{"paper_id":"012d511c-89f5-4526-9ed7-e3b5d5598a34","body_text":"Knowledge and attitude of patients on dialysis towards Holiday haemodialysis facilities and red kidney bus: A cross-sectional questionnaire-based survey study in an Indian setup. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge and attitude of patients on dialysis towards Holiday haemodialysis facilities and red kidney bus: A cross-sectional questionnaire-based survey study in an Indian setup. Usha Nayak, Bhavyatha Shettigar, Ravindra Prabhu Attur, Prasanna Kumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4214086/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background- Traveling or going on vacation might cause dialysis patients to miss their dialysis schedules, thus adversely affecting their health. Hence, facilities must help dialysis patients access information regarding dialysis centres in other places. This study would help in understanding the problems faced regarding travel and dialysis centre accessibility and determine the needs of dialysis patients to travel or to go on vacation/family functions/business meetings. Methods- We conducted a cross-sectional questionnaire survey in which all patients on dialysis who met our inclusion criteria were enrolled. The required data was collected using a self-developed questionnaire. Frequency was used for categorical variables and mean standard deviation/ Median and IQR were used to calculate continuous variables. The chi-square test was used to check patients' willingness to utilise Holiday haemodialysis facilities based on their age and duration since they are undergoing dialysis. Results - Most patients (80.95%) had abstained entirely from travelling since the initiation of haemodialysis for multiple reasons. Among the remaining patients who go on vacation, the maximum duration and frequency was three days and 2-3 times a year. This was due to a lack of proper facilities to undergo dialysis at the travel destination. None of the patients in our centre knew about holiday haemodialysis facilities; when explained, many were willing to utilise them. Their willingness was dependent on their age group as well as the duration since they were undergoing dialysis. Conclusion - Holiday haemodialysis facilities should be developed and promoted in India to provide affordable and safe travelling experiences to people undergoing haemodialysis. Tria registration - \" This study protocol was reviewed and approved by [Kasturba Medical College and Kasturba Hospital institutional Ethics Committee - 2], approval number [ Ethical Approval Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1) ] .\" Renal replacement therapy Holiday Haemodialysis Red kidney bus vacation. Background Chronic kidney disease (CKD) occurs when the glomerular filtration rate (eGFR) falls below 60 ml/min per 1.73 square meters, persisting for 3 or more months and resulting in gradual and irreversible loss of kidney function over time (1). CKD is a growing health issue worldwide. According to the Global Burden of Disease (GBD) Study Report 2019, there are 697 million prevalent cases of CKD globally (2). Of these, India alone accounts for 140.19 million cases, with 17.86 million cases being advanced CKD, i.e. Stages 4 and 5, as per a systematic review on CKD prevalence published in 2022 (3). End-stage renal disease (ESRD) occurs when there is a symptomatic decline in renal function that lasts for more than three months, necessitating the implementation of renal replacement therapy (RRT). Haemodialysis, peritoneal dialysis, and renal transplantation are a few of the RRT (28). Nearly 4 million people worldwide survive on RRT, of which haemodialysis (HD) remains the commonest form of RRT, accounting for approximately 69% of all RRTs and 89% of all dialysis (4). According to an estimate in 2018, India has 12,881 HD centres (5). With the lack of donor kidneys and the restricted application of peritoneal dialysis, HD has become India's most sought-after option for managing ESRD (6). HD is generally scheduled thrice a week, each session lasting four to five hours (7). This compulsive lifelong therapy puts a major setback on an individual's life. Dialysis can burden them in multiple ways. It can burden patients financially due to high treatment costs and unemployment; social life is also at stake as they may find it difficult to travel and attend social events. Apart from these two, dialysis might also impact them psychologically as leading an independent life becomes daunting for them (8) (9). As a result, many dialysis patients get depressed since they will not be able to appreciate life due to therapy restrictions (8) (9)(10) (11). Research has shown that skipping dialysis can put an individual at risk of hospitalisation and death within 30 days (12). Rescheduling dialysis appointments leads to fewer adverse effects compared to missed dialysis. However, the number of adverse effects experienced remains higher when compared to individuals who undergo dialysis according to the schedule (13)(14)(15,16) Travelling to distant places for various purposes, such as attending business meetings, family functions, or vacations, might cause the patients to miss the dialysis schedule if there is no access to the dialysis centre at their travel destination. This would adversely affect their health (16). As ESRD patients are dependent on dialysis for a lifetime, their quality of life is heavily compromised. Hence, travelling difficulties are one of the main problems faced by dialysis patients (9)(13) (7)(17) as they are dependent on dialysis machines (7)(17). A study by Traouda V et al. reported that the frequency of travel and duration of vacation is significantly reduced due to dialysis (18). This could be due to multiple reasons, such as a lack of information related to dialysis centres at the travel destination, a lack of facilities to book an appointment for dialysis, health and safety concerns, and concerns regarding the quality of services at other dialysis centres (19) (17) (20). These factors backed up with financial burdens, force individuals on dialysis to opt for a short-term or no vacation (21). Hence, there is a need for facilities that would help dialysis patients access information regarding dialysis centres in other places. Such situations can be addressed by developing 1) websites for identifying all dialysis centres and booking appointments at the holiday destination, bringing in facilities that would facilitate online consultations with various dialysis centres of a required destination to get more information and assurance before a person on dialysis travels to that location and by developing 2) dialysis networks. In India, Nephro-Plus and Fresenius Medical Care Dialysis centres are the two largest dialysis centres in the network that provide holiday HD facilities (29)(30). These dialysis networks do not cover the dialysis centres under the Pradhan Mantri National Dialysis Programme (PMNDP), developed to offer free dialysis treatment to poor patients in India. However, these dialysis networks offer dialysis facilities at a comparatively lower cost. Currently, there are 1146 dialysis centres in 36 states/ union territories with 7908 dialysis machines under this program (31). Apart from these, the “Big Red Kidney Bus” facility offered in Australia has proven to be a safe and feasible option for CKD patients on dialysis (17). “Big Red Kidney Bus'' is an HD bus with three dialysis machines developed to encourage dialysis patients to go on vacation. This facility is widely available in Australia, enabling dialysis patients to travel to various tourist destinations in Australia (17) (32). A study by Sims J et al. evaluated the impact of the “Big Red Kidney Bus” on dialysis patients’ lives (17), where many patients reported better mood and reduced side effects such as muscle cramps, fatigue, and dry skin. These positive effects were likely observed because patients had a holiday experience without compromising their dialysis treatment. However, this facility is not yet introduced in India. This study aims to improve the well-being of dialysis patients by understanding the common problems faced by patients regarding travel and dialysis centre accessibility and by determining the needs of dialysis patients to travel or to go on vacation/family functions/business meetings. We also plan to assess the patient's knowledge regarding various Holiday HD facilities available in India and the “Big Red Kidney Bus”. Furthermore, to the highest of our knowledge, our study is the first of its kind in an Indian setup that would determine the willingness of patients on dialysis to utilise these Holiday HD facilities and the “Big Red Kidney Bus” if they are introduced in India. Methodology Aims Determine the knowledge and acceptance of patients on dialysis towards holiday HD facilities available in India. Assess the knowledge and opinion towards the “Red Kidney Bus” facility of patients on dialysis, in India settings. Sample population Sample size: 265. Dialysis patients’ prevalence data from the systematic review was used to calculate the sample size (22). The sample size was calculated using the following formula (23). Study design and setting: This cross-sectional survey was conducted in a tertiary care hospital after being approved by the Institutional Ethics Committee (IEC) of Kasturba Medical College & Kasturba Hospital (KMC KH), Manipal. Ethical Approval Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1). The study was initiated after approval from the ethics committee for 6 months. Privacy and confidentiality of patients were maintained by collecting data anonymously. Characteristics of the participants Inclusion criteria: Chronic kidney disease patients above 18 years who are willing to participate in the study and who are on maintenance dialysis (> 3 months) are eligible to participate in this study. Exclusion criteria: Patients undergoing dialysis for acute conditions/ patients not undergoing maintenance dialysis were excluded. Cancer patients were excluded. Outcomes: To determine the problems dialysis patients, face regarding travelling and dialysis centre accessibility through a survey. To assess the patient's knowledge and acceptance towards various Holiday HD facilities. Development and validation of a questionnaire This study involved two phases: 1) Development and validation of the questionnaire, which would assess the patient's knowledge and acceptance towards Holiday HD facilities available in India and the “Big Red Kidney Bus”. We also assessed patients' acceptance towards various online platforms that would help them get information about dialysis centres in various locations. The first draft of the questionnaire to assess the travelling and dialysis centre accessibility difficulties in dialysis patients was structured/developed by referring to various existing literature works and relevant questionnaires (24) (25) (33), followed by considering the expert opinions of nephrologists and subject experts. The questionnaire was divided into multiple segments that included/ comprised 27 evidence-based questions on difficulties experienced in travelling due to disease and dialysis centre accessibility, dialysis shift, Knowledge regarding holiday HD facilities, Willingness to utilise travel and holiday