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Abstract: SA-PO1042

Dialysis Outcomes at 12 Months Among Patients Starting Hemodialysis in India

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • John, Oommen, George Institute for Global Health, New Delhi, India
  • Bassi, Abhinav, George Institute for Global Health, New Delhi, India
  • Shah, Kamal D., NephroPlus Dialysis Centres, Hyderabad, India
  • Kotwal, Sradha S., George Institute for Global Health, Sydney, New South Wales, Australia
  • Joshi, Rohina, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Jan, Stephen, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Gallagher, Martin P., George Institute for Global Health, Sydney, New South Wales, Australia
  • Knight, John, George Institute for Global Health, Sydney, New South Wales, Australia
  • Jha, Vivekanand, George Institute for Global Health, New Delhi, India

Group or Team Name

  • Dialysis Outcomes Study Group
Background


Hemodialysis (HD) is the dominant renal replacement therapy (RRT) in India. Despite a national free dialysis programme since 2016, outcomes in dialysis have received limited attention. 1000 incident HD patients were followed up to evaluate the determinants of outcomes. We describe the baseline socio-demographic and clinical characteristics associated with 12-month survival on HD.

Methods

1000 participants were recruited from 2016 to 2018 at 16 dialysis facilities across 9 Indian states. Demographic,clinical, socioeconomic and quality of life parameters were collected through a secure online data collection platform. We examined the association of survival with age, gender, education, family income, OoP expenditure, insurance coverage, vascular access, hemoglobin and intradialytic weight gain. Chi-square and Fishers T tests were used to test for associations and a p value of <0.05 was deemed significant.

Results

The median age (IQR) was 58 (18) years, and 29% were female. 20% of the participants had education beyond school. 80% of the females worked within the home, while 44% of the males were retired or not working. Of those who had a job, 9% changed their occupation. Median monthly family income was US$ 500 (586). Median distance traveled for dialysis was 10 (15) kms. 75% funded dialysis out of pocket (OoP), 19% had government or an employer-based, while 6% had private insurance. The median monthly OoP expenditure was US$ 360±220 for uninsured participants and US$ 180±140 for insured participants. At 12 months, 53.4% remain on HD, 18.5% had died, 14.9% withdrew from dialysis, 7.5% received a transplant, 2.9% switched to PD, and 2.8% were lost to follow-up. Survivors had shorter travel distance, higher family income, hemoglobin and lower interdialytic weight gain. In the QoL analysis, the highest decline of function was observed in the domain of self-care(16%) followed by mobility(15%).

Conclusion

In this national HD cohort, 64% continued on RRT at 12 months. Availing dialysis closer to home, adequate financial risk protection was associated with continuing on dialysis. Hemoglobin levels more than 10 g/dL and low Inter dialytic weight gain were strongly associated with survival. Monitoring outcomes in dialysis provides an opportunity to identify modifiable factors to improve quality and inform policy.

Funding

  • Commercial Support