Refusal of Hemodialysis by Hospitalized Chronic Kidney Disease Patients in Dera Ismail Khan Pakistan

Abstract

Background: Chronic kidney disease (CKD) is an important global public health issue and emerging non communicable disease that occurs more often in developing countries where few patients have access to renal replacement therapy and has a high burden of symptomatic illness. Methods: This descriptive cross-sectional study was performed Between September 2025 and February 2026, in the nephrology department of District Headquarters Teaching Hospital of Dera Ismail Khan Pakistan. A total 100 of hospitalized patients aged between 18 -80 years with CKD stage V and medical indication for the hemodialysis were recruited using successive sampling. Data were collected using a pre-tested structured questionnaire regarding clinical characteristics, utilization of healthcare services in the past, demography and acceptance of hemodialysis. Results: Out of 100 patients, 34% refused hemodialysis while 66% accepted treatment. Among those who refused, the mean age was 45.03 ± 7.08 years, with a slight female predominance (52.9%). Most patients were uneducated (67.6%) and belonged to lower socioeconomic class (67.6%). Family members were the primary decision-makers in 67.6% of cases. The most common reasons for refusal were fear of the dialysis procedure (88.2%), perceived poor quality of life (44.1%), financial constraints (29.4%), and influence of family or peers (26.5%). Clinical parameters indicated advanced disease at presentation. Conclusion: Refusal to hemodialysis is widespread and complex, mostly motivated by societal pressures, fear, and financial obstacles. Improved access to subsidized dialysis treatments, early counselling, and patient education are crucial for increasing treatment acceptability and lowering avoidable death.