Detection of Financial Toxicity in Italian Uremic Patients: A Single Center Cross-Sectional Study

Financial toxicity (FT) describes the strain individuals and families feel when they struggle with money due to medical expenses and related costs associated with their healthcare. Management of chronic kidney disease is expensive. The aim of this study was to detect FT in Italian patients undergoing renal replacement therapy.

FT was investigated using the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) questionnaire in 238 individuals, of whom 147 (61.8%) received hemodialysis, 30 (12.6%) peritoneal dialysis, and 61 had renal transplantation (25.6%). The PROFFIT score was normalized to a 0-100% range, with 100% indicating the highest level of toxicity, and mean values were compared in the different groups of uremic patients stratified by age, sex and treatment.

Mean age of the population was 66.2±13.7 years (range 23-89). The probability of FT due to financial distress in the whole population that was 42.1±24.1%, whilst mean probability of FT due to medical expenses response was 44.9±27.6%, mean probability of FT due to transportation response was 37.1±29.4% and mean probability of FT due to support from the Health System was 25.5±23.3%. FT was higher in the hemodialysis group.

Hemodialysis patients showed worse financial burden than peritoneal dialysis and kidney transplanted patients, while peritoneal dialysis subjects felt better cared for by health care professionals than kidney transplanted individuals, however the latter group could afford monthly expenses better than hemodialysis patients. Health care professionals should discuss financial problems or other social challenges that may impact on the health of uremic individuals.