Practice pattern of hemodialysis among end-stage renal disease patients in Rural South India: A single-center experience

Abstract

Hemodialysis (HD) is the most common mode of renal replacement therapy for end-stage renal disease (ESRD) patients in India. However, the practice and pattern of dialysis in a hospital serving rural population is largely unknown. A prospective study of 127 ESRD patients initiated on HD between January 2013 and December 2014 was done. The study included 101 males and 26 females, with a mean age of 50.05 ± 13.80 years. Native kidney disease was unknown in 45.67% of patients as they presented very late in their disease course. Nearly 87.4% of patients had emergency dialysis. Only 6.30% of patients had started dialysis with an arteriovenous fistula while 93.70% with a temporary catheter. The mean creatinine and hemoglobin at the initiation of dialysis were 11.18 mg/dL and 6.8 g/dL, respectively. All patients underwent twice weekly HD of 4 h duration with achieved average single-pool Kt/V of 1.52. The hospitalization rate was 3.25 per patient-year. The outcomes in our cohort were as follows: 3.94% transferred to other centers, 16.54% died, 0.79% underwent transplantation, 33.07% continued on HD, and majority 45.67% stopped dialysis. The most common cause of death was sepsis. The Kaplan-Meier analysis showed median survival time on dialysis to be 64 days. Patients initiated on HD in rural area often present late with poor predialysis care leading to high morbidity. Prognosis is generally poor with majority of the patients stopping dialysis within few weeks.