HD facilities, Need for such facilities and suggestions. The questionnaire containing 27 items was distributed among three experts to measure the content validity. It was reviewed and validated with the feedback form. The Item-level Content validity (I-CVI) was calculated for each item. Then, the Scale-level Content Validity Index (S-CVI) was calculated for the entire questionnaire. An s-CVI greater than 0.80 is acceptable (24)(25)(33), and an S-CVI of 0.9 for this questionnaire was obtained. A cross-sectional questionnaire study: From March 2023 to September 2023, a cross-sectional questionnaire-based survey was conducted at a tertiary care hospital in India. All patients diagnosed with CKD and receiving dialysis were enrolled in the study after signing the informed consent form. The common problems they faced with travel and dialysis centre accessibility, along with their knowledge and willingness to utilise the big red kidney bus, were assessed using a self-developed questionnaire mentioned above. Analysis Statistical methods: Frequency was calculated for the gender, different age groups, and categorical variables present in the different domains of the questionnaire (Type of dialysis, difficulties experienced after dialysis initiation, the reason for travel, information required for travelling for dialysis patients, travel and dialysis centre accessibility difficulties, dialysis shift, knowledge regarding holiday HD facilities, willingness to utilise travel and holiday HD facilities and need for such facilities). Mean and standard deviation/ Median and IQR will be calculated for continuous variables (Age, number of times in a year patient have gone on vacation, number of days or months patients were away from home, and number of times dialysis sessions missed by patients). Further, we used the chi-square test to check patients' willingness to utilise Holiday HD facilities based on their age and duration since they are undergoing dialysis, and p value less than 0.05 was considered to be statistically significant. Results Table 1 : Demographics Demographics n (%) N 105 Age-Mean (SD) 51.76 (12.88) Gender, n (%) Male 86 (81.9%) Female 19 (18.1%) Insurance, n (%) Yes 67 (63.81%) Dialysis cost, n (%) Free of cost 32 (30.48%) Educated, n (%) Yes 102 (97.14%) Table 2: General questions General questions n(%) Difficulties due to dialysis 77 (73.33%) Burden on family 19 (18.1%) Traveling difficulties 25 (23.81%) Loss of job 24 (22.86%) All the above 22 (20.95%) Reasons for travel Medical treatment 91 (86.67%) Vacation with family and friends 21 (20%) Attending family functions 13 (12.38%) Business-related 3 (2.86%) All of these 6 (5.71%) Attending temples 1 (0.95%) Bike rides 1 (0.95%) Other personal reasons 2 (1.9%) Table 3: Information required for travel. Information required for travel n(%) Patient options to the Dialysis Center Availability of Dialysis centre. Contact number. Provision to book appointments. Type and number of dialysis machines. Traveling facilities to that hospital. 94 (89.52%) Prefer to return to Manipal 3 (2.86%) Does not like to travel 7 (6.67%) Table 4: Difficulties experienced in travelling due to disease and dialysis centre accessibility. Difficulties experienced in travelling due to disease and dialysis centre accessibility n(%) Abstained going on vacation since dialysis commencement 85 (80.95%) Reasons Fatigue 36 (34.29%) Depressed 2 (1.9%) Scared that the condition might worsen 7 (6.67%) Not interested 30 (28.57%) Does not want to miss dialysis 1 (0.95%) Leg pain 2 (1.9%) Financial constraints 1 (0.95%) Travelling difficulties 1 (0.95%) Other reasons 5 (4.76%) Number of days of vacation 1 day 12 (11.43%) 2 days 3 (2.86%) 1-2 days 2 (1.90%) 2-3 days 2 (1.90%) 3 days 1 (0.95%) Frequency Once a Year 13 (12.38%) Twice a year 5 (4.76%) 2-3 times a year 2 (1.90%) Table 5: Dialysis Shift Dialysis shift n(%) Dialysis shifts due to travel 18 (17.14%) Frequency of dialysis shifts Once a year 5 (4.76%) Twice a year 2 (1.9%) Two-three times a year 1 (0.95%) Three- four times a year 1 (0.95%) Q. Duration of willingness to travel vs time since dialysis (in years). a. Willingness to travel Dialysis Vintage (years) Count of “are you willing to go on vacation if there are other similar haemodialysis facilities in India” 0-19 20-39 40-59 Total Yes 54 2 1 57 No 46 1 1 48 Grand total 100 3 2 105 p- value 0.903300897 Chi-square value 0.636576647 b. Willingness to travel Dialysis Vintage (years) Count of “are you willing to go on vacation if there is any other website to find all dialysis centres and book an appointment at your holiday destination” 0-19 20-39 40-59 Grand total Yes 61 2 1 64 No 39 1 1 41 Grand total 100 3 2 105 p- value 0.931436689 Chi-square value 0.62768405 c. Willingness to travel Dialysis Vintage (years) Count of are you willing to go on vacation if there are facilities to have an online consultation with other dialysis centres to get more information and assurance before you travel 0-19 20-39 40-59 Total Yes 61 2 1 64 No 39 1 1 41 Total 100 3 2 105 p-value 0.931437 Chi- square value 0.627684 Q. Age vs willingness to go on vacation and utilise holiday HD facilities. a. Willingness to travel Age group (years) Willingness to go on vacation and utilise holiday HD facilities. 0-19 20-39 40-59 Grand total Yes 17 29 11 57 No 4 23 21 48 Total 21 52 32 105 p-value 0.003743245 Chi- square value 0.998130128 b. Willingness to go on vacation Age group (years) Count of are you willing to go on vacation if there is any other website to find all dialysis centres, online consultation and book an appointment at your holiday destination 0-19 20-39 40-59 Total Yes 19 31 14 64 No 2 21 18 41 Grand total 21 52 32 105 p- value 0.002867411 Chi- square value 0.998567322 During the study period, 105 patients underwent interviews, revealing a mean age of 51.76 ± 12.88 years. The majority of participants were male (81.90%), educated (97.14%), and possessed health insurance (63.81%) ( Table 1 ). Among them, 73.33% expressed encountering difficulties due to dialysis, citing reasons such as family burden (18.10%), travel challenges (23.81%), job loss (22.86%), and a combination thereof (20.95%). Question asked regarding their travel purposes, most patients cited medical treatment (86.67%), followed by family and friends vacation (20%), attending family events (12.38%), business-related activities (2.86%), and a blend of these (5.71%). Other reasons encompassed dropping children off at school (0.95%), attending religious services (0.95%), embarking on extended bike rides (0.95%), and other personal commitments (1.90%) ( Table 2 ). To the question about the challenges of traveling due to illness and accessibility to dialysis centres, the majority of patients (80.95%) reported refraining from vacationing since beginning on dialysis, citing reasons such as fatigue (34.29%), depression (1.9%), fear of worsening health (6.67%), lack of interest (28.57%), preference not to miss dialysis (0.95%), leg pain (1.90%), financial constraints (0.95%), difficulty in travel (0.95%), and other factors (4.76%) ( Table 4 ). Among those desiring to travel, (89.52%) expressed interest in knowing the availability of dialysis centres, their contact details, appointment booking options, details regarding the dialysis machines, and transportation facilities to the hospital. Conversely, some patients expressed a preference to return to their usual dialysis center (2.86%), while others simply preferred not to travel (6.67%) ( Table 3 ). In our study cohort, patients' reported durations for their vacations were as follows: 1 day (11.43%), 1-2 days (2.86%), 2 days (1.90%), 2-3 days (1.90%), and 3 days (0.95%), with a mean duration of 1.45 ± 0.65 days. Regarding the frequency of vacations, respondents reported vacationing once a year (12.38%), twice a year (4.76%), and two to three times a year (1.90%) ( Table 4 ). Additionally, 17.14% of patients adjusted their dialysis schedules for travel-related reasons. The frequency of dialysis adjustments in a year was reported as once (4.76%), twice (1.90%), two to three times (0.95%), and three to four times a year (0.95%) ( Table 5 ). Moreover, 4.76% of patients indicated that altering their dialysis schedule did not adversely affect their overall health status, nor did it lead to prolonged hospital stays or increased treatment costs.Top of Form In our assessment of patients' awareness of holiday hemodialysis (HD) facilities, none were familiar with such facilities or the availability of mobile dialysis units like the big red buses. A notable proportion (54.29%) expressed willingness to consider vacationing if similar holiday HD facilities were available in India. Moreover, a majority of patients (60.95%) indicated their readiness to explore websites and online consultations for dialysis before embarking on travel. However, some patients (18.10%) exhibited hesitancy due to concerns such as fatigue (12.38%), stress associated with dialysis (0.95%), perceived disparities in quality of care compared to other countries (7.62%), potential increases in treatment costs (1.90%), financial constraints (0.95%), and miscellaneous reasons (3.81%). We conducted a chi-square test to examine the relationship between age and treatment duration-based responses of dialysis patients towards HD facilities and online consultations. Concerning the utilization of similar holiday HD facilities in India, 54% of patients undergoing dialysis for 0-19 years, 66.66% for 20-39 years, and 50% for over 40 years expressed willingness to utilize them. Similarly, 61% of patients in the 0-19 years group, 66.66% in the 20-39 years group, and 50% in the over 40 years group agreed to use online consultations for locating and scheduling appointments at dialysis centres in their travel destinations. Moreover, 61% of patients in the 0-19 years group, 66.66% in the 20-39 years group, and 50% in the over 40 years group were open to facilities enabling online consultations with other dialysis centres for additional information and reassurance before travel. However, none of these associations reached statistical significance. Willingness to go on vacation varied age group-wise, where 80.95% of patients in the range of 0-19 years, 55.76% of patients in the 20-39 age group range and 34.37% of patients of age 40 and beyond were willing to go on vacation, and this association was statistically significant (p= 0.998130128). Further, when we asked about their willingness to go on vacation and if there is any other website to find all dialysis centres, online consultation, and book an appointment at your holiday destination, 90.47% of them in the 0-19 years old age group, 59.61% in the 20-39 years old group and 43.75% patients of age 40and beyond agreed to go on vacation, and the association of willingness to go on vacation if there are other websites was also statistically significant (p= 0.998567322). The inclination for Willingness to go on vacation varied across different age groups: 80.95% of patients aged 0-19 years, 55.76% in the 20-39 age group, and 34.37% aged 40 and above expressed willingness to vacation, with a statistically significant association (p= 0.998130128). Moreover, when queried about their interest in vacationing and the availability of websites facilitating access to all dialysis centres, online