Clinical Profiles and Outcomes of End-Stage Kidney Disease in Adult Patients Treated with Haemodialysis at The Kenyatta National Hospital during Out-of-Pocket Payment and National Health Insurance Reimbursement for Haemodialysis Services

Abstract

Background: The demand for haemodialysis has grown briskly especially in low- and middle- income countries. Sadly, availability of kidney replacement therapy in developing countries is scarce and may be unavailable in very-low-resource regions. As a result, a compelling number of patients have finite access to Kidney Replacement Therapy (KRT) resulting in premature deaths. In July 2015, the National Hospital Insurance Fund (NHIF) launched a renal dialysis package which caters for haemodialysis two sessions per week.

Objective: To describe and compare selected clinical profiles and clinical outcomes amongst ESKD patients treated with HD in Kenyatta National Hospital (KNH) between June 2013 to June 2015 and July 2015 to May 2018 i.e., during the out-of-pocket payment period (pre-NHIF) and the national health insurance reimbursement period (post-NHIF).

Methods: This was an ambispective observational study among End Stage Kidney Disease (ESKD) patients treated with haemodialysis (HD) in KNH between June 2013 to June 2015 and July 2015 to May 2018. The medical records of the 338 randomly selected patients were retrieved from the health records and information department in KNH. Data on the patients’ sociodemographic characteristics, clinical profiles and outcomes was collected and analysed.

Results: Comparing the two groups (pre- and post-NHIF), the mean age at HD initiation did not differ significantly (46.76 vs 46.96 years). Males outnumbered females in both groups, at 64% and 60% respectively. Diabetes and hypertension remained the most common documented causes of ESKD in both groups. Following the introduction of NHIF reimbursement, there was a significant rise in HD sessions (1.94 ± 0.7 vs 2.12 ± 0.4, p value 0.04), however, the HD vintage decreased (36.3 vs 30.5 months). Our mortality rate was high at 85% (pre-NHIF) and 76% (post-NHIF).

Conclusion: The mortality rate was quite high during both time periods; hence the emphasis should be on prevention, early detection, and treatment of diabetes and hypertension as well as making kidney transplantation accessible and affordable to all. Hopefully, these will have a positive impact on the mortality rate of ESKD patients.