A Retrospective Comparison of Thai patients with End-stage Renal Disease Who Chose to Decline or Receive Dialysis Therapy
Keywords:End-stage renal disease, Decline dialysis therapy
Background : Chronic kidney disease is commonly observed in the rural area of Thailand. A part of patients with end-stage kidney disease declined to received dialysis care despite lack of medical contraindications.
Objectives : We compared the patients with end-stage renal disease (ESRD) living in the rural communities who decided to decline or accept dialysis upon counseling.
Methods : We retrospectively interviewed patients with ESRD, or their relatives, at 5 community hospitals in Kamphaeng Phet Province, Thailand during the last 3 years prior to the study. Those who were 18 years or older, had glomerular filtration rate at 10 mL/ min/ 1.73 m2 body surface area or less, had no medical contraindications to dialysis therapy, and had been counseled about dialysis modalities, were enrolled.
Results : At the time of the survey, 134 cases chose to decline (Group 1) and 61 to receive dialysis (Group 2). The Group 1 cases were 10 years older than Group 2 (p<0.001); had higher proportions of cases with limited mobility (30%), or deceased spouses (38%) than Group 2 (6%, p<0.001; and 11%, p<0.0001; respectively). The number of offspring in Group 1 (3.5 + 2.1) was higher than that Group 2 (2.6 + 1.7, p=0.003). The most reason cited by the Group 1 cases for declining dialysis was “not wanting to be a burden to family members” (90%). Their decision relied mostly on their own and on health personal at sub-district health offices, whereas that in Group 2 relied on spouses or offspring, and on dialysis personnel at the provincial hospital.
Conclusion : The majority of rural Thai patients with ESRD who had no medical contraindications preferred to decline dialysis. Age factor, physical limitation, loss of spouses and concern on a treatment burden to family members were causally associated with their decision.
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