Chronic Kidney Disease (CKD) is a major global health issue, often leading to End-Stage Renal Disease (ESRD), which requires renal replacement therapy, particularly hemodialysis (HD). This study aimed to evaluate the cost incurred by CKD patients undergoing hemodialysis at Shri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad, and to explore the financial burden of treatment. A cross-sectional descriptive study was conducted over one year, with 130 CKD patients undergoing hemodialysis. Data were collected on demographic factors, comorbidities, frequency of dialysis, and cost components. The findings revealed that the majority of costs were direct medical expenses (78.54%), followed by direct non-medical costs (16.83%) and indirect costs (4.63%). Hemodialysis session costs were the highest contributor to direct medical expenses (37.68%). Additionally, the study showed a significant variation in costs based on the frequency of dialysis. These results highlight the substantial financial strain on CKD patients and emphasize the need for policy reforms to make CKD care more affordable and accessible, especially in low-resource settings.
Chronic Kidney Disease (CKD) is a global public health concern characterized by a gradual loss of kidney function over time, often leading to end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) in the form of hemodialysis (HD) or kidney transplantation [1]. Hemodialysis remains the most common modality of treatment for ESRD patients worldwide, especially in low- and middle-income countries where access to kidney transplantation is limited [2].
The financial burden of CKD treatment, particularly hemodialysis, is significant due to the lifelong nature of the therapy, the need for multiple weekly sessions, and associated medical expenses such as medications, diagnostic tests, and hospital visits [3]. Several studies have highlighted that the direct and indirect costs of CKD treatment contribute to substantial economic strain on patients and their families, affecting their quality of life and treatment adherence [4,5].
In India, the economic implications of CKD treatment are further compounded by factors such as limited government-funded healthcare support, out-of-pocket expenses, and socioeconomic disparities [6]. The cost burden varies across different healthcare settings, and understanding these variations is crucial for developing policies that enhance affordability and accessibility of CKD care [7].
This study aims to analyze the cost incurred by CKD patients undergoing hemodialysis at Shri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad. By evaluating various cost components and socioeconomic factors influencing these expenses, the study seeks to provide valuable insights into the financial challenges faced by patients and potential strategies for cost reduction and healthcare policy improvements.
Study Design and Setting
This hospital-based cross-sectional descriptive study was conducted in the dialysis unit of the Nephrology Department at SDM College of Medical Sciences and Hospital, Dharwad. The study spanned one year, from December 2016 to November 2017.
Study Population
The study population included individuals of all age groups diagnosed with CKD who were undergoing haemodialysis (HD). Participants were selected based on predefined inclusion and exclusion criteria.
Inclusion Criteria
Exclusion Criteria
Sample Size and Sampling Procedure
A total of 130 CKD patients undergoing HD, who met the inclusion and exclusion criteria, were selected for the study. Data collection was conducted within the dialysis unit. After verification of records and obtaining informed consent, participants were interviewed using a semi-structured questionnaire.
Study Instruments
Data collection was conducted using a semi-structured questionnaire comprising two sections:
Part A: Sociodemographic factors and haemodialysis-related data.
Part B: Costs incurred by the patients at the hospital for HD over the last three months.
Study Variables
The study considered multiple independent variables, including demographic characteristics, educational and occupational status, economic status, and family structure.
Data Analysis
The collected data were coded, entered into an Excel spreadsheet, and analyzed using SPSS Software version 21. Descriptive statistical methods, including frequencies and percentages, were used to analyze sociodemographic and hemodialysis-related data. Normality tests (Shapiro-Wilk tests) were applied to all cost variables to determine their distribution.For normally distributed variables, the Mean and Standard Deviation (SD) were calculated.
For skewed distribution, the Median and Interquartile Range (IQR) were computed.
This section analyses the data collected to determine cost analysis among chronic kidney disease patients undergoing hemodialysis in the dialysis unit of SDM College of Medical Sciences and Hospital. The study was conducted among 130 CKD patients undergoing HD on an Outpatient basis and the data was collected using a semistructured questionnaire.
