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.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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