consultations, and appointment bookings at holiday destinations, 90.47% of those aged 0-19 years, 59.61% in the 20-39 age group, and 43.75% of patients aged 40 and above expressed willingness to travel, with a statistically significant association (p= 0.998567322). Discussion Chronic kidney disease (CKD) represents a formidable public health concern owing to its widespread prevalence, linked health complexities, and elevated mortality rates. In India, over 90% of individuals requiring Renal Replacement Therapy (RRT) succumb to the ailment, predominantly due to financial barriers hindering their access to vital care. Among those who commence RRT, 60% discontinue treatment due to economic constraints. Some patients manage to access RRT through government health insurance initiatives, which furnish chronic, twice-weekly hemodialysis, peritoneal dialysis, or transplantation options for economically disadvantaged individuals, thereby furnishing accessible healthcare alternatives (26) Dialysis patients are more likely to be prone to depression. A study by Chan L et al. showed that depression increased the rate of hospitalisation among patients with chronic HD (27).The constraints associated with HD, such as the substantial time commitment required for several hours multiple times a week and the restriction on travel, can have an impact on a patient’s life and potentially contribute to the development of depression. our study provided a comprehensive exploration of the travel-related challenges and preferences regarding holiday HD facilities. The study highlighted the considerable impact of dialysis on patients, with 73.33% reporting difficulties related to their treatment. The reasons behind these are diverse, including the burden on family, travelling obstacles, loss of employment, and combinations of these factors. These challenges emphasise the need for approaches to address the concerns faced by dialysis patients, recognising that their struggles extend beyond the medical realm. Patients reported various reasons for travel, primarily for medical treatment. However, the patients reported that travel reasons extended beyond medical necessities, including vacations, family functions, and business-related trips. Concerning information required for travel, a significant majority expressed the need for details about the dialysis centre, such as availability, contact numbers, appointment booking provisions, and information about the number and type of dialysis machines. This indicates a clear demand for accessible information to enable patients to plan their travels effectively. This emphasises the need for systems to ensure that such information is readily available and easily accessible to patients. Despite the desire to travel, most patients (80.95%) stopped going on vacation since the commencement of dialysis. The reasons for this were fatigue, fear of worsening health conditions, financial constraints, and other personal reasons. Among the smaller percentage of patients still travelling, 11.43% of 105 patients went for a one-day vacation, and the maximum vacation frequency was also once a year12.38%. And 17.14%of these 105 patients had to reschedule their appointments in their dialysis centres due to a lack of proper Holiday HD facilities at their travel destination. Understanding these barriers is pivotal, as addressing them could improve their overall quality of life. Holiday HD is a better alternative for patients on dialysis, as research conducted by Sim et al. revealed that individuals engaging in holiday activities expressed satisfaction with the haemodialysis bus service and the quality of care they received. They noted reduced dialysis-related side effects such as fatigue, muscle cramps, and dry skin (17). Hence, we assessed our patients’ knowledge regarding Holiday HD facilities, but none knew about it. However, when we educated them regarding the same, A substantial proportion of patients (54.29%) expressed willingness to go on vacation if holiday HD facilities were available in India. Additionally, the majority (60.95%) were open to utilising websites and online consultations for dialysis before travelling. However, this response varied according to the age group and duration since the patients were undergoing dialysis, and the majority showed a positive response. Thus, demonstrating a potential avenue for enhancing patient education and support in the digital realm. Conclusion While holiday hemodialysis (HD) facilities exist in India, they remain scarce considering the country's vast population. Enhancements can be made by networking existing dialysis centres, establishing a nationwide electronic medical database, and creating online platforms facilitating access to these facilities. Introducing the \"Red bus facility\" in India could also broaden options for individuals undergoing dialysis. Despite a few holiday HD facilities, most of India's dialysis patients remain unaware of them. This lack of awareness may stem from insufficient educational and outreach initiatives, highlighting an area where governmental and non-governmental organisations should collaborate. Consequently, holiday hemodialysis facilities offer a promising solution, enabling patients to enjoy extended vacations without compromising their health or treatment schedules. Our study underscores the willingness of dialysis patients to embrace holiday HD facilities if they are widely accessible across the nation. In conclusion, our research offers crucial insights into the challenges, preferences, and potential remedies related to the travel experiences of dialysis patients. Healthcare systems can leverage these insights to develop facilities that empower dialysis patients, fostering more fulfilling lives and enabling convenient travel. Addressing these issues holds the potential to enhance the overall well-being of dialysis patients significantly. Limitations A drawback of this study is the limited sample size, as numerous patients declined to participate in the interviews. The data was gathered from only 105 patients, which is patients' perspective from a single centre. Declarations Acknowledgement- We would like to thank the Department of Nephrology, Kasturba Medical College and the hospital staff and faculty of the Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, for their valuable contribution to this project. Statement of Ethics \" This study protocol was reviewed and approved by [Kasturba Medical College and Kasturba Hospital institutional Ethics Committee - 2], approval number [ Ethical Approval Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1) ] .\" Informed consent statement - written informed consent was obtained from participants (or their parent/legal guardian/next of kin) Consent for publication - not applicable. Competing of interest – \"The authors declare that they have no competing interests\" Funding – \"This study was not supported by any sponsor or funder.\" Author contribution – \"Conceptualization Usha Nayak, Bhavyatha Shettigar and Dr Prasanna Kumar.; Methodology, Usha Nayak and Bhavyatha Shettigar .; Software, Bhavyatha Shettigar and Usha Nayak.; Validation, Dr Ravindra Prabhu and Dr Prasanna Kumar ; Formal Analysis, Bhavyatha Shettigar ; Investigation, Dr Prasanna Kumar.; Resources, Usha Nayak.; Data Curation, Usha Nayak and Bhavyatha Shettigar.; Writing – Original Draft Preparation, Usha Nayak and Bhavyatha Shettigar; Writing – Review & Editing, Usha Nayak and Bhavyatha Shettigar.; Visualization, Dr Usha Nayak and Bhavyatha Shettigar.; Supervision, Dr Prasanna Kumar; Project Administration, Dr Prasanna Kumar ; Funding Acquisition,- not applicable.”, Availability of data and materials - The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. 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Appendix Appendix 1 is not available with this version Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4214086\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":288818183,\"identity\":\"a1f04e57-3d61-45b0-b074-5eb1b68fd61b\",\"order_by\":0,\"name\":\"Usha Nayak\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Usha\",\"middleName\":\"\",\"lastName\":\"Nayak\",\"suffix\":\"\"},{\"id\":288818184,\"identity\":\"6d9c7f01-c675-42c9-8d1a-e1f826114267\",\"order_by\":1,\"name\":\"Bhavyatha Shettigar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Bhavyatha\",\"middleName\":\"\",\"lastName\":\"Shettigar\",\"suffix\":\"\"},{\"id\":288818185,\"identity\":\"9dbdde55-a50c-468e-9ca0-72cddf291782\",\"order_by\":2,\"name\":\"Ravindra Prabhu Attur\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dept. of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ravindra\",\"middleName\":\"Prabhu\",\"lastName\":\"Attur\",\"suffix\":\"\"},{\"id\":288818186,\"identity\":\"a5609029-7544-45ed-8302-44f7039edb57\",\"order_by\":3,\"name\":\"Prasanna Kumar\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Prasanna\",\"middleName\":\"\",\"lastName\":\"Kumar\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-04-03 16:47:42\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4214086/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4214086/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":73359063,\"identity\":\"1d4909e1-adc0-482a-952a-5baa60f5eef8\",\"added_by\":\"auto\",\"created_at\":\"2025-01-09 08:32:23\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1133320,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4214086/v1/2389d7bf-6323-4a6f-b19b-a53dc388ac46.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Knowledge and attitude of patients on dialysis towards Holiday haemodialysis facilities and red kidney bus: A cross-sectional questionnaire-based survey study in an Indian setup. \",\"fulltext\":[{\"header\":\"Background \",\"content\":\"\\u003cp\\u003eChronic kidney disease (CKD) occurs when the glomerular filtration rate (eGFR) falls below 60 ml/min per 1.73 square meters, persisting for 3 or more months and resulting in gradual and irreversible loss of kidney function over time\\u0026nbsp;(1). CKD is a growing health issue worldwide.\\u0026nbsp;According to the Global\\u0026nbsp;Burden of Disease (GBD) Study Report 2019, there are 697 million prevalent cases of CKD globally\\u0026nbsp;(2). Of these, India alone accounts for 140.19 million cases, with 17.86 million cases being advanced CKD, i.e. Stages 4 and 5, as per a systematic review on CKD prevalence published in 2022\\u0026nbsp;(3). End-stage renal disease (ESRD) occurs when there is a symptomatic decline in renal function that lasts for more than three months, necessitating the implementation of renal replacement therapy (RRT). Haemodialysis, peritoneal dialysis, and renal transplantation are a few of the RRT (28).\\u0026nbsp;Nearly 4 million people worldwide survive on RRT, of which haemodialysis (HD) remains the commonest form of RRT, accounting for approximately 69% of all RRTs and 89% of all dialysis\\u0026nbsp;(4). According to an estimate in 2018, India has 12,881 HD centres\\u0026nbsp;(5). With the lack of donor kidneys and the restricted application of peritoneal dialysis, HD has become India's most sought-after option for managing ESRD\\u0026nbsp;(6). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eHD is generally scheduled thrice a week, each session lasting four to five hours\\u0026nbsp;(7). This compulsive lifelong therapy puts a major setback on an individual's life.