Risk factors associated with ESRD among patients undergoing hemodialysis in JDWNRH, Bhutan

Abstract

End stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD) when the kidney is severely damaged thus requires hemodialysis. ESRD is becoming a major public health concern as the economic burden is significantly high on the government as well as the patient. The previous researchers have found hypertension, diabetes, old age, male sex and family history of kidney disease to be major risk factors. Smoking, alcohol consumption, BMI, obesity, use of analgesic drugs and certain race are also linked with onset of ESRD. However, the previous researches lack focus on the objective and subjective experience of the ESRD patient and the impact of the disease on the quality of life. Moreover, the burden of the disease in significantly high in Bhutan as the government spends millions of ngultrum on the ESRD patients on hemodialysis. The burden is also high for the patient. They have to be in immunosuppressant drugs for lifetime, it is very difficult to find a donor and their quality of life is reduced. Despite the heavy burden and repeated concerns of health officials for need of a proper research on ESRD patients in Bhutan, there are hardly any published research study. Thus, this study was conducted in the Jigme Dorji Wangchuck National Referral Hospital in the capital Thimphu which provides

to the maximum number of ESRD patients out of the three dialysis centers in the country. A case- control study was conducted with patients diagnosed with ESRD on hemodialysis as cases (n=83)

and persons not diagnosed with ESRD as controls (n=83). The research was aimed to find the details of ESRD patients, the risk factors and other information specific to Bhutan since literature review showed that there can be differences due to genetic, social and cultural make-up. By doing so, the research aimed to find evidence for effective intervention and prevention studies for reduction of the disease burden. The study found that hypertension was the highest risk factor including others such as diabetes, cardiovascular disease and family history of renal disease which agrees with the previous research studies. However, the study found that the number of cases that reportedly had diabetes before onset of ESRD and smokers were low. This suggests that some patients with risk factors of ESRD might be going undetected and also showed the

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difference due to genetic and cultural factors. This study also showed that the patients with ESRD on HD had reduced mobility, physical activity and majority were not able to work thus affecting the quality of life. Thus, the study recommends services like counselling and further research on the quality of care and qualitative research for the ESRD patients. Improving the services and care is required including increase of dialysis machine and staff. The final recommendation to nationwide screening and intervention and preventive measures in the group at most risk that this study found. ESRD is an irreversible and chronic disease with heavy burden thus, must be dealt proactively rather than reactively to reduce the burden on the government and the people.