Haemodialysis for end-stage renal disease in Southern India--a perspective from a tertiary referral care centre.

BACKGROUND: There is little information available regarding the practice of haemodialysis, its population characteristics or outcomes in India. These aspects were studied in a cohort of end-stage renal disease (ESRD) patients enrolling in a maintenance haemodialysis (MHD) programme in a tertiary referral centre in S. India, over a 1 year period.
RESULTS: A total of 463 ESRD patients enrolled on MHD during the 1 year period. The mean (SD) age was 38.6 (13.9) years. Definitive renal replacement therapy was instituted in 34% of these patients, including renal transplantation in 22.8%. The median duration to transplant was 93 days, and there was a 50% reduction of the original cohort by 1 month. The largest fraction left the programme (59.7%). Renal transplantation as an outcome was determined by a younger age and a planned referral from outside the state of Tamil Nadu; continuation of any form of renal replacement therapy again was more likely in the younger patient who had external financial support. Dialysis therapy was empiric but uniform for all patients, and only 50% of the dialyses delivered a single pool Kt/V > or = 1. The overall mortality was 9.5%, but 58% of the deaths took place within a week of starting dialysis, a quarter being related to severe uraemic complications.
CONCLUSIONS: Haemodialysis in India is mainly a short-term measure to support the ESRD patient to transplantation. Economic factors play an important role in outcome, the majority undergoing discharge from the programme. Early mortality is disproportionately high. Subclinical underdialysis is common. The requirement for pre-dialysis care and earlier referral from the community is apparent. Prospective studies to define standards and optimize the practice of dialytic therapy against appropriate short-term outcomes, within prevalent economic frameworks, need to be undertaken.