\\u0026nbsp;Dialysis can burden them in multiple ways. It can burden patients financially due to high treatment costs and unemployment; social life is also at stake as they may find it difficult to travel and attend social events. Apart from these two, dialysis might also impact them psychologically as leading an independent life becomes daunting for them\\u0026nbsp;(8) (9). As a result, many dialysis patients get depressed since they will not be able to appreciate life due to therapy restrictions \\u0026nbsp;(8)\\u0026nbsp;(9)(10)\\u0026nbsp;(11).\\u0026nbsp;Research has shown that\\u0026nbsp;skipping dialysis can put an individual at risk of hospitalisation and death within 30 days\\u0026nbsp;(12). Rescheduling dialysis appointments leads to fewer adverse effects compared to missed dialysis. However, the number of adverse effects experienced remains higher when compared to individuals who undergo dialysis according to the schedule\\u0026nbsp;(13)(14)(15,16)\\u003c/p\\u003e\\n\\u003cp\\u003eTravelling to distant places for various purposes, such as attending business meetings, family functions, or vacations, might cause the patients to miss the dialysis schedule if there is no access to the dialysis centre at their travel destination. This would adversely affect their health\\u0026nbsp;(16).\\u0026nbsp;\\u0026nbsp;As ESRD patients are dependent on dialysis for a lifetime, their quality of life is heavily compromised. \\u0026nbsp;Hence, travelling difficulties are one of the main problems faced by dialysis patients (9)(13) (7)(17) as they are dependent on dialysis machines\\u0026nbsp;(7)(17).\\u0026nbsp;A study by Traouda V et al. reported that the frequency of travel and duration of vacation is significantly reduced due to dialysis (18). This could be due to multiple reasons, such as a lack of information related to dialysis centres at the travel destination, a lack of facilities to book an appointment for dialysis, health and safety concerns, and concerns regarding the quality of services at other dialysis centres\\u0026nbsp;(19)\\u0026nbsp;(17)\\u0026nbsp;(20). These factors backed up with financial burdens, force individuals on dialysis to opt for a short-term or no\\u0026nbsp;vacation\\u0026nbsp;(21).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eHence, there is a need for facilities that would help dialysis patients access information regarding dialysis centres in other places.\\u0026nbsp;Such situations can be addressed by developing 1) websites for identifying all dialysis centres and booking appointments at the holiday destination, bringing in facilities that would facilitate online consultations with various dialysis centres of a required destination to get more information and assurance before a person on dialysis travels to that location\\u0026nbsp;and by developing 2) dialysis networks.\\u0026nbsp;\\u0026nbsp;In India, Nephro-Plus and Fresenius Medical Care Dialysis centres are the two largest dialysis centres in the network that provide holiday HD facilities (29)(30). These dialysis networks do not cover the dialysis centres under the Pradhan Mantri National Dialysis Programme (PMNDP), developed to offer free dialysis treatment to poor patients in India. However, these dialysis networks offer dialysis facilities at a comparatively lower cost. Currently, there are 1146 dialysis centres in 36 states/ union territories with 7908 dialysis machines under this program (31).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eApart from these, the “Big Red Kidney Bus” facility offered in Australia\\u0026nbsp;has proven to be a safe and feasible option for CKD patients on dialysis\\u0026nbsp;(17).\\u0026nbsp;“Big Red Kidney Bus'' is an HD bus with three dialysis machines developed to encourage dialysis patients to go on vacation.\\u0026nbsp;This\\u0026nbsp;facility is widely available in Australia, enabling dialysis patients to travel to various tourist destinations in Australia\\u0026nbsp;(17)\\u0026nbsp;(32). A study by Sims J et al. evaluated the impact of the “Big Red Kidney Bus” on dialysis patients’ lives\\u0026nbsp;(17), where many patients reported better mood and reduced\\u0026nbsp;side effects such as muscle cramps, fatigue, and dry skin. These positive effects were likely observed because patients had a holiday experience without compromising their dialysis treatment.\\u0026nbsp;However, this facility is not yet introduced in India.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThis study aims to improve the well-being of dialysis patients by understanding the common problems faced by patients regarding travel and dialysis centre accessibility and by determining the needs of dialysis patients to travel or to go on vacation/family functions/business meetings. We also plan to assess the patient's knowledge regarding various Holiday HD facilities available in India and the “Big Red Kidney Bus”. Furthermore, to the highest of our knowledge, our study is the first of its kind in an Indian setup that would determine the willingness of patients on dialysis to utilise these Holiday HD facilities and the “Big Red Kidney Bus” if they are introduced in India.\\u003c/p\\u003e\"},{\"header\":\"Methodology\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eAims\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eDetermine the knowledge and acceptance of patients on dialysis towards holiday HD facilities available in India.\\u003c/p\\u003e\\n\\u003cp\\u003eAssess the knowledge and opinion towards the \\u0026ldquo;Red Kidney Bus\\u0026rdquo; facility of patients on dialysis, in India settings.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eSample population\\u0026nbsp;\\u003c/strong\\u003eSample size: 265.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eDialysis patients\\u0026rsquo; prevalence data from the systematic review was used to calculate the sample size\\u0026nbsp;(22).\\u003c/p\\u003e\\n\\u003cp\\u003eThe sample size was calculated using the following formula (23). \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cimg 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\\\"\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eStudy design and setting:\\u0026nbsp;\\u003c/strong\\u003eThis cross-sectional survey was conducted in a tertiary care hospital after being approved by the Institutional Ethics Committee (IEC) of Kasturba Medical College \\u0026amp; Kasturba Hospital (KMC KH), Manipal. Ethical Approval\\u0026nbsp;Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1). The study was initiated after approval from the ethics committee for 6 months. Privacy and confidentiality of patients were maintained by collecting data anonymously.\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eCharacteristics of the participants\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInclusion criteria:\\u0026nbsp;\\u003c/strong\\u003eChronic kidney disease patients above 18 years who are willing to participate in the study and who are on maintenance dialysis (\\u0026gt; 3 months) are eligible to participate in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExclusion criteria:\\u0026nbsp;\\u003c/strong\\u003ePatients undergoing dialysis for acute conditions/ patients not undergoing maintenance dialysis were excluded. Cancer patients were excluded.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOutcomes:\\u0026nbsp;\\u003c/strong\\u003eTo determine the problems dialysis patients, face regarding travelling and dialysis centre accessibility through a survey. To assess the patient\\u0026apos;s knowledge and acceptance towards various Holiday HD facilities.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eDevelopment and validation of a questionnaire\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eThis study involved two phases: 1) Development and validation of the questionnaire, which would assess the patient\\u0026apos;s knowledge and acceptance towards Holiday HD facilities available in India and the \\u0026ldquo;Big Red Kidney Bus\\u0026rdquo;. We also assessed patients\\u0026apos; acceptance towards various online platforms that would help them get information about dialysis centres in various locations. The first draft of the questionnaire to assess the travelling and dialysis centre accessibility difficulties in dialysis patients was structured/developed by referring to various existing literature works and relevant questionnaires (24) (25) (33), followed by considering the expert opinions of nephrologists and subject experts. The questionnaire was divided into multiple segments that included/ comprised 27 evidence-based questions on difficulties experienced in travelling due to disease and dialysis centre accessibility, dialysis shift, Knowledge regarding holiday HD facilities, Willingness to utilise travel and holiday HD facilities, Need for such facilities and suggestions.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe questionnaire containing 27 items was distributed among three experts to measure the content validity. It was reviewed and validated with the feedback form. The Item-level Content validity (I-CVI) was calculated for each item. Then, the Scale-level Content Validity Index (S-CVI) was calculated for the entire questionnaire. An s-CVI greater than 0.80 is acceptable (24)(25)(33), and an S-CVI of 0.9 for this questionnaire was obtained.\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e\\u0026nbsp;A cross-sectional questionnaire study:\\u0026nbsp;\\u003c/strong\\u003eFrom March 2023 to September 2023, a cross-sectional questionnaire-based survey was conducted at a tertiary care hospital in India. All patients diagnosed with CKD and receiving dialysis were enrolled in the study after signing the informed consent form. The common problems they faced with travel and dialysis centre accessibility, along with their knowledge and willingness to utilise the big red kidney bus, were assessed using a self-developed questionnaire mentioned above.\\u0026nbsp;\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAnalysis\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical methods:\\u0026nbsp;\\u003c/strong\\u003eFrequency was calculated for the gender, different age groups, and categorical variables present in the different domains of the questionnaire (Type of dialysis, difficulties experienced after dialysis initiation, the reason for travel, information required for travelling for dialysis patients, travel and dialysis centre accessibility difficulties, dialysis shift, knowledge regarding holiday HD facilities, willingness to utilise travel and holiday HD facilities and need for such facilities). Mean and standard deviation/ Median and IQR will be calculated for continuous variables (Age, number of times in a year patient have gone on vacation, number of days or months patients were away from home, and number of times dialysis sessions missed by patients). Further, we used the chi-square test to check patients\\u0026apos; willingness to utilise Holiday HD facilities based on their age and duration since they are undergoing dialysis, and p value less than 0.05 was considered to be statistically significant.