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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 132-136
Demographics and Social Factors Associated with Acceptance of Treatment in Patients with Chronic Kidney Disease

Department of Nephrology, St. John's Medical College Hospital, Bangalore, India

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Dialysis and transplantation have prolonged survival and quality of life in patients with chronic kidney disease (CKD). This is an exploratory/descriptive study, looking into the socio­demographic profile and social factors in these patients associated with acceptance of therapy. Association between attitudes and demographics were examined. A total of 670 patients with CKD were prospectively evaluated during the years 2000-2003 and based on the degree of renal failure, were categorized into conservative therapy, dialysis alone, or transplantation. A detailed psycho-social assessment and counseling regarding the treatment options was done. The mean age of the study patients was 49.27 ± 16.7 years. Of the study patients, 66.7% were males, 70.6% were married, 40% were undergraduates, 34% were employed, 41.6 and 37.3% were respectively from low- and middle-income groups, 60% lived in nuclear families and 64% had an urban background. Patients with CKD Stages II - IV (37.3%) were advised conservative treatment, while CKD Stage V patients were advised dialysis alone in 35.5% and dialysis and transplantation in 64.5%. The major psycho-social factors negatively influencing the acceptance of treatment were finance (69.3%), logistics (66.0%), no willing donors (11.0%), no medically fit donors (13.0%) and/or lack of social support (17.0%). Statistically significant association was noted between attitudes and marital status (p < 0.05, education and domicile (p = 0.05), occupation, income and family type (p < 0.05). Our study suggests that finance is one of the important factors deciding the acceptance of treatment. Social factors negatively affecting were logistics, lack of willing and medically fit donors and lack of social support.

Keywords: Chronic kidney disease, Dialysis, Renal replacement therapy, Socio-demographics, Transplant

How to cite this article:
Bapat U, Nayak SG, Kedleya PG, Gokulnath. Demographics and Social Factors Associated with Acceptance of Treatment in Patients with Chronic Kidney Disease. Saudi J Kidney Dis Transpl 2008;19:132-6

How to cite this URL:
Bapat U, Nayak SG, Kedleya PG, Gokulnath. Demographics and Social Factors Associated with Acceptance of Treatment in Patients with Chronic Kidney Disease. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2021 Dec 7];19:132-6. Available from: https://www.sjkdt.org/text.asp?2008/19/1/132/37453

   Introduction Top

Chronic kidney disease (CKD) is a very stressful condition, which is capable of producing a wide variety of complications. Chronic illness in a family member invariably affects all the members within the family.

Families report that the physical changes in the patients' financial strain of sustaining treat­ment and the fear of the future of the patient and the disruption of the family structure are the major causes of psychological stress. [1] Continuous advances in the knowledge of renal physiology as well as in the treatment of various kidney diseases have made it possible to prolong the life and the quality of survival in patients with chronic renal failure. [2] The availability of dialysis and transplantation has allowed the survival of patients with end­stage renal disease (ESRD). [3],[4] The options of dialysis and transplantation are compli­mentary and not competitive. An integrated approach allows the tailoring of the program to fit the medical and social needs of an indivi dual patient in an optimal manner. [5] Patients on dialysis have to follow strict dietary restrictions; social and recreational activities are frequently reduced. Medical complications, economic pressure, marital discord, sexual dysfunction, emotional stress and anxiety about loss or death are common regardless of the modality and hence, transplantation continues to be the choice of treatment as it offers the greatest potential for the return of healthy life. [3] The successful outcome of renal transplantation depends on the identification and preparation of suitable live donors. [5]

There is evidence to suggest that the patients who have received transplant enjoy a survival advantage over patients who continue to undergo dialysis. [6] In addition, the financial cost of maintaining a transplant recipient is substantially less than the alternative forms of renal replacement therapy. [7] Hence, it is well established that renal transplantation is the choice of treatment over hemodialysis for patients with ESRD. [8]

There is a paucity of published Indian studies focusing on the socio-demographic profile of patients with CKD as well as other social factors associated with acceptance of the prescribed treatment. Hence, this study was carried out.

