Frequency, Factors and Pattern of Delayed Presentation for Dialysis in Advanced Kidney Disease Patients Visiting Tertiary Care Hospital

Abstract

Background: Globally the burden of chronic kidney diseases is increasing. It is often a silent disease until the most advanced stages when symptoms develop. Late referral and presentation to a nephrologist for CKD management is the major issue. Objective: To determine the frequency, factors and pattern of delayed presentation for dialysis in advanced kidney disease patients visiting tertiary care hospitals. Methods: The current cross-sectional study was conducted in Memon Medical Institute Hospital and Dow University of Health Sciences Ojha Campus Karachi Pakistan from December 2019 to March 2020. Patients who presented in the hospital for first-time dialysis with advanced kidney diseases were included in the study. The threshold of patient presentation after a month of advice for dialysis is used to categorize the patient presentation as delayed or non-delayed. Proforma was designed to collect data and SPSS version 21 was used for analyzing the collected data. Results: A total of 214 participants were recruited into the study. The median age of the participants was 40 (29.75 - 53) years. The majority were male (71%) and belonged to rural areas (63.1%). 50.9% of the patients presented with a delay of more than a month. The delayed presentation was significant among those belonging to rural areas (p=0.009) with higher median creatinine (p=0.002) and lower levels of education (p=0.001). The most frequent presentation was high blood pressure (89.3%), followed by oliguria (66.8%). Oliguria was significant among patients with delayed presentation (p=0.003). Patient perception for the delayed presentation was looking for transplant (69.2%) and fear of needle prick (52.3%). Conclusion: Delayed presentation for dialysis at tertiary care centers is a frequently seen issue particularly in patients belonging to rural areas presenting with a symptom of oliguria and fluid overload. Seeking alternative options such as renal transplants and fear of needles are the major reasons for delayed presentations in our study.