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e\\u003cstrong\\u003e: Demographics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"351\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDemographics\\u0026nbsp;\\u003c/strong\\u003en (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAge-Mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e51.76 (12.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGender, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e86 (81.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19 (18.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eInsurance, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e67 (63.81%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDialysis cost, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree of cost\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e32 (30.48%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eEducated, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.15954415954416%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.84045584045584%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e102 (97.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2: General questions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"543\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGeneral questions\\u0026nbsp;\\u003c/strong\\u003en(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eDifficulties due to dialysis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e77 (73.33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eBurden on family\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e19 (18.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eTraveling difficulties\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e25 (23.81%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eLoss of job\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e24 (22.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eAll the above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e22 (20.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eReasons for travel\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eMedical treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e91 (86.67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eVacation with family and friends\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e21 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eAttending family functions\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e13 (12.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eBusiness-related\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e3 (2.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eAll of these\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e6 (5.71%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eAttending temples\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eBike rides\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"70.7182320441989%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eOther personal reasons\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.281767955801104%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3: Information required for travel.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"543\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eInformation required for travel\\u0026nbsp;\\u003c/strong\\u003en(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"76.97974217311234%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003ePatient options to the Dialysis Center\\u003c/p\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003eAvailability of Dialysis centre.\\u003c/li\\u003e\\n \\u003cli\\u003eContact number.\\u003c/li\\u003e\\n \\u003cli\\u003eProvision to book appointments.\\u003c/li\\u003e\\n \\u003cli\\u003eType and number of dialysis machines.\\u003c/li\\u003e\\n \\u003cli\\u003eTraveling facilities to that hospital.\\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.02025782688766%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e94 (89.52%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"76.97974217311234%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003ePrefer to return to Manipal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.02025782688766%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e3 (2.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"76.97974217311234%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eDoes not like to travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.02025782688766%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e7 (6.67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4: Difficulties experienced in travelling due to disease and dialysis centre accessibility.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"623\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDifficulties experienced in travelling due to disease and dialysis centre accessibility\\u0026nbsp;\\u003c/strong\\u003en(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAbstained going on vacation since dialysis commencement\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e85 (80.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eReasons\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eFatigue\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e36 (34.29%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eDepressed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eScared that the condition might worsen\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e7 (6.67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eNot interested\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e30 (28.57%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eDoes not want to miss dialysis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eLeg pain\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eFinancial constraints\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eTravelling difficulties\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eOther reasons\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e5 (4.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber of days of vacation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 day\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e12 (11.43%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e3 (2.86%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1-2 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2-3 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e3 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrequency\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eOnce a Year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e13 (12.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eTwice a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e5 (4.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"77.04654895666131%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2-3 times a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.953451043338685%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5: Dialysis Shift\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"543\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDialysis shift\\u0026nbsp;\\u003c/strong\\u003en(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"66.29834254143647%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eDialysis shifts due to travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.70165745856354%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e18 (17.14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"2\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eFrequency of dialysis shifts\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"66.29834254143647%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eOnce a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.70165745856354%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e5 (4.76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"66.29834254143647%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eTwice a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.70165745856354%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e2 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"66.29834254143647%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eTwo-three times a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.70165745856354%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"66.29834254143647%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003eThree- four times a year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.70165745856354%\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e1 (0.95%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eQ. Duration of willingness to travel vs time since dialysis (in years).\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ea.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\"\\u003e\\n \\u003cp\\u003eWillingness to travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"59.3186372745491%\\\" colspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eDialysis Vintage\\u0026nbsp;(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCount of \\u0026ldquo;are you willing to go on vacation if there are other similar haemodialysis facilities in India\\u0026rdquo;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.024048096192384%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0-19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.226452905811623%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20-39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.428857715430862%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e40-59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.639278557114228%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.024048096192384%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.226452905811623%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.428857715430862%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.639278557114228%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.024048096192384%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.226452905811623%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.428857715430862%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.639278557114228%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGrand total\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.024048096192384%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.226452905811623%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.428857715430862%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.639278557114228%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep- value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"59.3186372745491%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.903300897\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.6813627254509%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChi-square value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"59.3186372745491%\\\" colspan=\\\"4\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e0.636576647\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eb.