Table 1: Age-wise distribution of study participants
Age Group |
Frequency (n) |
Percentage (%) |
Young Adults (18-35 years) |
14 |
10.77 |
Middle-aged Adults (36-55 years) |
53 |
40.77 |
Old Adults (56+ years) |
63 |
48.46 |
Total |
130 |
100 |
The mean age of the study participants was 52.48 ± 13.4 years. The majority of participants were old adults (48.46%), followed by middle-aged adults (40.77%), and young adults (10.77%).
Figure 1: Gender-wise distribution of study participants
Table 2: Distribution of study participants according to number of week
Frequency of Hemodialysis (HD) |
Number of Participants (n) |
Percentage (%) |
|
|
|
Twice Weekly |
83 |
63.85 |
Thrice Weekly |
47 |
36.15 |
Total |
130 |
100 |
In our study, the majority of participants 83 (63.85%) underwent hemodialysis twice weekly, while 47 (36.15%) underwent it thrice weekly.
Table 3: Distribution of participants according to Co-morbidities.
Co-morbidity |
Number of Participants (n) |
Percentage (%) |
Diabetes Mellitus |
7 |
5.39 |
Hypertension |
63 |
48.46 |
Type II Diabetes Mellitus & Hypertension |
59 |
45.39 |
Chronic Liver Disease |
1 |
0.77 |
HIV |
1 |
0.77 |
HBV |
2 |
1.54 |
HCV |
15 |
11.54 |
Hypothyroidism |
4 |
3.08 |
Anemia |
21 |
16.15 |
Ischaemic Heart Disease |
3 |
2.31 |
Tuberculosis |
1 |
0.77 |
Total |
130 |
100 |
In our study, the majority of participants 63 (48.46%) were suffering from Hypertension, followed by 59 (45.39%) with both Type II Diabetes Mellitus and Hypertension, 21 (16.15%) with Anemia, and 15 (11.54%) with HCV. Other co-morbidities included Diabetes Mellitus (5.39%), Hypothyroidism (3.08%), Ischaemic Heart Disease (2.31%), HBV (1.54%), and HIV, Tuberculosis, and Chronic Liver Disease (each 0.77%).
Table 4: Distribution of study participants based on the duration of HD.
Duration of HD |
Number of Participants (n) |
Percentage (%) |
< 24 months |
74 |
56.92 |
24 – 48 months |
33 |
25.39 |
> 48 months |
23 |
17.69 |
Total |
130 |
10 |
The mean duration of HD was 30 ± 27 months. The majority of study participants 74 (56.92%) underwent HD for less than 24 months, followed by 33 (25.39%) for 24-48 months, and 23 (17.69%) for more than 48 months.
Table 5; The percent contribution of cost components to the total costs:
Cost Variables |
Percentage Contribution (%) |
Direct Medical |
78.54 |
Direct Non-medical |
16.83 |
Indirect |
4.63 |
Total |
100 |
In our study, the majority (78.54%) of the total costs were contributed by direct medical costs, followed by direct non-medical costs (16.83%) and indirect costs (4.63%). Direct medical and direct non-medical costs together contributed 95.37% of the total costs, indicating that direct costs had a significantly higher contribution compared to indirect costs.
In our study, majority (37.68%) of the total costs were contributed by HD session cost, 12.90% by transport costs,12.21% by hospitalization costs,10.08% by dialyser cost,7.90% by erythropoietin,7.55% by dialyser costs, 3.93% by food costs,3.55 by loss of income costs, 1.60% by haematological costs, 1.08 by rent costs,0.98% by 59 vascular access costs, 0.39% by iron costs,0.09% by blood transfusion costs,0.04% by radiological costs and 0.01% by registration costs.
In our study, majority (47.99%) of the direct medical costs were contributed by HD session costs, 15.54% by hospitalization costs,12.83% by dialyser costs,10.05% by erythropoietin costs,9.61% by daily medicine costs, 2.03% by haematological costs, 1.25% by vascular access costs, 0.49% by Iron costs, 0.13% by blood transfusion costs, 0.06% by radiological costs, and 0.02% by registration costs.
Table 6: Distribution of costs incurred by the study participants based on the frequency of dialysis
Frequency of Dialysis |
Direct Medical Cost (INR) (Q3-Q1) |
Direct Non-Medical Cost (INR) (Q3-Q1) |
Indirect Cost (INR) (Q3-Q1) |
Total Cost (INR) (Q3-Q1) |
Twice (n=83) |
38,495 (46,117-29,400) |
6,000 (10,080-3,168) |
21,000 (36,550-13,500) |
45,700 (63,415-35,579) |
Thrice (n=47) |
49,562 (65,020-6,000) |
7,920 (12,600-5,992) |
12,000 (22,500-10,875) |
55,904 (78,600-24,900) |
Table 7: Median costs of direct non-medical cost components in the study participants.
