HEMODIALYSIS FOR END-STAGE RENAL-DISEASE IN SOUTHERN INDIA - A PERSPECTIVE FROM A TERTIARY REFERRAL CARE CENTER

Background. There is little information available regarding the practi ce of haemodialysis, its population characteristics or outcomes in Ind ia. These aspects were studied in a cohort of end-stage renal disease (ESRD) patients enrolling in a maintenance haemodialysis (MHD) program me in a tertiary referral centre in S. India, over a 1 year period. Re sults. 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 repl acement therapy was instituted in 34% of these patients, including ren al 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 transplantatio n 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 ren al replacement therapy again was more likely in the younger patient wh o had external financial support. Dialysis therapy was empiric but uni form for all patients, and only 50% of the dialyses delivered a single pool Kt/V greater than or equal to 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 shortterm measure to support the ES RD patient to transplantation. Economic factors play an important role in outcome, the majority undergoing discharge from the programme. Ear ly mortality is disproportionately high. Subclinical underdialysis is common. The requirement for pre-dialysis care and earlier referral fro m the community is apparent. Prospective studies to define standards a nd optimize the practice of dialytic therapy against appropriate short -term outcomes, within prevalent economic frameworks. need to be under taken.