Frequency, factors and pattern of delayed presentation for dialysis in advanced kidney disease patients visiting tertiary care hospital

Background: Globally the burden of chronic kidney diseases is increasing. It is often a silent disease until the most advanced stages when symptoms develop. Late referral and presentation to nephrologist for CKD management is the major issue. Objective: To determine the frequency, factors and pattern of delayed presentation for dialysis in advanced kidney disease patients visiting tertiary care hospital. Methods: The current cross-sectional study was conducted in Memon Medical Institute Hospital and Dow University of Health Sciences Ojha Campus Karachi Pakistan from December 2019 to March 2020. Patients who presented in hospital for first time dialysis with advanced kidney diseases were included in the study. The threshold of patient presentation after a month of advice for dialysis is used to categorize the patient presentation as delayed or non-delayed. Results: Total 214 participants were recruited into the study. The median age of the participants was 40 (29.75 - 53) years. Majority were male (71%) and belonged to rural area (63.1%). 50.9% of the patients presented with delay of more than a month. Delayed presentation was significant among belonging to rural area (p=0.009) with higher median creatinine (p=0.002) and lower level of education (p=0.001). The most frequent presentation was high blood pressure (89.3%), followed by oliguria (66.8%). Oliguria was significant among patients with delayed presentation (p=0.003). Patient perception for delayed presentation was looking for transplant (69.2%) and fear of needle prick (52.3%). Conclusion: Delayed presentation for dialysis is more common in male, from rural areas, with lower level of education and with symptoms like oliguria and fluid overload. Looking for renal transplant followed by the fear of needle emerged as the potential reasons of delayed presentation