Subsidization of Renal Replacement Therapy in Ghana: Far more overdue

Abstract Background: The incidence of end stage kidney disease (ESKD) seems to be increasing in Ghana as with the rest of the world. This study compared the sociodemographic features, diagnostic characteristics (clinical, biochemical and imaging) and clinical outcomes of ESKD patients who chose either renal replacement therapy (RRT) or conservative therapy as well as the factors that influenced their choice. Methods: A cross-sectional retrospective study of 382 ESKD patient records at the Komfo Anokye Teaching Hospital (KATH) nephrology clinic during the period of 2006 to 2018 . Sociodemographic, diagnostic (clinical, biochemical and imaging) and therapeutic data were obtained, organized and analyzed with Statistical Package for the Social Sciences (SPSS). Results: Of the 382 patients, 321 had conservative therapy whiles 61 had renal replacement therapy. The mean age of participants was 47.71±16.10 years. Major clinical features were bipedal swelling (60), fatigue (37) and facial swelling (32). Chronic glomerulonephritis (31.4%), hypertension (30.3%) and diabetes mellitus nephropathy (28.2%) were the majority predisposing conditions. The RRT patients were more on NifecardXL (82.0) Bisoprolol (32.8%) Aspirin (19.7%) Ranitidine (26.2%), Metformin (13.1%) and Lasix (78.7%) than their conservative therapy counterparts. Whereas conservative therapy patients were more on Irbesartan/Lisinopril (57.9%) and NaHCO 3 (52.0%) than their RRT counterparts. Diastolic blood pressure (DBP) (p=0.047), uremic gastritis (p=0.007), anaemia, uraemia, haematuria and hyperkalaemia (p < 0.001) were higher in conservative therapy patients than RRT patients with RRT patients showing better corticomedullary differentiation (38.1% vs. 27.7%, p < 0.001) and normal echotexture (15.0% vs. 11.6%, p=0.005). Variables significantly associated with the decision to opt for conservative therapy were age, gender, occupation and duration of illness. Duration of illness was an independent variable. Conclusion: Conservative therapy is associated with worse clinical features and biochemical derangements than RRT in our participants. Early referrals to nephrologist as well as subsidized RRT should be targeted.