This is an exploratory cum descriptive study. The purpose was to find out the socio­demographic profile of patients with CKD and to examine the influence of social factors in accepting the prescribed treatment.

   Subjects and Methods Top

A prospective study was performed on 670 patients with CKD attending the Nephrology Department during the period from 2000 to 2003. The patients were admitted for assess­ment, evaluation and management. Detailed clinical, biochemical and ultra-sonological investigations were performed on all study patients. Based on these reports and depending on the degree of renal failure, the patients were given various treatment options: conservative treatment, dialysis alone (hemodialysis, continuous ambulatory peritoneal dialysis) and kidney transplantation. Option of kidney transplantation was initially offered to all medically fit patients.

During the admission a detailed psycho­social assessment was done. A specially designed proforma was used to collect the socio-demographic characteristics of the sub­jects. These included variables like age, gender, religion, marital status, education, occupation, economy and family type. Addi­tionally, psycho-social factors that might play a role in the acceptance of the prescribed therapy were studied. The patient and the family members were extensively counseled regarding the nature of illness, the treatment options, and the psycho-social and financial issues. An average of 3-15 sessions, each session lasting between 30 minutes to one hour, were conducted. Individual, family and group therapy models were used for counseling. Descriptive statistics and chi square test of association were applied to analyze the variables using SPSS Windows Version 10.

   Results Top

The demographic characteristics of the study patients are shown in [Table - 1]. The socio­demographic profile of patients in the present study indicates the maximum concentration to be in the age-group of 41-60 years with a mean age of 49.27 ± 16.7 years. This conforms to the productive age-group. Also, 26.8% of the patients were aged 61years and above.

A total of 66.0% of the patients were males and there was a definite preponderance of males over female patients. Majority of the patients belonged to Hindu religion (77.3%) followed by Muslims and Christians.

A large majority of them were married (78.7%), 34.0% patients were employed and 24.6% were housewives. The results show that nearly half of the patients came from low socio-economic background, 37.3% were from the middle class and 19.5% were from high socio-economic background. In this sample, 70.6% of the patients represented nuclear families and 64.1% patients came from urban background.

The suggested treatment and the outcome show that nearly a third of the CKD patients who were in Stages II-IV were advised conser­vative treatment. Among the CKD Stage V patients (n = 415), 147 were advised dialysis alone and 268 patients who were eligible for transplantation were advised dialysis and trans­plantation; 219 of the respondents got dis­charged without any treatment for various reasons which included economic constraints, logistics, medically unfit or unwilling donors and/or lack of social support. Out of the 223 patients initiated on treatment, 198 were compliant.

Statistically significant association was noted between the following demographics and attitude towards treatment: marital status (p < 0.05), education (p = 0.05), income (p < 0.05), family type (p < 0.05) and domicile (p = 0.05).

   Discussion Top

The exact number of patients with CKD requiring renal replacement therapy in the developing world is not known due to the lack of appropriate renal registries. [9] There is a paucity of Indian literature on the social factors associated with the acceptance of prescribed treatment for CKD. The present study was carried out focusing on this dimension at one of the largest tertiary care centers in South India. As there are no systematic studies available, this cannot be corroborated statistically

The age-group 41-60 years, which is most productive both in the familial and vocational areas, had the highest prevalence of CKD in our study. A possible explanation for this younger age preponderance in the developing countries is due probably to inadequate preventive and curative medical care, which allows more rapid development of CKD. [10] The increasing numbers in the elderly age­group coming for treatment could be attri­buted to the increased life span and the advances made in medicine and research.

The male preponderance seen in our study could be due to socio-economic and socio­cultural factors. We find lesser number of female patients seeking treatment; it is unlikely that the incidence of CKD is higher in men. [10] It is interesting to note that 10-15% of female patients undergoing treatment at this center are reimbursed, and only a small minority could afford on their own.

Our results on family structure reflect a social change in the family types, where small nuclear family units are increasing in number and the joint families are disappearing and so are the social support-structures. This could explain the migration from rural to urban places in search of better job prospects.

