health, New Delhi, India

Oommen John,

• G, Venkatraman, NephroPlus Dialysis Centres, Hyderabad, India

Venkatraman G,

• Kolli, Sumathi, NephroPlus Dialysis Centres, Hyderabad, India

Sumathi Kolli,

Background

Dialysis in India is associated with a relatively higher mortality and early dropout when compared to developed countries. Poor clinical outcomes of dialysis patients are associated with socio-demographic predictors that have received limited attention thus far.

Methods

Data from a cohort of 9,058 subjects receiving HD between April 2014 and December 2016 at 92 centres of NephroPlus, India’s largest dialysis center network was analysed retrospectively. We retrieved baseline demographics, medical history, treatment cost, dialysis frequency and erythropoiesis stimulating agent (ESA) use from the patient records. Univariate Cox proportional hazards model was used for the calculation of mortality and dialysis discontinuation hazard ratios (HR).

Results

The mean age of the subjects was 51±14 years. Subjects were predominantly male (70%), from metropolitan cities (37%) and paying out of pocket for dialysis (61%). A total of 16% of the subjects died, 46% discontinued dialysis and 37% continued dialysis. Out of the 1494 deaths, 60% and 75% subjects died within the 1^st and the 2^nd year from their first dialysis, respectively. Of the 4181 subjects discontinuing dialysis, 21% and 76% discontinued within the 1^st and the 2^nd year from their first dialysis respectively. Subjects younger than 40 years (HR 0.55, 95% CI, 0.47-0.65), residing in a metropolitan city (HR 0.56, 95% CI, 0.49-0.63), undergoing dialysis three times per week (HR 0.91, 95% CI, 0.84-0.98), on erythropoiesis-stimulating agents (ESAs) (HR 0.88, 95% CI, 0.78-0.99) and paying dialysis cost through health insurance (HR 0.89, 95% CI, 0.66-0.90) had lower mortality HR. Subjects not receiving ESAs (HR 2.56, 95% CI, 2.18-3.03) and paying out of pocket for dialysis (HR 1.15, 95% CI, 1.03-1.27) had higher odds of discontinuing dialysis. Gender was not found to be a predictor of outcomes.

Conclusion

The findings of the analysis of the data from this large cohort show high mortality and dropout rates and highlight the associated socio-economic and treatment related factors that will need to be addressed to reduce inequity in dialysis access and improve outcomes in India.