Adherence Factors Affecting Kidney Transplant Recipient among Patients on Maintenance Haemodialysis in Côte d’Ivoire

Abstract

Background: Kidney Transplantation is the best treatment for patients in end stage renal disease. It's a new therapeutic approach for such patients in Cote d'Ivoire which is expected to develop. Aim: Determine the adherence factors affecting kidney transplant recipient among patients on maintenance haemodialysis in Cote d'Ivoire and point out possible obstacles to the development of this new practice in the country. Patients and Methods: This was a cross-sectional study carried out from May to June 2016 in the Haemodialysis Centres of Abidjan. Any patient aged ≥18 years, on haemodialysis for at least 6 months, who signed the inform consent were subjected to a questionnaire. None of the respondents had been transplanted. The subjects addressed in the document were sociocultural status, opinion related to kidney transplantation and willingness to be transplanted or not and the reasons. A statistical analysis was performed to determine factors associated with kidney transplantation desire. Results: We included 295 (71.53% males) patients, with a mean age of 44.53 ± 12.09 years. Among this population, 36.61% had a higher level of education, 70.85% were Christians, 66.44% lived with partners, 56.61% had no income and 74.92% were treated in Public Health Centres. The median duration on dialysis was 34 months. A total of 287 (97.29%) patients had already heard of kidney transplantation among which 149 (51.94%) for the first time after initiation of haemodialysis. There was 231 (78.31%) patients willing to be transplanted with only 91 (39.39%) of them having a potential living donors. The main motivations were the desire to stop dialysis (52.38%) and the search for a better quality of life (41.13%). Among the 64 (21.69%) patients unfa- vourable to renal transplantation, 45.31% raised its higher cost compared to haemodialysis. Duration on haemodialysis (>34 months) was significantly higher in patients willing to be transplanted compare to non-applicants (51.95% versus 37.50%, p < 0.04). Factors associated with renal transplantation willingness were younger age (<45 years) (OR = 2.14 CI: 1.12 -4.06 p = 0.02), longer median duration on dialysis (>34 months) (OR = 2.12 CI: 1.15 -3.88 p = 0.01) and the Christian religion (OR = 0.43 CI: 0.20 -0.92 p = 0.03). Conclusion: Almost all patients on maintenance haemodialysis were willing to be transplanted. However, the rate of living donor remains insufficient. For the non-seekers, the high cost of the process remains the main obstacle to kidney transplantation. Transplantation should be given more attention and political support economically by the Government to allow its development in Cote d'Ivoire.

Sex and gender differences in chronic kidney disease and access to care around the globe

“…The low prevalence of kidney transplantation reflects the lack of regulatory frameworks for organ donation, financial constraints, low education level, misperceptions, cultural and religious behavior, and nonavailability of donors. [63][64][65][66][67] Despite the low number of patients receiving a transplant, male predominance was prominent, again likely owing to cultural behavior or socioeconomic status (Fig. 2).…”

Knowledge, Perception and Attitude of Indian Maintenance Hemodialysis Patients toward Renal Transplantation

“…Sadly only 72% of our patients had knowledge about transplant as a modality for renal replacement therapy, lesser than the West-African MHD patients from Cote d'Ivoire (97.3%) and Nigeria (75%), [4,5] however they were better informed than the Saudi Arabian (39%) and Bangladesh CKD cohorts (30%, 34%). [6][7][8] Consequently lesser number of our patients (69.4%) were willing for transplant than the Cote d'Ivoire cohort (78.3%), [4] Saudi-Arabians had comparable willingness (69%) as they also feared their old age (61%) and surgical complications (26%), whereas Chinese feared transplantation the most with only 46.4% willing for transplant. [9] Even the high income country like Hungary had no different experience, with only 71% of their MHD patient willing for transplant.…”

“…[10] The main motivations for the Cote d'Ivoire cohort was the desire to stop dialysis (52.4%) and the quest for a better quality of life (41.1%). [4] The concern about high cost of transplant compared to hemodialysis, were common to many. [4,5] Another common deterring factor in our study as well as in worldwide meta-analysis, [11] was the concern for family donor's health, whereas many of these wished to undergo transplantation if deceased donor kidney was available.…”

“…[4] The concern about high cost of transplant compared to hemodialysis, were common to many. [4,5] Another common deterring factor in our study as well as in worldwide meta-analysis, [11] was the concern for family donor's health, whereas many of these wished to undergo transplantation if deceased donor kidney was available. Unfortunately deceased donor program has not yet kick-started in our state, and we refer our patients to get enrolled at a nearby union territory central government premium institute, where the whole process is very lengthy and painstaking, and consequently only 11% of our patients were enrolled for the same, and these too were on waiting list for years.…”