Muhammad Anees, Johar Ameen Khan, Abdul Basit, Muhammad Ibrahim, Asim Mumtaz.
Refusal of dialysis amongst patients of chronic kidney disease (CKD).
Ann King Edward Med Uni Jan ;20(3):228-32.

Objective:  This study was conducted to determine the refusal of dialysis amongst patients of chronic kidney disease presenting for the first time for dialysis in uremic condition. Study Design: Cross sectional Study. Place and Duration of the Study:  Outpatient department of Nephrology, Mayo Hospital, Lahore from 1st Jan 2012 to 31st December 2012. Patients and Methods:  Patients of CKD due to any cause presenting with uremia for the first time for dialysis were included in the study. History and physical examination was done and demographic data was collected in pre designed form. Patients were offered for dialysis while explaining to them the advantages of getting and disadvantages of not getting dialysis. Patient’s response on the offer was recorded and the reason for the refusal were noted. Results:  According to the criteria 150 patients were included in the study. Most of the patients were male 92 (61.3%) and illiterate 78 (52.0%). Major cause of CKD was diabetes mellitus 58 (38.7%) followed by hypertension 38 (25.3%). Mean age of the patients was 42.59 ± 13.72 year and income of the most of the patients 126 (84%) was less than US$100/-month. Most of the patients 126 (77.0%) were asked about the need of dialysis in less than three months, 61 (41.3%) offe-red for the first time and amongst them 85 (54.0%) were offered dialysis already. Majority of the patients 101 (67.3%) refused dialysis when it was offered to them for the first time. Major reason of the refusal was fear of dialysis procedure in 76 (76%) patients followed by treatment by spiritual 14 (14%) and alternative ways and others 11 (11%). Middle age persons refused dialysis significantly. Conclusion:  Diabetes mellitus is the leading cause of CKD. Most of the patients were informed about dialysis at very late stage. Majority of the patients refused dialysis. Major reason of the refusal was fear of dialysis procedure followed by treatment from some spiritual ways and alternative treatment.

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