Economic Burden and Clinical Epidemiology of Dialysis: A Cross-Sectional Analysis of Chronic Kidney Disease Patients

Chronic kidney disease (CKD) represents a rising global health burden, with millions requiring dialysis as a form of kidney replacement therapy. In low- and middle-income countries such as Pakistan, dialysis care is partially subsidised, but patients often face substantial out-of-pocket (OOP) costs, creating financial strain.

This descriptive, cross-sectional study was conducted at a dialysis unit of a secondary care hospital in Pakistan. All patients on maintenance hemodialysis were invited to participate; the response rate was 80.8%. Data were collected through structured questionnaires and review of medical records. Demographic, clinical, and economic variables were captured, including comorbidities, dialysis duration and frequency, use of supportive therapies, and direct, indirect medical and non-medical costs in 2024 US dollars (USD). Statistical analysis was done using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).

The cohort comprised 42 patients, 66.7% of whom were male (n = 28), with a mean CKD duration of 6.8 ± 5.2 years and a median dialysis duration of 1.0 year (IQR, 0.6-2.0 years). The mean age of the cohort was 58.3 ± 13.7 years (range, 25-83 years). Most (95.2%) were on twice-weekly hemodialysis. Despite full coverage of dialysis sessions through the Sehat Sahulat Programme, all patients incurred recurrent OOP costs. The median monthly "basic bundle" (consultation, labs, medications) cost was Pakistani rupees (PKR) 22,100 (approximately USD $78.40), equivalent to a mean annual cost of PKR 316,057 ± 149,030 (USD $1,121.55 ± $528.92). Additional costs included erythropoietin (85.7%, median PKR 7,600/month), blood transfusions (42.9%, median PKR 12,000/year), hospitalisations (38.1%, median PKR 190,000/year), transport (median PKR 4,800/month), and special diet (57.1%, median PKR 10,000/month). Using cumulative burden thresholds, 28.6% of households exceeded 100% of their monthly household income for expanded costs (4.8% for basic costs).

Dialysis patients in Pakistan carry a heavy dual burden of disease and economic hardship. While sessional dialysis is publicly financed, significant ancillary costs remain, often exceeding household income and driving catastrophic health spending. Policies expanding financial protection to include medications, laboratory testing, nutrition, and transport are urgently needed.