Barriers to Kidney Transplantation among Adults on Maintenance Dialysis in Western Region Saudi Arabia: A Cross-Sectional Study

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease. However, in Saudi Arabia, KT accounts for only 4.5% of the total existing renal replacement therapies in 2016. This cross-sectional study was conducted from September 2017 to January 2018. The aim was to assess the main barriers to the low KT rate in the Saudi community. Data were obtained by direct interviewing using a specifically pre-coded and pre-tested online questionnaire. A total of 321 adult hemodialysis and peritoneal dialysis (PD) (hemodialysis and PD, respectively) patients eligible for KT were selected from several dialysis units in Jeddah, accounting for 11% of the total dialysis population in Jeddah. The mean age was 49.9 ± 14.9 years, and 62.1% were male. Twenty-six percent were employed, and 88.2% were Saudis. Of those interviewed, 90.7% had been counseled for KT mostly by the nephrologist (86.5%) and 178 (55.5%) were referred for pre-transplant evaluation and 92 (28.6 %) were on the active transplant list. The most common barriers were lack of donor availability for 107 patients (40.5%), 58 patients (22%) worried about long-term complications, and 24 (9.1%) worried about surgical complications. Only 17 patients (6.4 %) reported financial constraints as the main reason for not having a KT, especially in non-Saudi patients. Additional initiatives to promote and improve the education and knowledge about kidney donation and the current outcome of KT is needed to improve the transplant rate in the country