{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:53:11Z","timestamp":1791899591783,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle\u2010income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out\u2010of\u2010pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ\u20105D\u20105L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9\u2009\u00b1\u200912.5\u2009years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6\u2013663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4\u2013292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128\u2013297). One hundred and forty\u2010two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient\u00a0=\u00a0\u22120.04 (95% CI \u22120.008 \u2212 0.092), <jats:italic>p<\/jats:italic>\u00a0=\u00a00.039.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.13037","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T05:39:26Z","timestamp":1656394766000},"page":"569-574","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Out\u2010of\u2010pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-3605","authenticated-orcid":false,"given":"Josephine","family":"Valsa Jose","sequence":"first","affiliation":[{"name":"Department of Pharmacology Believers Church Medical College Hospital  Thiruvalla Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyothi","family":"Susan George","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Believers Church Medical College Hospital  Thiruvalla Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Nephrology Believers Church Medical College Hospital  Thiruvalla Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9016-8875","authenticated-orcid":false,"given":"E. T.","family":"Arun Thomas","sequence":"additional","affiliation":[{"name":"Department of Nephrology Believers Church Medical College Hospital  Thiruvalla Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geo","family":"Philip John","sequence":"additional","affiliation":[{"name":"Department of Nephrology Believers Church Medical College Hospital  Thiruvalla Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)00071-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0173554"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30486-2"},{"key":"e_1_2_8_5_1","volume-title":"An estimation of the economic impact of chronic noncommunicable diseases in selected countries","author":"Abegunde D","year":"2006"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0003982020"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfx152"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027880"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2018.12.007"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/1319-2442.128613"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S84929"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.21767\/2254-9137.100069"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x"},{"key":"e_1_2_8_14_1","volume-title":"EQ\u20105D\u20105L User Guide","author":"EuroQol Research Foundation","year":"2019"},{"issue":"1","key":"e_1_2_8_15_1","article-title":"Current situation of health care coverage in India, ISPOR","volume":"5","author":"Singh A","year":"2016","journal-title":"News Across Asia"},{"key":"e_1_2_8_16_1","volume-title":"USRDS annual data report: epidemiology of kidney disease in the United States","author":"United States Renal Data System","year":"2017"},{"key":"e_1_2_8_17_1","unstructured":"Median Income by Country 2022.[cited 2021 Aug 11]. 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