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Background <p>End-stage renal disease poses a catastrophic health burden in low-income countries, where access to life-saving hemodialysis (HD) is limited and outcomes are poorly characterized. This study provides the first survival analysis from a public hemodialysis center in South Ethiopia, a region with profound healthcare constraints.</p> Objective <p>To determine survival rates and predictors of mortality among chronic kidney disease (CKD) patients on hemodialysis in Southern Ethiopia.</p> Methods <p>A retrospective cohort study was conducted among 241 adult CKD patients who initiated maintenance hemodialysis between October 1, 2019, and September 30, 2023, at a tertiary hospital in South Ethiopia. Data were extracted from medical records, entered into EpiData, and analyzed with STATA 14. Mortality incidence was calculated per 100 person-years, and survival probabilities were estimated using life tables. Predictors were identified via multivariable Cox proportional hazards regression.</p> Results <p>Of 241 patients, 142 (58.9%) died during a median follow-up of 283 days (IQR: 185-412), contributing 81,618 person-days of observation. The overall mortality rate was 63.5 deaths per 100 person-years (95% CI:54-74.8). The median survival time was 298 days (95% CI: 260-342 days), with cumulative survival probabilities of 47.6% at 12 months and 13.8% at 36 months. Independent predictors of mortality included hypertension-attributed CKD (AHR=2.43, 95%CI: 1.26-3.68; p&lt;0.001). The presence of one or more comorbidities (cardiovascular disease, chronic infection, diabetes, or malignancy) was associated with mortality (AHR = 9.78, 95% CI: 6.15-14.21; P = 0.002), central venous catheter use for vascular access (AHR=2.00, 95% CI: 1.27-3.14; p = 0.003), and inadequate total weekly dialysis hours (&lt;6 hours/week: AHR = 2.42, 95% CI: 1.52-3.89; p&lt;0.001; 6-8 hours/week: AHR =1.87, 95% CI: 1.08-3.24; p= 0.026, compared to ≥ 12 hours/week).</p> Conclusion <p>This study reveals critically low survival among hemodialysis patients in Southern Ethiopia, with median survival under one year and only 13.8% surviving to 36 months. Independent predictors of mortality: comorbid conditions, central venous catheters use, hypertension-attributed CKD, and inadequate weekly dialysis hours, are modifiable health system factors. These findings underscore an urgent need for policies promoting early CKD detection, timely AVF creation, adequate dialysis dosing, and integrated comorbidity management in resource-limited settings.</p>

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Survival and Predictors of Mortality in Hemodialysis Patients: A 4-year Retrospective Cohort Study from Southern Ethiopia

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Tigistu Kolcha Balango,
  • Shemisu Nuriye,
  • Bereket Yohannes Kabalo,
  • Mengistu Garbo,
  • Temesgen Anjulo Ageru

摘要

Background

End-stage renal disease poses a catastrophic health burden in low-income countries, where access to life-saving hemodialysis (HD) is limited and outcomes are poorly characterized. This study provides the first survival analysis from a public hemodialysis center in South Ethiopia, a region with profound healthcare constraints.

Objective

To determine survival rates and predictors of mortality among chronic kidney disease (CKD) patients on hemodialysis in Southern Ethiopia.

Methods

A retrospective cohort study was conducted among 241 adult CKD patients who initiated maintenance hemodialysis between October 1, 2019, and September 30, 2023, at a tertiary hospital in South Ethiopia. Data were extracted from medical records, entered into EpiData, and analyzed with STATA 14. Mortality incidence was calculated per 100 person-years, and survival probabilities were estimated using life tables. Predictors were identified via multivariable Cox proportional hazards regression.

Results

Of 241 patients, 142 (58.9%) died during a median follow-up of 283 days (IQR: 185-412), contributing 81,618 person-days of observation. The overall mortality rate was 63.5 deaths per 100 person-years (95% CI:54-74.8). The median survival time was 298 days (95% CI: 260-342 days), with cumulative survival probabilities of 47.6% at 12 months and 13.8% at 36 months. Independent predictors of mortality included hypertension-attributed CKD (AHR=2.43, 95%CI: 1.26-3.68; p<0.001). The presence of one or more comorbidities (cardiovascular disease, chronic infection, diabetes, or malignancy) was associated with mortality (AHR = 9.78, 95% CI: 6.15-14.21; P = 0.002), central venous catheter use for vascular access (AHR=2.00, 95% CI: 1.27-3.14; p = 0.003), and inadequate total weekly dialysis hours (<6 hours/week: AHR = 2.42, 95% CI: 1.52-3.89; p<0.001; 6-8 hours/week: AHR =1.87, 95% CI: 1.08-3.24; p= 0.026, compared to ≥ 12 hours/week).

Conclusion

This study reveals critically low survival among hemodialysis patients in Southern Ethiopia, with median survival under one year and only 13.8% surviving to 36 months. Independent predictors of mortality: comorbid conditions, central venous catheters use, hypertension-attributed CKD, and inadequate weekly dialysis hours, are modifiable health system factors. These findings underscore an urgent need for policies promoting early CKD detection, timely AVF creation, adequate dialysis dosing, and integrated comorbidity management in resource-limited settings.