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\"\\u003e\\n \\u003cp\\u003eWillingness to travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.40625%\\\" colspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eDialysis Vintage\\u0026nbsp;(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCount of \\u0026ldquo;are you willing to go on vacation if there is any other website to find all dialysis centres and book an appointment at your holiday destination\\u0026rdquo;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.375%\\\"\\u003e\\n \\u003cp\\u003e0-19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.3125%\\\"\\u003e\\n \\u003cp\\u003e20-39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.96875%\\\"\\u003e\\n \\u003cp\\u003e40-59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.75%\\\"\\u003e\\n \\u003cp\\u003eGrand total\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eYes\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.3125%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.96875%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.75%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.3125%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.96875%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.75%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGrand total\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.3125%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.96875%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.75%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ep- value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.40625%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.931436689\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.59375%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eChi-square value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.40625%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.62768405\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003ec.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\"\\u003e\\n \\u003cp\\u003eWillingness to travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.4635761589404%\\\" colspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003eDialysis Vintage\\u0026nbsp;(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCount of are you willing to go on vacation if there are facilities to have an online consultation with other dialysis centres to get more information and assurance before you travel\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.920529801324504%\\\"\\u003e\\n \\u003cp\\u003e0-19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.933774834437086%\\\"\\u003e\\n \\u003cp\\u003e20-39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.900662251655628%\\\"\\u003e\\n \\u003cp\\u003e40-59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.70860927152318%\\\"\\u003e\\n \\u003cp\\u003eTotal\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.920529801324504%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.933774834437086%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.900662251655628%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.70860927152318%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.920529801324504%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.933774834437086%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.900662251655628%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.70860927152318%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.920529801324504%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.933774834437086%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.900662251655628%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.70860927152318%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.4635761589404%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.931437\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"44.5364238410596%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChi- square value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"55.4635761589404%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.627684\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eQ. Age vs willingness to go on vacation and utilise holiday HD facilities.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ea.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"32.11805555555556%\\\" colspan=\\\"3\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWillingness to travel\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"67.88194444444444%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge group\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e(years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"30.08695652173913%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWillingness to go on vacation\\u0026nbsp;and utilise holiday HD facilities.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.130434782608695%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0-19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20-39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e40-59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.73913043478261%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGrand total\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"30.08695652173913%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.130434782608695%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.73913043478261%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"30.08695652173913%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.130434782608695%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.73913043478261%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"30.08695652173913%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTotal\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.130434782608695%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.52173913043478%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.73913043478261%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.041666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"73.95833333333333%\\\" colspan=\\\"6\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e0.003743245\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.041666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChi- square value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"73.95833333333333%\\\" colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.998130128\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eb.\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWillingness to go on vacation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.58730158730159%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge group\\u0026nbsp;\\u003c/strong\\u003e(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCount of are you willing to go on vacation if there is any other website to find all dialysis centres, online consultation and book an appointment at your holiday destination\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.523809523809524%\\\"\\u003e\\n \\u003cp\\u003e0-19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.428571428571429%\\\"\\u003e\\n \\u003cp\\u003e20-39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.53968253968254%\\\"\\u003e\\n \\u003cp\\u003e40-59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.095238095238095%\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.523809523809524%\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.428571428571429%\\\"\\u003e\\n \\u003cp\\u003e31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.53968253968254%\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.095238095238095%\\\"\\u003e\\n \\u003cp\\u003e64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.523809523809524%\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.428571428571429%\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.53968253968254%\\\"\\u003e\\n \\u003cp\\u003e18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.095238095238095%\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGrand total\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"9.523809523809524%\\\"\\u003e\\n \\u003cp\\u003e21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.428571428571429%\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.53968253968254%\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.095238095238095%\\\"\\u003e\\n \\u003cp\\u003e105\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ep- value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.58730158730159%\\\" colspan=\\\"4\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e0.002867411\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"48.41269841269841%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eChi- square value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"51.58730158730159%\\\" colspan=\\\"4\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.998567322\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;During the study period, 105 patients underwent interviews, revealing a mean age of 51.76 \\u0026plusmn; 12.88 years. The majority of participants were male (81.90%), educated (97.14%), and possessed health insurance (63.81%) (\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e). Among them, 73.33% expressed encountering difficulties due to dialysis, citing reasons such as family burden (18.10%), travel challenges (23.81%), job loss (22.86%), and a combination thereof (20.95%). Question asked regarding their travel purposes, most patients cited medical treatment (86.67%), followed by family and friends vacation (20%), attending family events (12.38%), business-related activities (2.86%), and a blend of these (5.71%). Other reasons encompassed dropping children off at school (0.95%), attending religious services (0.95%), embarking on extended bike rides (0.95%), and other personal commitments (1.90%) (\\u003cstrong\\u003eTable 2\\u003c/strong\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eTo the question about the challenges of traveling due to illness and accessibility to dialysis centres, the majority of patients (80.95%) reported refraining from vacationing since beginning on dialysis, citing reasons such as fatigue (34.29%), depression (1.9%), fear of worsening health (6.67%), lack of interest (28.57%), preference not to miss dialysis (0.95%), leg pain (1.90%), financial constraints (0.95%), difficulty in travel (0.95%), and other factors (4.76%) (\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e). Among those desiring to travel, (89.52%) expressed interest in knowing the availability of dialysis centres, their contact details, appointment booking options, details regarding the dialysis machines, and transportation facilities to the hospital. Conversely, some patients expressed a preference to return to their usual dialysis center (2.86%), while others simply preferred not to travel (6.67%) (\\u003cstrong\\u003eTable 3\\u003c/strong\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eIn our study cohort, patients\\u0026apos; reported durations for their vacations were as follows: 1 day (11.43%), 1-2 days (2.86%), 2 days (1.90%), 2-3 days (1.90%), and 3 days (0.95%), with a mean duration of 1.45 \\u0026plusmn; 0.65 days. Regarding the frequency of vacations, respondents reported vacationing once a year (12.38%), twice a year (4.76%), and two to three times a year (1.90%) (\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e).