Clinical Profiles and Outcomes of End-stage Kidney Disease Adult Patients Treated With Hemodialysis at the Kenyatta National Hospital During Out-of-pocket Payment and National Health Insurance Reimbursement for Hemodialysis Services

Abstract

Background: The demand for hemodialysis has grown briskly especially in low- and middle income countries. Sadly, availability of kidney replacement therapy in developing countries is scarce and may be unavailable in very-low-resource regions. As a result, a compelling number of patients have finite access to KRT resulting in premature deaths. In July 2015, NHIF launched a renal dialysis package which caters for hemodialysis two sessions per week. Objective: To describe and compare selected clinical profiles and clinical outcomes amongst ESKD patients treated with HD in KNH between June 2013 - June 2015 and July 2015 - May 2018 i.e., during the out-of-pocket payment period (pre-NHIF) and the national health insurance reimbursement period (post-NHIF). Methods: This was an ambispective observational study among ESKD patients treated with HD in KNH between June 2013 - June 2015 and July 2015 - May 2018. The medical records of the 338 randomly selected patients were retrieved from the health records and information department in KNH. Data on the patients’ sociodemographic characteristics, clinical profiles and outcomes was collected and analyzed. Results: Comparing the two groups (pre- and post-NHIF), the mean age at HD initiation did not differ significantly (46.76 vs 46.96 years). Males outnumbered females in both groups, at 64% and 60% respectively. Diabetes and hypertension remained the most common documented causes of ESKD in both groups. Following the introduction of NHIF reimbursement, there was a significant rise in HD sessions (1.94 ± 0.7 vs 2.12 ± 0.4, p value 0.04), however, the HD vintage decreased (36.3 vs 30.5 months). Our mortality rate was high at 85% (pre-NHIF) and 76% (post- NHIF) with no statistical significance across all the clinical outcomes assessed. Conclusion: The mortality rate remained quite high during both time periods. In as much as NHIF reimbursement increased access to hemodialysis, it did not have any impact on clinical outcomes including survival. This suggests that there could be other factors like quality of hemodialysis offered, complications associated with hemodialysis that play a crucial role in the clinical outcomes as well.