Catastrophic health expenditure and distress financing among patients with non-dialysis CKD in Uddanam, India

INTRODUCTION C hronic kidney disease (CKD) is the third fastest growing cause of death worldwide and projected to rise to fifth place in the list of causes of death in 2040. The burden is particularly high and growing rapidly in transitional countries, especially among rural communities of tropical countries. Treatment of CKD is expensive. An estimated 188 million people experience catastrophic health expenditure (CHE) annually because of kidney diseases across lowand lower middle-income countries, the greatest of any disease group. Studies have focused on costs of treating advanced stages of CKD with dialysis and/or transplantation. Patients with earlier stages of CKD need long-term care, have multiple comorbidities that require specific treatment, and likely incur substantial health care expenditure, which has not yet been quantified. In one study, patients with CKD made 10.8 physician visits per year. Another study reported that 60% of patients with stage 3 CKD consumed $5 medications/d. Uddanam is a high CKD-burden region in India with an adult population prevalence of CKD of 21%, almost 3 times that described from elsewhere in the country, but it has scarce kidney care services. Despite the commitment to provide universal health coverage to the population, outpatient care for chronic disease management including CKD has remained excluded from the ambit of the universal health coverage. We undertook this study to understand the household financial burden in the care of patients with predialysis CKD in rural communities in Uddanam.