\\u0026nbsp;Additionally, 17.14% of patients adjusted their dialysis schedules for travel-related reasons. The frequency of dialysis adjustments in a year was reported as once (4.76%), twice (1.90%), two to three times (0.95%), and three to four times a year (0.95%) (\\u003cstrong\\u003eTable 5\\u003c/strong\\u003e). Moreover, 4.76% of patients indicated that altering their dialysis schedule did not adversely affect their overall health status, nor did it lead to prolonged hospital stays or increased treatment costs.Top of Form\\u003c/p\\u003e\\n\\u003cp\\u003eIn our assessment of patients\\u0026apos; awareness of holiday hemodialysis (HD) facilities, none were familiar with such facilities or the availability of mobile dialysis units like the big red buses. A notable proportion (54.29%) expressed willingness to consider vacationing if similar holiday HD facilities were available in India. Moreover, a majority of patients (60.95%) indicated their readiness to explore websites and online consultations for dialysis before embarking on travel. However, some patients (18.10%) exhibited hesitancy due to concerns such as fatigue (12.38%), stress associated with dialysis (0.95%), perceived disparities in quality of care compared to other countries (7.62%), potential increases in treatment costs (1.90%), financial constraints (0.95%), and miscellaneous reasons (3.81%).\\u003c/p\\u003e\\n\\u003cp\\u003eWe conducted a chi-square test to examine the relationship between age and treatment duration-based responses of dialysis patients towards HD facilities and online consultations. Concerning the utilization of similar holiday HD facilities in India, 54% of patients undergoing dialysis for 0-19 years, 66.66% for 20-39 years, and 50% for over 40 years expressed willingness to utilize them. Similarly, 61% of patients in the 0-19 years group, 66.66% in the 20-39 years group, and 50% in the over 40 years group agreed to use online consultations for locating and scheduling appointments at dialysis centres in their travel destinations. Moreover, 61% of patients in the 0-19 years group, 66.66% in the 20-39 years group, and 50% in the over 40 years group were open to facilities enabling online consultations with other dialysis centres for additional information and reassurance before travel. However, none of these associations reached statistical significance.\\u003c/p\\u003e\\n\\u003cp\\u003eWillingness to go on vacation varied age group-wise, where 80.95% of patients in the range of 0-19 years, 55.76% of patients in the 20-39 age group range and 34.37% of patients of age 40 and beyond were willing to go on vacation, and this association was statistically significant (p= 0.998130128). Further, when we asked about their willingness to go on vacation and if there is any other website to find all dialysis centres, online consultation, and book an appointment at your holiday destination, 90.47% of them in the 0-19 years old age group, 59.61% in the 20-39 years old group and 43.75% patients of age 40and beyond agreed to go on vacation, and the association of willingness to go on vacation if there are other websites was also statistically significant (p=\\u0026nbsp;0.998567322).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe inclination for Willingness to go on vacation varied across different age groups: 80.95% of patients aged 0-19 years, 55.76% in the 20-39 age group, and 34.37% aged 40 and above expressed willingness to vacation, with a statistically significant association (p= 0.998130128). Moreover, when queried about their interest in vacationing and the availability of websites facilitating access to all dialysis centres, \\u0026nbsp;online consultations, and appointment bookings at holiday destinations, 90.47% of those aged 0-19 years, 59.61% in the 20-39 age group, and 43.75% of patients aged 40 and above expressed willingness to travel, with a statistically significant association (p= 0.998567322).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eChronic kidney disease (CKD) represents a formidable public health concern owing to its widespread prevalence, linked health complexities, and elevated mortality rates. In India, over 90% of individuals requiring Renal Replacement Therapy (RRT) succumb to the ailment, predominantly due to financial barriers hindering their access to vital care. Among those who commence RRT, 60% discontinue treatment due to economic constraints. Some patients manage to access RRT through government health insurance initiatives, which furnish chronic, twice-weekly hemodialysis, peritoneal dialysis, or transplantation options for economically disadvantaged individuals, thereby furnishing accessible healthcare alternatives\\u0026nbsp;(26)\\u003c/p\\u003e\\n\\u003cform\\u003e\\n \\u003cp\\u003eDialysis patients are more likely to be prone to depression. A study by Chan L et al. showed that depression increased the rate of hospitalisation among patients with chronic HD\\u0026nbsp;(27).The constraints associated with HD, such as the substantial time commitment required for several hours multiple times a week and the restriction on travel, can have an impact on a patient’s life and potentially contribute to the development of depression. our study provided a comprehensive exploration of the travel-related challenges and preferences regarding holiday HD facilities. The study highlighted the considerable impact of dialysis on patients, with 73.33% reporting difficulties related to their treatment. The reasons behind these are diverse, including the burden on family, travelling obstacles, loss of employment, and combinations of these factors. These challenges emphasise the need for approaches to address the concerns faced by dialysis patients, recognising that their struggles extend beyond the medical realm. Patients reported various reasons for travel, primarily for medical treatment. However, the patients reported that travel reasons extended beyond medical necessities, including vacations, family functions, and business-related trips. Concerning information required for travel, a significant majority expressed the need for details about the dialysis centre, such as availability, contact numbers, appointment booking provisions, and information about the number and type of dialysis machines. This indicates a clear demand for accessible information to enable patients to plan their travels effectively. This emphasises the need for systems to ensure that such information is readily available and easily accessible to patients. Despite the desire to travel, most patients (80.95%) stopped going on vacation since the commencement of dialysis. The reasons for this were fatigue, fear of worsening health conditions, financial constraints, and other personal reasons. Among the smaller percentage of patients still travelling, 11.43% of 105 patients went for a one-day vacation, and the maximum vacation frequency was also once a year12.38%. And 17.14%of these 105 patients had to reschedule their appointments in their dialysis centres due to a lack of proper Holiday HD facilities at their travel destination.\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eUnderstanding these barriers is pivotal, as addressing them could improve their overall quality of life. \\u0026nbsp;Holiday HD is a better alternative for patients on dialysis, as research conducted by Sim et al. revealed that individuals engaging in holiday activities expressed satisfaction with the haemodialysis bus service and the quality of care they received. They noted reduced dialysis-related side effects such as fatigue, muscle cramps, and dry skin (17). Hence, we assessed our patients’ knowledge regarding Holiday HD facilities, but none knew about it. However, when we educated them regarding the same, A substantial proportion of patients (54.29%) expressed willingness to go on vacation if holiday HD facilities were available in India. Additionally, the majority (60.95%) were open to utilising websites and online consultations for dialysis before travelling. However, this response varied according to the age group and duration since the patients were undergoing dialysis, and the majority showed a positive response. Thus, demonstrating a potential avenue for enhancing patient education and support in the digital realm.\\u003c/p\\u003e\\n\\u003c/form\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eWhile holiday hemodialysis (HD) facilities exist in India, they remain scarce considering the country's vast population. Enhancements can be made by networking existing dialysis centres, establishing a nationwide electronic medical database, and creating online platforms facilitating access to these facilities. Introducing the \\\"Red bus facility\\\" in India could also broaden options for individuals undergoing dialysis.\\u003c/p\\u003e\\n\\u003cp\\u003eDespite a few holiday HD facilities, most of India's dialysis patients remain unaware of them. This lack of awareness may stem from insufficient educational and outreach initiatives, highlighting an area where governmental and non-governmental organisations should collaborate. Consequently, holiday hemodialysis facilities offer a promising solution, enabling patients to enjoy extended vacations without compromising their health or treatment schedules.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study underscores the willingness of dialysis patients to embrace holiday HD facilities if they are widely accessible across the nation. In conclusion, our research offers crucial insights into the challenges, preferences, and potential remedies related to the travel experiences of dialysis patients. Healthcare systems can leverage these insights to develop facilities that empower dialysis patients, fostering more fulfilling lives and enabling convenient travel. Addressing these issues holds the potential to enhance the overall well-being of dialysis patients significantly.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;A drawback of this study is the limited sample size, as numerous patients declined to participate in the interviews. The data was gathered from only 105 patients, which is patients' perspective from a single centre.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement-\\u003c/strong\\u003eWe would like to thank the Department of Nephrology, Kasturba Medical College and the hospital staff and faculty of the Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, for their valuable contribution to this project.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch6\\u003eStatement of Ethics\\u003c/h6\\u003e\\n\\u003cp\\u003e\\\"\\u003cem\\u003eThis study protocol was reviewed and approved by [Kasturba Medical College and Kasturba Hospital institutional Ethics Committee - 2], approval number [\\u003c/em\\u003eEthical Approval\\u0026nbsp;Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1)\\u003cem\\u003e]\\u003c/em\\u003e.\\\"\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInformed consent statement\\u003c/strong\\u003e\\u003cstrong\\u003e-\\u003c/strong\\u003e written informed consent was obtained from participants (or their parent/legal guardian/next of kin)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e- not applicable.