Hemodialysis Patients' Willingness to Undergo Kidney Transplantation: An Observational Study

Background

The number of dialysis patients is increasing, with only 20% undergoing kidney transplantation. In Saudi Arabia, no studies had examined transplantation barriers from the patients' perspectives. We aimed in this study to estimate hemodialysis (HD) patients' willingness to undergo kidney transplantation and to explore its underlying determinants.

Methods

In an observational cross-sectional study involving adult HD patients from King Abdulaziz Medical City and King Abdullah Dialysis Center-Jeddah, patients were interviewed through a pre-tested questionnaire. Calculated sample size was 243.

Results

Among the 252 HD patients (mean age, 55 years standard deviation = 15.21]; 59% men; median duration on HD, 24 months interquartile range, 11.1, 60]), 61% described their knowledge about kidney transplantation as “poor” or “very poor.” Only 69% chose “willingness to undergo kidney transplantation” (proportion, 0.69; 95% confidence interval CI], 0.64–0.75). The main reported reasons against willingness were being too old for transplantation (61%) and fear of surgical complications (26%). Less willingness was shown with age ≥60 years (adjusted odds ratio AOR], 0.2; 95% CI, 0.11–0.36; P < .001), duration on HD ≥5 years (AOR, 0.47; 95% CI, 0.25–0.89; P = .021), and being non-married (AOR, 0.47; 95% CI, 0.24–0.93; P = .03).

Conclusions

Approximately one third of the respondents did not choose “willingness to undergo kidney transplantation.” Willingness was negatively associated with older age, lack of spouse, and longer duration on HD. The majority of HD patients reported poor knowledge about kidney transplantation. Therefore, structured education may optimize the knowledge, perceptions, and attitudes of HD patients toward kidney transplantation and hence improve their transplantation willingness.