Saudi Journal of Kidney Diseases and Transplantation

: 2020  |  Volume : 31  |  Issue : 3  |  Page : 693-

Refusal rate for dialysis in a rural community in Indochina: What about the rate?

Won Sriwijitalai1, Viroj Wiwanitkit2,  
1 Private Academic Practice, Bangkok, Thailand
2 Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Correspondence Address:
Won Sriwijitalai
Private Academic Practice, Bangkok

How to cite this article:
Sriwijitalai W, Wiwanitkit V. Refusal rate for dialysis in a rural community in Indochina: What about the rate?.Saudi J Kidney Dis Transpl 2020;31:693-693

How to cite this URL:
Sriwijitalai W, Wiwanitkit V. Refusal rate for dialysis in a rural community in Indochina: What about the rate?. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2022 May 19 ];31:693-693
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Full Text

To the Editor,

Dialysis is specific management for end-stage renal disease. At present, the availability of dialysis facilities is usually limited in rural areas of developing countries. Many patients who require dialysis management cannot receive medical care. On the other hand, another little-mentioned issue is on the refusal for dialysis care from the patient who has the chance to get dialysis care.

In the present short report, the authors summarize and reappraise on a locally avai-lable public data on dialysis service of a rural hospital in a tropical country in Indochina where the facilities for dialysis care are available. The setting is namely Mae-Ta Hospital located in Lamphun province, about 650 km from Bangkok, capital of Thailand. The recent two-year period data, 2015–2016, are hereby retrospec-tively analyzed. In the mentioned period, there were 122 patients with stage 5 renal failure who require dialysis management. The free dialysis care, according to the local universal coverage policies, was offered to each patient. Of interest, 16 from these patients (13.11%; 95% confidence interval between 8.31% and 20.71%) refused dialysis. All gave the reason relating to) concerns about the postoperative quality of life.

Of interest, although there is availability for free dialysis care service, some patients still deny the care. Indeed, the terminally ill patients who receive dialysis or transplantation might have underlying psychological suffer and denial is a common response.[1] In a recent report by Frierson et al, the 15% of patients with end-stage heart failure also refused offer for heart transplantation.[2] Similar to the present report, concerns about the postoperative quality of life is an important reason for refusal.[2] The refusal for dialysis is an important consideration in clinical nephrology. Sometimes, it becomes an important ethical issue for management.[3]

Conflict of interest: None declared.


1Nowak Z, Wankowicz Z, Laudanski K. Denial defense mechanism in dialyzed patients. Med Sci Monit 2015;21:1798-805.
2Frierson RL, Tabler JB, Lippmann SB, Brennan AF. Patients who refuse heart transplantation. J Heart Transplant 1990;9:385-91.
3Willig L, Paquette E, Hester DM, Warady BA, Lantos JD. Parents refusing dialysis for a 3- month-old with renal failure. Pediatrics 2018 Mar;141(3):e20172096.