ACCESS TO HEMODIALYSIS AND BARRIERS TO ACCESS HEMODIALYSIS SERVICES - A MULTICENTRIC CROSS-SECTIONAL STUDY IN INDIA, 2023

Introduction:

Globally, the End Stage Kidney Disease requiring renal replacement therapy is estimated to be 4.902 to 7.083 million, but only 4 million receive kidney replacement therapy, and hemodialysis is the most common form. There is a lack of access to hemodialysis especially in lower-middle income countries and countries like India are making rapid transitions in improving access. Hence, it is important to understand current challenges. This multi-centric study was conducted to determine the barriers patients face towards accessing maintenance hemodialysis services.

Methods:

We conducted a cross-sectional observational study in 100 randomly chosen centers across India, that provide hemodialysis services under a single large private dialysis network. The study was conducted during 2023 with a total sample size of 2,573. Hemodialysis technicians administered a pre-tested semi-structured questionnaire to interview the patient. Data entry and analysis were done using SPSS software. We descriptively present the socio-demographic characteristics of patients, their mode of awareness regarding availability and accessibility to hemodialysis services and the barriers they face to access the services.

Results:

Among 2573 study participants, distribution of the study population was 14% from north, 33% from south, 14% from central region, 19% from east and 20% from west. 72% were males and 28% were females. 24%,48% and 28% belonged to the age groups 18 to 40, 41 to 60 and >60 respectively. 76% were on arteriovenous fistula or graft and 24% on catheters. 12% were hypertensives and 4% diabetics. 18% had hemoglobin level < 8g/dl, 42%, 8 – 9.9g/dl, 33%, 10 – 12g/dl and 7%, > 12g/dl. 68% had their albumin level ≥ 3.5g/dl and 32% had < 3.5g/dl. 8% had private insurance, 20% paid cash and 72% had government insurance. 24% traveled less than 5km to get to the dialysis centre, 33%, 5 to 15 km, 33%, 15 to 50 km and 10%, >50 km respectively. Source of information to learn about the hemodialysis services in the centre:  61% knew about it through a local doctor/nurse/health care practitioner, 19% through friends or family, 9% through the internet, 6% through billboards and other advertisements in the community and 5% through TV/radio/newspaper. The barriers to access are shown in figure 1. 27% of them had difficulty with transportation, 11% had financial constraints, 11% found it difficult to spend time on dialysis treatments owing to work or household responsibilities, 10% found it difficult to get support from family members and 1% felt ashamed and embarrassed about it.

Conclusions:

In the context of growing public funding and improving access to End Stage Kidney Disease, awareness of services is dominantly through healthcare providers. There is scope to improve channels of communication to raise awareness about the availability and accessibility of hemodialysis. In this population, distance, finances, inadequate family support and inability to find time off work remain as barriers to be addressed.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.