N Scholes-Robertson1, K Blazek1, A Tong1, J Craig2, B Essue3, K Howard1, M Howell1 

1The University Of Sydney, Camperdown, Australia, 2Flinders University , Adelaide, Australia, 3The University of Toronto , Canada 

Aim: To quantify the economic burden and out-of-pocket expenditure of rural patients with chronic kidney disease (CKD) in Australia. 

 Background: CKD care poses a financial burden on patients in Australia, yet little is known of the specific economic impact on rural households.  

 Methods: A self-administered survey was completed (on-line or hard copy) between November 2020 – February 2021 by people with CKD (Stage III-V) from rural communities in response to a flyer distributed on social media sites. We defined rural to include all areas outside of major cities and used the Modified Monash Model (MMM) to define whether a location is a city, rural, remote or very remote. Data collected from this convenience sample included current treatment modality, quality of life (EQ-5D), demographics, travel distances and out-of-pocket expenses. Mean out-of-pocket costs, households reporting economic hardship and catastrophic spending were assessed. 

 Results: 92 out of 145(63%) CKD patients completed 100% of the survey (61% female, 13% identifying as Aboriginal/Torres Strait Islander, mean age 52 years, range 23-77). 24% of respondents reported having to relocate (for a period > than 3 months) to access treatment. 81% of rural households reported financial hardship (inability to pay essential expenses), 57% experienced reduced employment due to medical reasons. A mean $1266 (95%CI $802-1730) per three months was paid out-of-pocket for direct and indirect medical expenses, with 54% exceeding catastrophic spending defined as out-of-pocket costs greater than 10% of household income.  

 Conclusion: A majority of rural households experienced economic hardship due to out-of-pocket costs associated with CKD care. This financial burden restricts access to kidney replacement modalities for rural patients with CKD.  


Nicki is a patient partner, physiotherapist, and a PhD candidate at the Sydney School of Public Health, The University of Sydney. In 2014, Nicki commenced peritoneal dialysis and was fortunate to receive a living donor kidney transplant from her brother in November that year. Her research focus is on access to dialysis and transplantation services for rural patients in Australia and for this she was awarded an NHMRC postgraduate scholarship. Nicki is the Consumer Editor of Cochrane Kidney and Transplant, and works on many projects with AKTN and CARI guidelines.

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