ASSESSMENT OF FACTORS BEHIND HEMODIALYSIS REFUSAL IN CHRONIC KIDNEY DISEASE PATIENTS: CROSS SECTIONAL STUDY

Abstract

Background: Chronic kidney disease (CKD) is becoming more common, and this suggests that it is a public health concern. The progressive and irreversible destruction of functional nephrons in chronic kidney disease (CKD) is linked to a considerable morbidity and death rate.

Objective: To assess the factors contributing to refusal of hemodialysis among chronic kidney disease patients.

Method: A descriptive cross-sectional study was conducted in the Ghurki hospital Punjab. Data was collected with help of modified questionnaire from 138 patients who were in the 3rd, 4th and 5th stage of CKD. The informed consent was taken from the study participants and data was analyzed with help SPSS version 27 by using   frequency and percentage while to assess factor a statistical chi square test used with a p less than 0.05.

Results: Most of them were females (80.3%), aged above 32 (67.9%), married (75.2%),  unemployed (50.4%), living in urban area 58.4% with dialysis sessions of 1-2 per week (50.4%), advised with catheter route of dialysis by physician (56.2%) inability to afford hemodialysis  (HD) (64.2%), fear of HD catheter(55.5%), fear of AV fistula needles (49..9%), presence of HD center near their residence (28.5%) and the acceptability for the lifelong and permanent HD (59.1%). perception that HD has poor quality of life (23.36%). the fear of complications of HD. (80.29%). the perception that HD leads to death (68.61%) . dissatisfaction with the frequency of  HD (35%), adverse outcomes among family or friends(46%), received advice against HD from family members(31.4%), alternatives to HD (39.4%), and  kidney transplant(24.8%).

Conclusion: Factors contributing to CKD patients' refusal of HD include fear of complications, perceived poor quality of life and mortality, financial constraints, acceptance of lifelong HD, urban residence, physician recommendations for catheter-based dialysis, apprehension about HD catheters, and a limited dialysis schedule. Addressing these challenges necessitates a comprehensive approach involving medical, psychological, and social support to enhance patient outcomes and quality of life.