Direct Non-Medical Costs |
Median Cost in INR (Q3-Q1) |
Transport |
4,800 (9,150-2,400) |
Food |
1,800 (2,400-1,200) |
This table presents the median costs of direct non-medical cost components in the study participants.
Chronic Kidney Disease (CKD) is an emerging health challenge, especially in low- and middle-income countries such as India. It is associated with significant financial implications due to the long-term need for treatment, particularly hemodialysis (HD), which remains the most common modality for end-stage renal disease (ESRD) patients [1]. The results from this study conducted at Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, shed light on the substantial economic burden faced by CKD patients undergoing HD. The primary aim of this study was to evaluate the cost of treatment and identify the major components contributing to the total financial strain on these patients.
The study found that the majority of participants undergoing HD were from older age groups, with a mean age of 52.48 years. This finding is consistent with global patterns where CKD is more prevalent in the elderly population due to age-related kidney decline and the accumulation of comorbidities such as hypertension and diabetes mellitus [2]. In this cohort, hypertension and Type II Diabetes Mellitus were the most common comorbidities, aligning with previous studies that identify these conditions as primary risk factors for the development of CKD [3,4].
Our study revealed that the majority of patients (63.85%) underwent HD twice a week, with a significant number (36.15%) receiving dialysis three times a week. The frequency of HD treatments directly affects the overall cost burden, with patients on thrice-weekly dialysis incurring higher costs than those on a twice-weekly regimen. This is reflected in the findings, where the median total cost for patients on thrice-weekly dialysis was substantially higher (55,904 INR) compared to those on a twice-weekly schedule (45,700 INR). Previous studies have also highlighted that increasing the frequency of dialysis leads to higher direct medical costs, including session costs and medications [5,6].
The breakdown of cost components in this study revealed that direct medical costs (78.54%) were the largest contributor to the total expenses incurred by CKD patients undergoing HD, followed by direct non-medical costs (16.83%) and indirect costs (4.63%). This trend is consistent with findings from other studies where dialysis session costs and associated medical expenses form the majority of the financial burden on patients [7]. Among the direct medical costs, the majority was attributed to HD session costs, followed by hospitalization costs and the cost of consumables such as dialysers and erythropoietin. These results highlight the importance of cost-effective strategies in reducing the overall medical expenses for CKD patients, particularly in resource-limited settings.
Additionally, direct non-medical costs, particularly transport and food costs, were substantial in the context of CKD treatment. The median transport cost for patients was 4,800 INR, and food expenses amounted to 1,800 INR, which are significant when considered in the context of the low socioeconomic status of many CKD patients in India. Previous studies have noted that out-of-pocket expenses, including transport and food, pose a significant financial burden on patients, which may affect their ability to adhere to prescribed treatment regimens [8].
The impact of indirect costs, including loss of income due to the patient's inability to work, also adds to the overall economic strain. In this study, loss of income accounted for 3.55% of the total costs, which may further exacerbate the financial hardship of CKD patients and their families. A study by Agarwal et al. (2009) suggested that the economic burden of CKD in India is not limited to medical and non-medical costs but is also influenced by the patient's ability to remain employed and the indirect costs associated with their condition [9].
The results of this study have important implications for healthcare policy and cost management strategies for CKD treatment in India. Efforts to reduce the financial burden on patients should focus on increasing access to affordable dialysis, improving transportation services, and addressing the indirect costs associated with CKD treatment. Furthermore, policymakers need to prioritize support for CKD patients through better insurance coverage, government subsidies, and more equitable distribution of healthcare resources.
In conclusion, this study provides valuable insights into the cost dynamics of hemodialysis treatment for CKD patients in a tertiary care setting. The high direct medical costs, combined with the significant out-of-pocket expenses for transport and food, underline the urgent need for affordable dialysis solutions in India. Policymakers, healthcare providers, and social support systems must collaborate to alleviate the financial burden on CKD patients and improve access to treatment.