Shafi Salman Tahir, Saleem Mohammad, Anjum Roshina, Abdullah Wajid, Shafi Tahir
Department of Nephrology, Sharif Medical and Dental College, Lahore, Pakistan.
Saudi J Kidney Dis Transpl. 2018 Mar-Apr;29(2):401-408. doi: 10.4103/1319-2442.229270.
In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.
在巴基斯坦，慢性肾脏病（CKD）患者通常在疾病晚期才被诊断出来。对于需要进行血液透析（HD）的住院CKD患者拒绝血液透析的情况以及这些患者接受和拒绝的原因，相关信息较少。所有患有Ⅴ期CKD且有医学指征需进行HD并在一家三级医疗设施住院超过六个月的患者均受邀参与本研究。就患者对HD的接受或拒绝情况及其决定的原因进行了调查。对接受或拒绝HD的患者的人口统计学、社会经济和临床特征进行了比较。本研究共纳入125例患者。患者的平均年龄为47.9±12.1岁。CKD的平均诊断时长为2.5±0.6个月。在所有患者中，72例（57.6%）同意进行HD，53例（42.4%）拒绝HD。已建立动静脉内瘘的患者（27.1%对9.1%，P＜0.02）以及中高收入组患者（64.4%对38.6%，p = 0.03）更愿意接受HD。信任医生的建议（86.1%）是接受HD最常见的原因。每周HD的频次（52.8%）、HD的终身性和永久性（50.9%）、家人或朋友的建议（37.7%）、对HD生活质量差的认知（35.8%）以及对HD穿刺针和HD期间并发症的恐惧（33.9%）是拒绝HD最常见的原因。在有医学指征需进行HD的住院CKD患者中，拒绝HD的情况很常见，尤其是在低收入群体中。
