Back
Population-based registries are not present in India, and therefore there is difficulty in finding the patient needs and assessing the treatment gaps. Reliable population-based estimates on prevalence and ESRD on RRT is not available in Kerala. As a pilot project we are conducting a comprehensive facility-based registry of patients on RRT in Thiruvananthapuram district ,the capital of Kerala(Population -3,521,153) will enable us to capture prevalence, dialysis adequacy and dialysis session duration, treatment modalities, mortality, and variations in dialysis practices. Further, it will help us to capture reliable information on disease aetiology, treatment practices, quality of care, quality of life and mortality in ESRD patients seeking RRT. The data generated from this project will help us to plan the resources required for ESRD management at the state level.
Prospective Observational Longitudinal Study (facility-based disease registry) of ESRD patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis & continuous ambulatory peritoneal dialysis (CAPD) in Thiruvananthapuram district.
All healthcare facilities providing renal replacement therapy (HD & CAPD) in Thiruvananthapuram District was enrolled as study centres.A longitudinal database was established and data collection done at the time of enrolment in the study, and follow-up visits are also captured.
We are presenting the cross-sectional data of the ESRD population of the Thiruvananthapuram district as the study is ongoing.We recruited 1485 MHD( approx 42.5 ESRD pmp) patients with a mean age of 57.8 ± 12.54 years and 80 patients are on CAPD. Nearly three-quarters of the enrolled MHD patients were male (69.8%). Almost all patients had hemodialysis as their mode of first dialysis. More than half of the patients had diabetic kidney disease (59.1.0%) or renal disease due to hypertension (17.4%). Around 10% of MHD patients suffer from heart failure. The mean predialysis creatinine value was 11.20 ± 4.6 mg/dL, and the mean hemoglobin value was 9.81 ± 4.1 g/dL. A jugular catheter was used for the first renal replacement therapy (RRT) in more than half of the patients (54.7%), and approximately 60% of maintenance hemodialysis (MHD) patients underwent dialysis twice weekly (61.3%). Brachial AV Fistula is the current dialysis access for more than half of the patients (54.3 %). Nearly half of the MHD patients take erythropoietin injections twice weekly for anemia correction. Darbepoetin is given to less than one percent of MHD patients. More than half of the MHD patients have government insurance. For one-quarter of patients, 25-50% of their household monthly income goes toward dialysis and dialysis-related medical care
The study found that Haemodialysis is the preferred modality of renal replacement therapy with CAPD comprising less than 0.05%.Most patients were initiated on Haemodialysis as an emergency indication and were on temporary catheters at the time of initiation. Twice weekly is the preferred frequency of Haemodialysis especially in government-owned centres. The Ethology of ESRD is predominantly diabetic kidney disease. We also observed a huge gender difference in ESRD patients receiving ESRD care. The mean haemoglobin value was low, indicating anaemia. The most common treatment for anaemia was erythropoietin injections twice weekly. The kidney quality of life is better among males than females. The conclusions imply that MHD patients in Kerala’s Thiruvananthapuram District represent a high-risk demographic with a substantial illness burden and financial difficulties. Targeted therapies are required to raise MHD patients' quality of life and lessen their financial burden.