Hyderabad, April 06: A study conducted by nephrologists of Nizams Institute of Medical Sciences (Nims) on 237 dialysis patients for three years has revealed that a majority of patients are dropping out of dialysis treatment due to financial constraints. Ultimately, the patients pass away due to kidney failure and other complications.
According to the study, published last month in the online edition of the journal Hemodialysis International, of the 237 patients on dialysis, 105 had discontinued and did not show up for follow-up. The patients who had opted out died.
Lack of medical insurance to cover for dialysis is also a major factor. The study revealed that 123 patients (of the 237), which is more than 50 per cent, did not have medical insurance and were self-paying.
At the end of the three-year period, the number of self-paying patients came down to 20 who continued to be on dialysis.
“There is a drop because patients realised that dialysis was not a cure and a long-term treatment would impoverish them. Some patients opted for once a week dialysis at a different centre, but most were never heard-of later,” the study said.
According to Nims nephrologists, the research paper is the first ever systematic study of Indian dialysis patients drawn from a Government hospital. “There are three similar studies but all of them are from corporate hospitals. Our study had the largest number of patients and longest follow-up of three years between 2004 and 2007.
The patient population at Nims reflects the true picture of dialysis patients in our country,” says Assistant Professor, Department of Nephrology, Dr. Ram Rapur, a member of the team that took up the study.
The doctors said that 155 patients (out of 237) came to the hospital with kidney disease without being treated by any doctor earlier. “They required emergency dialysis. Late admission is due to lack of finance, awareness, not recognizing the ailment early by the local doctor, and presence of middle-men who misdirect patients to some other local hospital,” the study said.
The research also explored the etiology or the causes that lead to end stage renal or kidney disease among the patients. “Our study has revealed that diabetes and hypertension continue to remain the two leading causes of end stage renal disease. Interestingly, this is consistent with the results in other countries,” Dr. Ram said.
There is a need for dialysis patients to be made aware of the steps that have to be taken before initiation of dialysis.
The study has revealed that only 73 patients had received intravenous iron therapy, close to 150 students had received vaccination against Hepatitis B virus and only 81 persons had undergone cardiac consultation before dialysis.
Malnourishment
Death due to cardiac episodes, malnourishment, and tuberculosis are the most important complications among dialysis patients.
They should undergo regular cardiac evaluation and follow a good dietary advice, study said. The research team consisted of Dr. G. Swarnalatha, Dr. R. Ram, Dr. N. Prasad, and Dr. K.V. Dakshinamurty.
–Agencies