Refusal for Hemodialysis and Outcome in Chronic Kidney Disease Patients

Abstract

Background: Chronic kidney disease (CKD) is a major burden of chronic illnesses. It has been observed that majority of the patients refuse hemodialysis leading to very high mortality even in younger ones. Objective: This study was conducted to determine the effect of refusal of hemodialysis on survival in CKD patients. Methods: Prospective study was done in Nephrology Department of Mayo and Shalamar Hospital, Lahore.Patients presenting in Nephrology Out Patient Department with the indication of dialysis were included in the study. Patients with acute kidney Injury and with loss of follow up were excluded from the study. Patients were divided in two groups, patients who accepted hemodialysis and patients who refused dialysis. Both groups were followed up for outcomes mortality at one, three and twelve months. Results: Total number of the patients was 118. Major cause of CKD was Diabetes Mellitus 54(45.8%) followed by Hypertension 45(38.1%).Patients who accepted hemodialysis were 59(50%). Overall mean survival days of the patient were 151± 129 in all patients. Patients who opted for dialysis survived longer as compared to patients who refused dialysis (200 vs 112 days) (p< 0.0004). Highest mortality was observed within first three months in both groups [accepted vs. refusal group 21.4 % vs 41.5 % respectively, (p<0.005)].Relative risk (RR) showed that mortality in patient who refused dialysis was 1.37 time higher than who accepted for dialysis (p<0.05). Conclusion: This study shows that patients who accepted dialysis survived longer as compared to patients who refused dialysis and patients refusing dialysis were having high mortality.