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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Pediatric CKD care in India is limited to a few centres, a mix of public sector and private sector. To access CKD treatment, caregivers must pay out-of-pocket (OOP) for healthcare related expenses. Little objective data exists on the occurrence and severity of financial hardship incurred by pediatric CKD care. This ISN CRP funded study performed a prospective measurement of this financial burden and studied its association with clinical outcomes.
We enrolled children (1-18 years) with CKD stages 3b–5/5D in 3 pediatric CKD centres (2 private, non-profit, 1 public sector). Mean monthly direct medical, direct non-medical and indirect costs for 3 months prior to enrolment (baseline) and at follow up clinic visits within 12 months of baseline. Direct expenses were verified with invoices/bills. Indirect expenses and income were patient reported. Definitions of financial burden:
1.Catastrophic Healthcare Expenditure (CHE) -WHO definition: monthly OOP healthcare expenditure ≥10% of total household expenditure/income.
2. Severe CHE = monthly OOP healthcare expenditure > 50% of total household expenditure/income.Moderate CHE =10-50%
3. Persistent CHE = CHE at baseline AND at ≥1 follow-up
4. Financial distress = selling belongings/taking loans to cover healthcare costs
Final Clinical outcomes: Classified as ‘treatment as advised’, ‘non-adherent’ ( to treatment advised) and ‘discontinuation of treatment/death.’
Factors associated with financial burden and clinical outcomes were analysed.
Caregivers were surveyed on their most significant financial burdens and their financial needs.
Patients: We enrolled 166 children [65% male, aged 12.4 years(±4.2), 85% with non-glomerular disease, 49% of low socioeconomic status who travelled a median(IQR) of 77.5km(15, 150) to access CKD care]. Eight one(49%) were in stage 5 CKD but of these only 58(70%) had initiated dialysis. In the 2 private sector hospitals, 96 (89%) paid OOP for healthcare expenses. All patients from the public sector hospital paid OOP for non-medical costs (travel, lodging).
Financial Burden: At baseline, 161(97%) experienced CHE (including 96% in the public sector hospital). Severe CHE occurred in 117(71%) and was associated with CKD Stage 5, dialysis therapy and longer travel distance (all p<0.05). There was no difference in CHE occurence between HD and PD patients. Persistent CHE follow up occurred in 134 (94%) and 75 (54%) of these continued to suffer severe CHE.
Financial distress occurred in 60 (36%) and was associated with dialysis therapy (p<0.001), severe CHE (p=0.04) and the discontinuation of schooling. 51% (p=0.01).
Final Clinical Outcomes: At study conclusion 55 (33%) had discontinued treatment/died. Of these 31 (56%) were CKD Stage5, 16 of whom had refused dialysis. Non-adherence to therapy/visits occured in 34(20%), more frequently in younger patients (p=0.008) and amongst those not on dialysis (p=0.028).
Survey Results: The most frequently reported challenge to adherence was the travel time and costs and the OOP costs of dialysis (30 – 60%). Monetary support towards general family expenses (public sector) and reimbursement of dialysis costs (private sector) was desired.
In this first objective economic evaluation of pediatric CKD, CHE occurred almost universally and was severe. Despite the availability of CKD care patient outcomes were poor, especially in CKD stage 5. Content from this abstract has been submitted to Indian Society of Pediatric Nephrology Conference.
