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Abstract: FR-PO898

Nephrologists' Perspectives on Kidney and Dialysis Care in Pakistan: A Qualitative Study

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology


  • Malik, Sheza, Rochester General Hospital, Rochester, New York, United States
  • Anwar, Ayesha, Allama Iqbal Medical College, Lahore, Pakistan
  • Allen, Rebecca Jane, Mount Saint Joseph University, Cincinnati, Ohio, United States
  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States

While most research on kidney care in developing countries has focused on patients, in-depth perspectives of Pakistani nephrologists on kidney and dialysis care are lacking.


Between May 2021 and September 2021, we interviewed 19 nephrologists and nine nephrology fellows working in nine hospitals in Pakistan. Those who hesitated to spare time for the qualitative interviews (n=09) were provided with the opportunity to write their responses to 8 open-ended questions (e.g., ‘can you please share some common challenges when a patient needs dialysis?’). For the face-to-face interviews, we recorded and transcribed the conversations. Two reviewers coded the transcripts and used the inductive content analysis approach to formulate themes.


We observed the following three main themes: (1) Nephrologists felt privileged when able to relieve patients' suffering. Still, they feared delivering bad news of kidney failure and lifelong dialysis to their patients. (2) Financial issues were the most significant reported barrier to providing maintenance dialysis. (3) Nephrologists were almost evenly divided in their comfort with end-of-life conversation. Some found these discussions challenging, while others found these discussions easy.
Other challenges faced by patients with CKD, according to Pakistani nephrologists, included low literacy, limited awareness of kidney disease, fear of dying on dialysis, lack of transportation, poor social support, medical complications of dialysis, and common use of alternative medications.


Our study highlights key shortcomings of kidney and dialysis care in Pakistan. Our findings call for raising awareness about kidney disease in the general public. While patients need to be supported financially and psychologically, nephrologists' training in communication skills and end-of-life care is also urgently needed.