Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov-Dec;61(6):307-311.
doi: 10.4103/nmj.NMJ_106_20. Epub 2020 Dec 19.

Demographics, Cost, and Sustainability of Haemodialysis among End-Stage Kidney Disease Patients in Southern Nigeria: A Single-Center Study

Effiong E Akpan  1 , Udeme E Ekrikpo  1 , Emmanuel Edet Effa  2 , Aniema I A Udo  1 , Victor A Umoh  1
Affiliations

Demographics, Cost, and Sustainability of Haemodialysis among End-Stage Kidney Disease Patients in Southern Nigeria: A Single-Center Study

Effiong E Akpan et al. Niger Med J. 2020 Nov-Dec.

Abstract

Context: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage.

Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disease (ESKD) patients.

Methods: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time-to-HD discontinuation and reasons for discontinuation were recorded. Using Kaplan-Meier graphs, the time-to-dialysis discontinuation experience of the cohort was shown. Log-rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time-to-dialysis discontinuation.

Results: Over the 5-year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person-days to the study and the median time-to-HD discontinuation was 10 days (interquartile range, 2-42). Females had a shorter time to HD discontinuation (8 days [1-32 days]) compared to males (11 days [2-48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice-weekly HD. Most sustained the treatment for the 1st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation.

Conclusion: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care.

Keywords: Cost; end-stage kidney disease; hemodialysis; sustainability.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart showing patient recruitment over a 5-year period
Figure 2
Figure 2
Kaplan–Meier curves for survival of end-stage kidney disease patients on hemodialysis
See this image and copyright information in PMC

References

    1. Eggers PW. Has the incidence of end-stage renal disease in the USA and other countries stabilized? Curr Opin Nephrol Hypertens. 2011;20:241–5. - PubMed
    1. Oluyombo R, Okunola OO, Olanrewaju TO, Soje MO, Obajolowo OO, Ayorinde MA. Challenges of hemodialysis in a new renal care center: Call for sustainability and improved outcome. Int J Nephrol Renovasc Dis. 2014;7:347–52. - PMC - PubMed
    1. Okpechi IG, Chukwuonye II, Tiffin N, Madukwe OO, Onyeonoro UU, Umeizudike TI, et al. Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach. PLoS One. 2013;8:e73403. - PMC - PubMed
    1. Okwuonu CG, Chukwuonye II, Adejumo OA, Agaba EI, Ojogwu LI. Prevalence of chronic kidney disease and its risk factors among adults in a semi-urban community of South-East Nigeria. Niger Postgrad Med J. 2017;24:81–7. - PubMed
    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1545–602. - PMC - PubMed