Introduction: The prevalence of end-stage renal disease (ESRD) is increasing, mimicking the epidemiology of diabetes and hypertension, exposure to agrochemicals, and low socioeconomic status. Despite the global increase in renal replacement therapies (RRT), 23% of patients in need of the services die before receiving RRT, the majority of whom located in Asia and sub-Saharan Africa (SSA). From 2005 through 2019, Tanzania, an SSA country, observed drastic improvements in RRT infrastructure and services, encompassing an increase in the number of nephrologists (i.e., 14-fold), hemodialysis (HD) units (i.e., 28-fold), the establishment of two local kidney transplant facilities, and a reduction in abroad referrals. However, challenges, including patients’ residence remoteness, restricted health insurance coverage, high costs, lack of renal registry, and shortage of published literature regarding service output evaluation, are still evident. Our study aimed to explore one-year survival and predictors of mortality among ESRD patients on HD attending a tertiary healthcare facility, the Benjamin Mkapa Hospital (BMH), in Tanzania.

Methods: This retrospective study was approved by the National Health Research Ethics Review Committee (NIMR/HQ/R.8a/Vol.IX/3545). Eligible patients were all-etiology-ESRD patients starting maintenance HD at BMH between October 2015 and June 2019. We required at least 210 patients. We excluded patients with acute kidney injury, missing data, and patients switching RRT modality before the study-completion. From eligible patients, we recorded demographic characteristics, physical examination findings, baseline laboratory results, comorbidities, and dialysis adequacy, and conducted a one-year follow-up. Outcome variables were deaths, if any, and the time-taken to deaths. We explored the one-year survival by the Kaplan-Maier survival analysis. We then performed univariate, followed by multivariate Cox-regression analysis to identify significant predictors of one-year mortality.

Results: 311 patients (Mean age=50.4years; Males=44.1%) were eligible. 90(28.9%) patients had died by the study’s end, 50(55%) of which within the first 3 months, and 62(68.8%) by the sixth month. Therefore, overall survival at 3 months, 6 months, and 1 year were 83.9%, 80.0%, and 71.1%, respectively. Patients with no formal education were more likely to die. ESRD due to hypertension had the worst mortality outcome. Patients with a high waist-hip circumference ratio had a higher risk of death, the Hazard ratio (HR) 2.83 (Confidence interval: 1.31, 6.12). Patients with normal or higher platelet levels had a lesser risk of deaths as compared to low levels. Increasing serum phosphorus levels from low to normal doubled the risk of deaths, HR 2.30 (CI: 1.20, 4.40).

Conclusions: One-year survival for ESRD patients on HD in Tanzania is 71.1%. The first 3 months of HD are associated with the highest risk of mortality. Education level, ESRD etiology, waist-hip circumference ratio, phosphorus, and platelet levels predict one-year mortality.

No conflict of interest

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