Introduction:
Disease-specific registries are scarce in India because of a lack of uniform access to digital health records. India's southernmost state. Kerala is the top-ranking state in the Sustainable Development Goals(SDG) India index. The state is in an epidemiologic transition with a huge burden of Non-Communicable Diseases with an overall prevalence of Type 2 Diabetes of 16.3%. The high burden of Diabetes is in turn contributing to the CKD burden putting the public health system under severe stress. The Trivandrum Nephrogy Club an academic society of all the Nephrologists of Trivandrum decided to conduct a study to assess the burden of Dialysis requiring End Stage Renal Disease, the epidemiology of the disease and practice patterns across the different types of healthcare delivery. This is the first population-based disease-specific estimate of ESRD in India.The entire research project was funded by Trivandrum Nephrology club
Methods:
As of 2011 Census of India, the population of Trivandrum district was approximately 3.3 million. A database was established to collect data on all prevalent Maintenance Hemodialysis (MHD) cases from thirty-nine dialysis centres from January 1, 2023, covering the entire district. All patients who were permanent residents were included and the patients from neighbouring districts were excluded based on their ration card and AADHAR(UID). Demographic, socioeconomic, clinical, biochemical, and quality of life variables were captured at baseline using a structured paper-based tool by the dialysis nurse/technician. Additionally, all new patients who started dialysis in 2023 were duly enrolled in the registry to estimate the incidence of dialysis-requiring ESRD cases in the district. The study used the direct enumeration method to estimate the population-based prevalence of dialysis-dependent ESRD. Descriptive statistics were applied to all the variables and expressed using proportions and percentages. Summary measures were computed for quantitative data. The central data centre was Achta Menon centre of Health Sciences and the data was manged by a clinical epidemiologists and research assistants
Results:
We recruited 2201 MHD patients with a mean age of 58.2 ± 12.3 years. Nearly three-quarters of the enrolled MHD patients were male (70%). Almost all patients had haemodialysis as their mode of the first dialysis. More than half of the patients had diabetic kidney disease (56.2%). Around 10% of MHD patients suffer from heart failure. The mean Predialysis creatinine value was 11.15 ± 4.5 mg/dL, and the mean haemoglobin value was 9.5 ± 3.0 g/dL. A jugular catheter was used for the first renal replacement therapy (RRT) in more than half of the patients (55.1%), and a little more than 60% of maintenance haemodialysis (MHD) patients underwent dialysis twice weekly (62.5%). Brachial AV Fistula is the dialysis access for almost half of the patients (48.9%). Nearly half of the MHD patients take erythropoietin injections twice weekly for anaemia correction. Approximately 64% of MHD patients have financial assistance for treatment from insurance. For one-quarter of patients, 50-75% of their household monthly income goes toward dialysis and dialysis-related medical care. Only 22 patients underwent renal transplants in the study year and patients on peritoneal dialysis were only 62 number.
Conclusions:
The study identified the huge burden of ESRD patients in Thiruvananthapuram District and Diabetes being the common cause of ESRD in this population confirming the epidemiologic transition. There is a significant variation in the practice pattern of ESRD care between private and public healthcare facilities. Temporary access is the predominant form of vascular access while initiating Hemodialysis. The majority of patients undergoing maintenance Hemodialysis have some form of financial assistance in the form of Government or private health insurance reflecting the high SDG index of the state. The access to transplants is negligible because of the non-availability of donors and an ineffective deceased donation program.Population-based registries are the need of the hour to channelise the health care expenditure and need based asessment of ESRD care delivery.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.