Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

Abstract

BackgroundKidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania.MethodsIn this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software.ResultsOf the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2–8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26–18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4–12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis.ConclusionUnavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression.

Challenges of haemodialysis: A single centre experience in South West Nigeria

“…A high percentage (43.6%) of patients were lost to follow up during this period due to reasons which may not be unrelated to inancial constraints, traditional belief, and concept about the disease among others. A similar igure was reported by Meremo et al in Tanzania [16] and Bello et al in a Nigerian study [8]. Causes of death were inadequate dialysis due to inancial constraints with its attendant complications, poor compliance to medication including antihypertensive, and sepsis among others.…”

“…This grossly fell short of the recommended target as outlined by Kidney Disease Outcomes Quality Initiative (KDOQI) [15]. Similarly, an unacceptable low number of patients having inadequate frequency of dialysis was documented by other researchers [5,8,16]. Almost all our patients paid out of pocket without any inancial aids from the government hence they could not cope with the cost implication of dialysis.…”

Can we still ignore renal replacement therapy in sub-Saharan Africa? All living beings are created equal

“…Meremo et al published the challenges and outcomes of HD center in Dodoma, Tanzania, where we supported to establish HD center at 2013 [16]. They have had no experiences to treat HD at the beginning of 2013, but they treated 116 patients with HD from January 2013 to June 2015.…”

“…Meremo et al demonstrated that renal transplantation is not performed in Tanzania and only a few patients can afford going abroad [16], especially to India until 2017. Kidney transplant recipient, donor, and a person who takes care of them go to India and stay there for a few weeks for the kidney transplant operation, after that they come back to Tanzania and get immunosuppressants from the hospital in Tanzania.…”

Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study

“…Haemodialysis services in Tanzania are largely reimbursed by the National Health Insurance Fund (NHIF), others pay 'out of pocket' and for a few patients HD services are covered by other private insurance or companies. Those paying 'out of pocket' may not be able to afford HD services and have higher risk of poor outcomes after initiation of HD [4]. This can be attributed to non-adherence to the standard three times per week HD.…”