Abstract
BACKGROUND: Low socioeconomic status (SES) has been linked to poorer outcomes among patients with advanced chronic kidney disease, including those undergoing maintenance hemodialysis. Limited data are available from Sub-Saharan Africa. In this region, traditional SES indicators like education and income can be challenging to measure. Household wealth may serve as a more reliable SES indicator. Our aim was to evaluate SES using household wealth, its association with non-adherence, quality of life, anxiety and depression among hemodialysis patients in Cameroon. METHODS: A cross-sectional study was conducted over four months in one urban and one semi-urban hemodialysis facilities in Cameroon. Consenting adult patients on maintenance hemodialysis for at least three months were included. Patients with cognitive impairment or language barriers (English or French) were excluded. Household wealth was assessed using the World Bank's household wealth index adapted for Cameroon. Non-adherence was defined as missing ≥ 2 hemodialysis sessions within a six-week period. Quality of life was evaluated using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire. Anxiety and depression risk were assessed using the Hospital Anxiety and Depression Scale (HADS); p-values < 0.05 were considered statistically significant. RESULTS: A total of 199 participants were included, with 52.8% (n = 109) males and a median age of 46 [IQR 36-56] years. Poverty affected 47.7% (n = 95) of participants, urban dwellers being more susceptible (52.5% n = 73 vs. 36.7% n = 22, p = 0.039). Poor participants had a greater percentage of patients < 46 years (56.8% n = 58 vs. 49% n = 40, p = 0.001) and unmarried status (43.1% n = 41 vs. 28.9% n = 30, p = 0.014). Non-adherence frequency was higher among poorer participants (42% n = 40 vs. 25% n = 26, p = 0.01). Globally, the quality of life was low across all household wealth groups. However, poorer participants experienced less physical function impairment (39% n = 37 vs. 52.9% n = 55, p = 0.04), fewer emotional role limitations (9.5% n = 9 vs. 19.2% n = 20, p = 0.048), and less depression (13.7% n = 13 vs. 26% n = 27, p = 0.04). In multivariate analysis, poverty increased the risk of non-adherence by 4.3 (95%CI 2.063-8.969, p < 0.001) and decrease the risk of depression by 0.7 (95%CI 0.063-0,963, p = 0.045). CONCLUSION: Poverty, as assessed by household wealth, is common among hemodialysis patients, particularly the younger patients and urban dwellers. It is associated with increased risk of non-adherence but a lesser risk of depression.