TRANSFORMING CRITICAL CARE FOR RENAL PATIENTS IN RESOURCE-LIMITED SETTINGS: THE IMPACT OF ICU EXPANSION AT KIDNEY FOUNDATION HOSPITAL AND RESEARCH INSTITUTE, BANGLADESH

The Kidney Foundation Hospital and Research Institute, initially a 100-bed facility, has expanded into a 300-bed comprehensive renal care center. It now includes a 110-bed dialysis unit, 8 ICU beds, and 4 HDU beds dedicated to transplant patients. In 2023, in collaboration with the ISN SRC program and Royal London Hospital, the hospital inaugurated its Renal ICU—a significant milestone in critical care expansion. The hospital has since earned recognition as an ISN SRC graduate center 2024.

Objective: This study aims to evaluate how establishing a dedicated Renal ICU has improved accessibility and affordability of critical care for renal patients in a resource-constrained environment, highlighting its impact on patient outcomes.

An observational study was conducted from February 2023 to September 2025 at the Kidney Foundation Hospital and Research Institute. The analysis encompassed patient outcome data including mortality rates, length of stay, discharge rates, and referral rates. Additionally, it compared the costs of critical care before and after ICU implementation. The study also assessed how many patients previously lacked access to specialized critical care and are now able to receive such services due to the ICU's availability.  Statistical Analysis was done in Excel using t test two sample assuming unequal variance to compare ventilated and non-ventilated patients. Data analysis descriptive statistics was used for means and standard deviation.  

During the study period, 1,361 critically ill renal patients received care. Among them 664 were male and 667 female. In the first year (February 2023–January 2024), 399 patients were treated, with a discharge rate of 62.66% (250 patients), a mortality rate of 27% (123 patients), and a referral rate of 6.52% (26 patients). The admission numbers increased by 44% in the second year, totaling 578 patients. While mortality rates remained comparatively low at approximately 27–28%. Referral rates decreased from 6.52% to 4.33%, indicating enhanced in-house care capacity. Up to September 2025, 384 patients have been treated in the ongoing year. The overall average length of stay was 3 days (±2SD, n=1,266). Of these, 337 patients required ventilatory support with an average duration of 3 days, while 930 patients received other organ support with an average stay of 4 days. The combined outcomes showed a mortality rate of 27.36%, a discharge rate of 68.65%, and a referral rate of 4.13%.  

The Renal ICU at Kidney Foundation Hospital and Research Institute has markedly improved Renal critical care access for renal patients within a resource-limited context. Before this expansion, many of these patients had little or no access due to financial and capacity constraints nationwide. Currently, 1,346 patients have benefitted from equitable healthcare services. The mortality rate (27.36%) is notably lower than the global ICU average of 36%, demonstrating better-than-average outcomes. This sustainable, replicable model can be adapted to similar settings to improve critical care delivery. The ICU has also established an outreach team providing bedside care for indigent patients unable to afford minimal costs, further extending its positive impact. Importantly, the hospital offers significantly lower and transparent ICU charges compared to private hospitals in Bangladesh, with ICU bed costs ranging from ৳9,000 to ৳13,000 per day nationally. This initiative exemplifies how targeted expansion and equitable resource allocation can transform renal critical care landscapes in resource-limited environments.