The Burden of Decisional Regret in Haemodialysis in South Asian Lower Middle Income Countries

Background: Haemodialysis (HD) is the primary renal replacement therapy available to patients with end-stage kidney disease (ESKD) in low- and middle-income countries (LMICs), but the financial and emotional burdens can lead to significant decisional regret. Although decisional regret has been explored in patients from high-income countries, little is known about the experiences of regret in HD patients in LMICs. Objective: This study aimed to explore the prevalence and pre dictors of decisional regret among HD patients in four South Asian LMICs (Pakistan, India, Bangladesh, and Nepal). Methods: A cross-sectional study was conducted across Pakistan, India, Bangladesh, and Nepal. Data were collected using validated scales to assess quality of life, and the Decision Regret Score (DRS) used to measure decisional regret. Sociodemographic, clinical, and treatment-related data were also gathered. Results: A total of 1048 responses were received. The mean age of the cohort was 52.6 years, with 54.2% being male. Decisional regret, defined as a DRS score ≥50, was reported by 14.1% of respondents, with 4.4% expressing extreme regret (scores ≥75). Younger age (<50 years), use of temporary vascular access, emergency dialysis initiation, and feelings of being a burden to others were all significantly associated with higher levels of regret (p<0.001). Patients who discussed multiple treatment options prior to starting dialysis reported lower levels of regret. Conclusion: Decisional regret is prevalent among HD patients in LMICs, with younger patients and those initiating dialysis in suboptimal conditions at greater risk. The findings suggest that early interventions, including timely nephrology referrals, optimal vascular access planning, and comprehensive pre-dialysis education, are crucial to reducing regret.