SP626SOCIO DEMOGRAPHICS, CLINICAL CHARACTERISTICS, QUALITY OF LIFE AND GEOGRAPHICAL ACCESS TO CARE OF HEMODIALYSIS PATIENTS IN INDIA

Abstract

INTRODUCTION AND AIMS: To report the baseline characteristics and distances travelled to treatment for kidney failure patients recruited under a prospective cohort study across 9 states in India. METHOD(S): We present the baseline socio-demographic, clinical characteristics, Quality of Life (QoL) and distance travelled to care data of incident patients commencing hemodialysis. The study subjects were recruited from November 2016 to November 2017. Routine medical records were utilized for collection of demographic and clinical information, with patient interviews to collect distance travelled to care and QOL assessment (via Euroqol-5D-3LVR questionnaire). Data were collected using an electronic platform by trained staff representatives at the dialysis units. RESULT(S): A total of 702 patients (216 female) were enrolled, from 18 dialysis units across 9 states in India. Median age at enrollment was 56.8 years (female 58 years; male 56.1 years). More than 62% (female 71.3% and males 54.1%) of the patients had received high school education or less. A large proportion of the female participants were housewives or unemployed (88%), with only 7% having a job. Nearly 37% of the male subjects were either retired or not working, followed by 23% having a job, 14% having their own business and 13% being involved in agriculture. Median monthly income was reported as US$ 453. More than 6% of the subjects reported a loss of job due to kidney disease. A large majority of the subjects (80%) were not performing any form of exercise. More than 15% were using tobacco in one form or the other. Half of the patients were overweight (BMI: 23.0-24.9 kg/m2) or obese (BMI >=25 kg/m2). Nearly 76%, 49%, 8% and 5% of the patients had history of hypertension, diabetes, ECG abnormalities and stroke, respectively. Mean values of creatinine and urea nitrogen were 8.7 mg/dL and 114.4 mg/dL, respectively. Mean eGFR was 8.6 mL/min/1.73 m2. Mean distance travel to reach the dialysis unit was reported to be 29.2 kilometers, with 16% of the patients having to travel more than 50 kilometers. Half of the patients were prescribed two sessions of dialysis per week. Majority of patients (56%) received their first dialysis through AV Fistula. Two-third of the patients were receiving erythropoietin. Results of the five dimensions of QoL tool indicated the highest scores being recorded for self-care, with 68% of the patients reporting no limitation, and the lowest scores for anxiety with 16% of the patients reporting severe anxiety and depression. CONCLUSION(S): An alarming number of subjects losing their job highlights the challenges related to maintaining employment for patients undergoing dialysis. Anxiety symptoms and longer distance travelled to care may be associated with poor clinical outcomes and lower health care maintenance. The complete follow-up data will provide much-needed information for improvement of dialysis services in India.