Determinants of Kidney Transplantation Uptake among Chronic Kidney Disease Patients on Haemodialysis at Selected National Referral Hospitals in Kenya

Abstract

In Kenya, Chronic Kidney Disease has a significant epidemiological burden with a prevalence of approximately 4 out of 10 in-patients. 1 in every 7 patients has End Stage Kidney Disease that needs Kidney Transplantation or dialysis for survival. Kidney Transplant offers greater benefits in comparison to dialysis because of the potential for recovery, less financial costs in the long run and improved Quality of Life. Despite the evidence that kidney transplant is the best treatment modality, its uptake is generally slow compared to dialysis especially in Kenya and Africa at large. The study investigated the determinants of kidney transplantation uptake among chronic kidney disease patients on haemodialysis at selected national referral hospitals in Kenya. A cross-sectional correlational design was used to determine association between variables (socio-demographic factors, patients’ perceived health factors and health system factors) and kidney transplant uptake among chronic kidney disease patients on haemodialysis at KNH and MTRH renal units. Using a simple random sampling method, 128 respondents were selected. Pretesting was done at Kenyatta National Hospital renal unit. Data was analyzed using SPSS version 25 and presented using descriptive statistics (Mean, SD, Proportions), for association inferential statistics (Chi-square and Fischer exact) and logistic regression for predictors. The findings revealed that age ꭓ2 (2) =18.37, p=0.005, religion ꭓ2 (1) =3.9, p=0.045 and occupation ꭓ2 (1) =8.268, p=0.003 were significantly associated with kidney transplant uptake. Discussion of kidney transplant with service provider ꭓ2 (1) =16.12, p <0.001, referral for kidney transplant evaluation ꭓ2 (1) =47.49, p<0.001, knowledge on kidney transplantation (df=1, p=0.007), and presence of comorbidity (df=5, p<0.001) were also associated with kidney transplant uptake. Predictors for kidney transplantation included; age, fear of surgery, concern of poor health and having a donor. In conclusion, only about a third of patients on haemodialysis had initiated the process of kidney transplant. This was influenced by factors mentioned above among others. A defined protocol for counseling, referral and evaluation for kidney transplantation is recommended. Government should consider fully financing kidney transplantation costs through National Health Insurance Fund to increase the uptake of kidney transplantation.