Quality-of-Life Assessment in Patients on Maintenance Hemodialysis: Role of Social Security Among a Disadvantaged Population in Mexico

Background: ESRD negatively impact QoL. Illeteracy and unemployement has been sugested as low KDQOL score determinants among underpreviligied and rural population (Manavalan, 2017). Mexico lacks of a Universal Health System, with 49% of the population uninsured and a significant impact among ESRD patients: low acces to RRT (Madero, 2020), increased mortality (Valdez, 2018) and limited access to KT (García, 2021). Methods: Prevalent HD patients in a single facilitie in Mexico answered the KDQOL SF36 V1.3 questionnaire. Clinical, laboratory and KDQOL scores were compared between insured and uninsured patients. Risk factors associated with high KDQOL scores were analyzed in a multivariate logistic regression. Results: 123 prevalent HD patients answered (36 with Social Security and 87 Uninsured). Uninsured patients were older (median 57 vs 38y; p=0.01), have more male (59 vs 39%, p=0.046), more DM2 (52 vs 28%, p=0.050), less vintage days in HD (730 vs 910; P=0.050), more illeterate (15 vs 0%, p=0.050), uneemployed (80 vs 58%, p=0.017) and attend only two sessions x week (80 vs 17%, p=0.001). All KDQOL scales mean scores were similar with no statistical signifcancy between both groups. Variables associated with higher overall KDQOL score in a multivariate logistic regression were employeed (OR 7.644; 95% CI: 2.855 - 12.434; p=0.002) and platelets 109/L (OR 0.033; 95% CI: 0.003 - 0.063; p=0.033). Conclusion: Uninsured patients have particular characteristics compared with social security patients with no impact in laboratory results and QoL scores measured by a validated questionarie. Only platelets count and being employeed showed an association with higher KDQOL scores.