Patients with CKD Stages II-IV were advised conservative treatment while CKD Stage V patients were advised dialysis alone and/or transplantation. The group that was advised dialysis alone comprised of patients who had multiple complications, those in advanced age, and those with co-morbid conditions making them medically unfit for transplantation. However, a large majority was eligible for transplantation. It is observed in this sample that nearly a third of the patients got discharged and another third opted for either dialysis or transplantation. Of these, 47.7% were compliant with treatment.

The major factors negatively affecting the acceptance of treatment were lack of finance followed by logistic problems. The other factors affecting the refusal of treatment among those who were advised transplantation were absence of medically fit and/or willing donors in the family apart from financial constraints and logistic problems. Finally, lack of adequate social support was another reason for not seeking treatment even when the subjects had a positive attitude towards treatment.

Majority of the patients coming from low and middle-income group could not afford the treatment, which resulted in discon­tinuation of treatment. On account of lack of medical facilities in rural areas, patients living there do not reach the tertiary care hospitals.

In this study group, we found a statis­tically significant association between attitude and demographics namely; marital status, education, occupation, income, family type and domicile. Subjects who are married, educated, having an occupation with a regular income, coming from an urban background and living in a nuclear family are likely to have a positive attitude towards the acceptance of the suggested treatment. Similar pattern is observed in our study population.

   Conclusion Top

In this large study carried out in a tertiary care centre in South India, we analyzed the various psychosocial factors that had an impact on the acceptance of renal replacement therapy.

Large number of CKD patients in the productive age-group was seen; males were predominant. About 64.0% were eligible for transplantation. Economic constraint was one of the most important factors deciding the acceptance of treatment. The major social factors negatively affecting the acceptance of the treatment were logistics, lack of willing donors, medically unfit donors and lack of social support.

   References Top

1.Petrie K. Psychological well being and psychiatric disturbance in dialysis and transplantation. Br J Med Psychol 1989;62 (1):91-6.  Back to cited text no. 1    
2.Velasco De Parra ML. Changes in family structure after a renal transplant. Fam Process 1982;21(2):195-202.  Back to cited text no. 2    
3.Bloembergen WE. Outcome of end-stage renal disease therapies. In: Greenberg A, ed. Primer on kidney diseases. Academic Press: California; 1998:422-6.  Back to cited text no. 3    
4.Brown CB. On transplantation in Manual of renal disease: Churchill livingstones: London Melbourne and New York; 1985:75.  Back to cited text no. 4    
5.Mage CC, Milford E. Clinical aspects of Renal Transplantation. In: Barry N, Brenner eds. Brenner and Rectors The Kidney (5 th Edition). WB Saunders; Philadelphia: 1996: 2609-39.  Back to cited text no. 5    
6.Bonal J, Cleries M, Vela E. Transplantation versus haemodialysis in elderly patients. Nephrol Dial Transplant 1997;12(2):261-4.  Back to cited text no. 6    
7.Vella JP, Carpenter CB. Current results and determinants of graft outcome in kidney transplantation. In: Owen WF, Periera BJ, Sayegh MH, eds. Dialysis and Transplantation­A companion to Brenner and Rectors The Kidney, WB Saunders; Philadelphia: 2000: 499-510.  Back to cited text no. 7    
8.Agarwal S, Singh AK, Sharma RK. Impact of HLA matching on renal transplantation. Int J Nephrol 2000;:45-50.  Back to cited text no. 8    
9.Kher V. End stage renal disease in developing countries. Kidney Int 2002;62 (1):350-62.  Back to cited text no. 9    
10.Moosa RM, Walele AA, Daar AS. Renal transplantation in developing countries. In: Morris PJ, ed. Kidney Transplantation Principles and Practice. WB Saunders; Philadelphia: 2001:669-92.  Back to cited text no. 10    

Correspondence Address:
Usha Bapat
Department of Nephrology, St. John’s Medical College Hospital, Sarjapur Road, Bangalore-560034
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PMID: 18087143

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