Predictors of one-year mortality in hemodialysis patients with end-stage renal disease at a Kenyan county hospital.

Abstract

Background: In Kenya, end-stage renal disease (ESRD) poses a significant public health burden. While hemodialysis is primarily delivered through county hospitals, comprehensive outcome data from these routine clinical settings remain scarce.

Aim: To evaluate one-year clinical outcomes and identify independent predictors of mortality among ESRD patients undergoing hemodialysis at a Kenyan county hospital.

Methods: We conducted a retrospective cohort study of all patients who initiated hemodialysis for ESRD at Murang'a County Referral Hospital between January 2024 and January 2025. Data on demographics, clinical characteristics, comorbidities, and treatment parameters were extracted from electronic medical records and dialysis unit logs. Cox proportional hazards regression was used to identify factors associated with one-year mortality.

Results: Among 79 patients analyzed [median age 62.0 years, interquartile range (IQR) 48.0-74.0; 65.8% male], the cumulative all-cause mortality rate during the study period was 34.2% (27/79). The cohort demonstrated a heavy reliance on central venous catheters (CVCs) (89.9%, 71/79) rather than arteriovenous fistulas (10.1%, 8/79). Non-survivors were significantly older (median 73.0 years vs 58.0 years, P < 0.001) and had lower baseline hemoglobin (7.1 g/dL vs 8.6 g/dL, P = 0.008). In multivariable analysis, older age [adjusted hazard ratio (aHR) = 1.05 per year, 95%CI: 1.01-1.09, P = 0.012] and CVC use (aHR = 3.12, 95%CI: 1.08-9.01, P = 0.036) remained independent predictors of mortality. While lower baseline hemoglobin and estimated glomerular filtration rate were significant in univariate analysis, they lost significance after adjustment. Comorbidities, including human immunodeficiency virus and diabetes, were not statistically significant predictors.

Conclusion: Mortality among hemodialysis patients in this Kenyan cohort is high, with older age and CVC use strongly associated with poorer survival. The near-universal reliance on CVCs highlights systemic challenges in pre-dialysis care, underscoring the urgent need for robust vascular access programs and early intervention strategies to improve patient outcomes.