Patients’ Experiences and Cost of Hemodialysis in Management of Chronic Kidney Disease in Togo, 2024: An Exploratory Mixed-Method Approach

Abstract

At the stage of kidney failure, hemodialysis, peritoneal dialysis, and kidney transplantation are the therapeutic alternatives for prolonging patients' lives. In Togo, in-center hemodialysis is the only treatment option available to patients. This study aimed to evaluate the direct cost of in-center hemodialysis treatment and to understand the challenges faced by patients with kidney failure in Togo in 2024. We conducted a sequential exploratory mixed-methods study. The qualitative study included patients who had been undergoing hemodialysis in a center from March 1 to June 31, 2024. In the quantitative study, a linear regression model was used to describe the factors associated with the cost of hemodialysis. From 15 interviews, four themes were identified: 1) patients' perception of the disease and its management, 2) the burden of the disease and hemodialysis on the patient and their family and friends, 3) financial difficulties, and 4) geographical challenges in accessing a hemodialysis center. For the quantitative study, 88 patients were included (41.0% female), and 84.0% were hypertensive. The median age of patients was 51 years old (interquartile range [IQR]: 40-58). The median monthly income of patients was 45,000 CFA francs (franc de la Communauté Financière Africaine, the currency in Togo) (approximately €69; IQR: 0-162,500 CFA francs). The median overall cost of hemodialysis per month was 276,000 CFA (approximately €421; IQR: 163,600-527,000). Being male and living alone were associated with the overall cost of hemodialysis. This study mainly reports on the financial difficulties that patients face in accessing hemodialysis. Advocacy is needed for better subsidization of hemodialysis care in Togo.