Demographics, cost, and sustainability of haemodialysis among end-stage kidney disease patients in Southern Nigeria: A single-center study

Abstract

Context: Access to chronic hemodialysis for patients with end‑stage kidney disease has improved over the years. However, it is unclear if thisbhas resulted in lower cost and improved dialysis vintage. Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end‑stage kidney disease (ESKD) patients. Methods: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time‑to‑HD discontinuation and reasons for discontinuation were recorded. Using Kaplan–Meier graphs, the time‑to‑dialysis discontinuation experience of the cohort was shown. Log‑rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time‑to‑dialysis discontinuation. Results: Over the 5‑year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person‑days to the study and the median time‑to‑HD discontinuation was 10 days (interquartile range, 2–42). Females had a shorter time to HD discontinuation (8 days [1–32 days]) compared to males (11 days [2–48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice‑weekly HD. Most sustained the treatment for the 1^st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation. Conclusion: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care.