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting of interest\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;–\\u003c/strong\\u003e \\\"The authors declare that they have no competing interests\\\"\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;–\\u0026nbsp;\\u003c/strong\\u003e\\\"This study was not supported by any sponsor or funder.\\\"\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contribution\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;–\\u0026nbsp;\\u003c/strong\\u003e\\\"Conceptualization Usha Nayak, Bhavyatha Shettigar and Dr Prasanna Kumar.; Methodology, Usha Nayak and Bhavyatha Shettigar .; Software, Bhavyatha Shettigar and Usha Nayak.; Validation, Dr Ravindra Prabhu and Dr Prasanna Kumar ; Formal Analysis, Bhavyatha Shettigar ; Investigation, Dr Prasanna Kumar.; Resources, Usha Nayak.; Data Curation, Usha Nayak and Bhavyatha Shettigar.; Writing – Original Draft Preparation, Usha Nayak and Bhavyatha Shettigar; Writing – Review \\u0026amp; Editing, Usha Nayak and Bhavyatha Shettigar.; Visualization, Dr Usha Nayak and Bhavyatha Shettigar.; Supervision, Dr Prasanna Kumar; Project Administration, Dr Prasanna Kumar ; Funding Acquisition,- not applicable.”,\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAvailability of data and materials\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cem\\u003e-\\u0026nbsp;\\u003c/em\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eKalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. The Lancet. 2021 Aug;398(10302):786\\u0026ndash;802.\\u003c/li\\u003e\\n \\u003cli\\u003eRamasamy S, Rathore V, Galhotra A, Agrawal S. Health equity in dialysis care: Time for action. Indian Journal of Community and Family Medicine. 2023;9(1):8.\\u003c/li\\u003e\\n \\u003cli\\u003eLiyanage T, Toyama T, Hockham C, Ninomiya T, Perkovic V, Woodward M, et al. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health. 2022 Jan 25;7(1):e007525.\\u003c/li\\u003e\\n \\u003cli\\u003eBello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022 Jun 22;18(6):378\\u0026ndash;95.\\u003c/li\\u003e\\n \\u003cli\\u003eJha V, Ur-Rashid H, Agarwal SK, Akhtar SF, Kafle RK, Sheriff R. The state of nephrology in South Asia. Kidney Int. 2019 Jan;95(1):31\\u0026ndash;7.\\u003c/li\\u003e\\n \\u003cli\\u003eBharati J, Jha V. Global Dialysis Perspective: India. Kidney360. 2020 Oct;1(10):1143\\u0026ndash;7.\\u003c/li\\u003e\\n \\u003cli\\u003eDąbrowska-Bender M, Dykowska G, Żuk W, Milewska M, Staniszewska A. The impact on quality of life of dialysis patients with renal insufficiency. Patient Prefer Adherence. 2018 Apr;Volume 12:577\\u0026ndash;83.\\u003c/li\\u003e\\n \\u003cli\\u003eČengić B, Resić H. Depression in Hemodialysis Patients. Bosn J Basic Med Sci. 2010 Apr 20;10(1):73.\\u003c/li\\u003e\\n \\u003cli\\u003eBrown EA, Zhao J, McCullough K, Fuller DS, Figueiredo AE, Bieber B, et al. Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program. American Journal of Kidney Diseases. 2021 Oct;78(4):489-500.e1.\\u003c/li\\u003e\\n \\u003cli\\u003eWu PH, Lin MY, Huang TH, Lin YT, Hung CC, Yeh YC, et al. Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study. PLoS One. 2019 Jun 13;14(6):e0218335.\\u003c/li\\u003e\\n \\u003cli\\u003eSim\\u0026otilde;es e Silva AC, Miranda AS, Rocha NP, Teixeira AL. Neuropsychiatric Disorders in Chronic Kidney Disease. Front Pharmacol. 2019 Aug 16;10.\\u003c/li\\u003e\\n \\u003cli\\u003eGray K, Cohen D, Brunelli S. In-center hemodialysis absenteeism: prevalence and association with outcomes. ClinicoEconomics and Outcomes Research. 2017 May;Volume 9:307\\u0026ndash;15.\\u003c/li\\u003e\\n \\u003cli\\u003eBalhara KS, Fisher L, El Hage N, Ramos RG, Jaar BG. Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study. BMC Nephrol. 2020 Dec 6;21(1):4.\\u003c/li\\u003e\\n \\u003cli\\u003eWiegley N, Chin AI. Does Rescheduling a Missed In-Center Hemodialysis Treatment Improve Clinical Outcomes? Kidney Med. 2020 Jan;2(1):3\\u0026ndash;4.\\u003c/li\\u003e\\n \\u003cli\\u003eCohen DE, Gray KS, Colson C, Van Wyck DB, Tentori F, Brunelli SM. Impact of Rescheduling a Missed Hemodialysis Treatment on Clinical Outcomes. Kidney Med. 2020 Jan;2(1):12\\u0026ndash;9.\\u003c/li\\u003e\\n \\u003cli\\u003eAl Salmi I, Larkina M, Wang M, Subramanian L, Morgenstern H, Jacobson SH, et al. Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2018 Nov;72(5):634\\u0026ndash;43.\\u003c/li\\u003e\\n \\u003cli\\u003eSims J, Bennett PN, Ockerby C, Ludlow M, Fairbairn J, Wilson A, et al. The effect of holiday haemodialysis treatments on patient mood, adverse symptoms and subjective wellbeing using the Big Red Kidney Bus. Nephrology. 2017 Feb 8;22(2):107\\u0026ndash;13.\\u003c/li\\u003e\\n \\u003cli\\u003eTraouda V, Mpogiatzidis P. \\u0026ldquo;Dialysis and medical tourism. Investigating patients\\u0026rsquo; perceptions in Greece\\u0026rdquo;. Int J Hum Rights Healthc. 2021 Nov 23;14(5):411\\u0026ndash;25.\\u003c/li\\u003e\\n \\u003cli\\u003eBarnieh L, King-Shier K, Hemmelgarn B, Laupacis A, Manns L, Manns B. Views of Canadian Patients on or Nearing Dialysis and Their Caregivers: A Thematic Analysis. Can J Kidney Health Dis. 2014 Jan 1;1:4.\\u003c/li\\u003e\\n \\u003cli\\u003eWu PH, Lin MY, Huang TH, Lin YT, Hung CC, Yeh YC, et al. Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study. PLoS One. 2019 Jun 13;14(6):e0218335.\\u003c/li\\u003e\\n \\u003cli\\u003eBatakis D, Sidiropoulos S, Emmanouil-Kalos A, Fouskas T, Zopounidis C, Vozikis A. Medical Tourism in the Region of Crete, Greece: Perspectives from Healthcare Providers, Hotel Managers, and Medical Tourists. Sustainability. 2023 Dec 14;15(24):16822.\\u003c/li\\u003e\\n \\u003cli\\u003eLiyanage T, Toyama T, Hockham C, Ninomiya T, Perkovic V, Woodward M, et al. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health. 2022 Jan 25;7(1):e007525.\\u003c/li\\u003e\\n \\u003cli\\u003eNaing L, Nordin R Bin, Abdul Rahman H, Naing YT. Sample size calculation for prevalence studies using Scalex and ScalaR calculators. BMC Med Res Methodol. 2022 Dec 30;22(1):209.\\u003c/li\\u003e\\n \\u003cli\\u003eDavis LL. Instrument review: Getting the most from a panel of experts. Applied Nursing Research. 1992 Nov;5(4):194\\u0026ndash;7.\\u003c/li\\u003e\\n \\u003cli\\u003eGrant JS, Davis LL. Selection and use of content experts for instrument development. Res Nurs Health. 1997 Jun;20(3):269\\u0026ndash;74.\\u003c/li\\u003e\\n \\u003cli\\u003eVarughese S, Abraham G. Chronic Kidney Disease in India. Clinical Journal of the American Society of Nephrology. 2018 May;13(5):802\\u0026ndash;4.\\u003c/li\\u003e\\n \\u003cli\\u003eChan L, Tummalapalli SL, Ferrandino R, Poojary P, Saha A, Chauhan K, et al. The Effect of Depression in Chronic Hemodialysis Patients on Inpatient Hospitalization Outcomes. Blood Purif. 2017;43(1\\u0026ndash;3):226\\u0026ndash;34.\\u003c/li\\u003e\\n \\u003cli\\u003eCKD Evaluation and Management \\u0026ndash; KDIGO [Internet]. [cited 2022 Oct 25]. Available from: https://kdigo.org/guidelines/ckd-evaluation-and- management/\\u003c/li\\u003e\\n \\u003cli\\u003eHoliday Dialysis | No Stress, No Distress, Only Relax [Internet]. [cited 2022 Oct 25]. Available from: https://nephroplus.com/patients/holiday-dialysis/\\u003c/li\\u003e\\n \\u003cli\\u003eFresenius Kidney Care Dialysis Center Finder | Asia Pacific [Internet]. [cited 2022 Oct 25]. Available from:https://www.freseniuskidneycare.asia/dialysis-centers\\u003c/li\\u003e\\n \\u003cli\\u003eHome | Pradhan Mantri National Dialysis Programme, [Internet]. [cited 2022 Oct 25]. Available from: https://pmndp.nhp.gov.in/en\\u003c/li\\u003e\\n \\u003cli\\u003eHoliday dialysis with the Big Red Kidney Bus | Kidney Health Australia [Internet]. [cited 2022 Oct 25]. Available from:https://kidney.org.au/ways-we-help/big-red-kidney-bus\\u003c/li\\u003e\\n \\u003cli\\u003ePolit DF, Beck CT. Nursing research: Principles and methods. Lippincott Williams \\u0026amp;amp; Wilkins.2004.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Appendix\",\"content\":\"\\u003cp\\u003eAppendix 1 is not available with this version\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Renal replacement therapy, Holiday Haemodialysis, Red kidney bus, vacation. \",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4214086/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4214086/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground- \\u003c/strong\\u003eTraveling or going on vacation might cause dialysis patients to miss their dialysis schedules, thus adversely affecting their health. Hence, facilities must help dialysis patients access information regarding dialysis centres in other places. This study would help in understanding the problems faced regarding travel and dialysis centre accessibility and determine the needs of dialysis patients to travel or to go on vacation/family functions/business meetings.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods- \\u003c/strong\\u003eWe conducted a cross-sectional questionnaire survey in which all patients on dialysis who met our inclusion criteria were enrolled. The required data was collected using a self-developed questionnaire. Frequency was used for categorical variables and mean standard deviation/ Median and IQR were used to calculate continuous variables. The chi-square test was used to check patients' willingness to utilise Holiday haemodialysis facilities based on their age and duration since they are undergoing dialysis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e- Most patients (80.95%) had abstained entirely from travelling since the initiation of haemodialysis for multiple reasons. Among the remaining patients who go on vacation, the maximum duration and frequency was three days and 2-3 times a year. This was due to a lack of proper facilities to undergo dialysis at the travel destination. None of the patients in our centre knew about holiday haemodialysis facilities; when explained, many were willing to utilise them. Their willingness was dependent on their age group as well as the duration since they were undergoing dialysis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e- Holiday haemodialysis facilities should be developed and promoted in India to provide affordable and safe travelling experiences to people undergoing haemodialysis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTria registration\\u003c/strong\\u003e- \\\"\\u003cem\\u003eThis study protocol was reviewed and approved by [Kasturba Medical College and Kasturba Hospital institutional Ethics Committee - 2], approval number [\\u003c/em\\u003eEthical Approval Number-IEC2:30/2023, dated 27 April 2023 (Appendix 1)\\u003cem\\u003e]\\u003c/em\\u003e.\\\"\\u003c/p\\u003e\",\"manuscriptTitle\":\"Knowledge and attitude of patients on dialysis towards Holiday haemodialysis facilities and red kidney bus: A cross-sectional questionnaire-based survey study in an Indian setup. \",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-04-10 14:32:16\",\"doi\":\"10.21203/rs.3.rs-4214086/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"911c4055-30e0-4f54-a801-c9fb9c176d1e\",\"owner\":[],\"postedDate\":\"April 10th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-01-09T08:24:08+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-04-10 14:32:16\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4214086\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4214086\",\"identity\":\"rs-4214086\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}