title: Problems Associated With Access to Renal Replacement Therapy: Experience of the Sindh Institute of Urology and Transplantation.
abstract: OBJECTIVE
  The prevalence of end-stage renal disease is increasing worldwide. It is also one of the main health problems in Pakistan. Currently, hemodialysis represents the main mode of treatment for patients with end-stage renal disease in this country. Despite 24-hour free dialysis at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan), a significant number of patients do not turn up for regular dialysis or miss regular sessions of dialysis. We conducted this study to identify and highlight the factors leading to poor compliance with regular hemodialysis treatment despite free dialysis treatment offered at our center.
  
  
  METHODS
  In 2014, 4565 patients with end-stage renal disease were registered at the Sindh Institute of Urology and Transplantation. Among these, 610 patients (13.4%) missed more than 2 sessions of dialysis and were included in the present study. Patients provided written informed consent before study participation. Data were collected from a questionnaire survey and analyzed by SPSS software (SPSS: An IBM Company, version 20.0, Chicago, IL, USA).
  
  
  RESULTS
  Despite 24-hour dialysis facilities, the patient drop-out rate (779; 18%) was high. In addition, a significant minority of patients (610; 13.4%) was erratic in adherence to maintenance hemodialysis schedules, with > 2 missed appointments. The mean age of these 610 patients was 33.4 ± 7.4 years, and 345 patients (57%) were males. The main factors leading to poor compliance included cost of travel (33.2%), lack of affordable lodging and boarding facilities near dialysis center (30.9%), long distances from dialysis center (20.1%), and lack of family support (15.6%).
  
  
  CONCLUSIONS
  This study shows that there is significant drop-out and poor compliance rates for regular dialysis despite free dialysis facilities.
authors.affiliation: Departments of Medical Social Welfare and Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Farida
authors.initials: F
authors.lastname: Mazhar
authors.forename: Naveeda
authors.initials: N
authors.lastname: Nizam
authors.forename: Nazia
authors.initials: N
authors.lastname: Fatima
authors.forename: Sana
authors.initials: S
authors.lastname: Siraj
authors.forename: Syed Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D003695:Delivery of Health Care / Q000191:economics; D005195:Family Relations; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006297:Health Services Accessibility; D006798:Housing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010349:Patient Compliance; D010352:Patient Dropouts; D006435:Renal Dialysis / Q000191:economics; D012307:Risk Factors; D012944:Social Support; D013997:Time Factors; D014195:Travel; D016896:Treatment Outcome; D055815:Young Adult