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

doi:10.5527/wjn.v15.i2.118111

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Publication Name

World Journal of Nephrology

ISSN

2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Jun 25, 2026; 15(2): 118111
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118111

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

Felix Pius Omullo, Thomas Kimanzi Kitheghe, Maureen Mueni Mark, Allan Kariuki Ng’ang’a, Magdalene Wanjiru Parsimei, Wambugu Charles Kanyi, Ooko Anyang’o Emma, Ismail Abdi Sheikh, Joshua Macharia Gitumu, Abel Mwangi Gakuya, Glory Kawira Gitonga, John Alex Ndung’u, Elisheba Moraa Nyaro

Author contributions: Omullo FP and Kitheghe TK conceptualized and designed the study; Omullo FP, Kitheghe TK, Mark MM, and Ng’ang’a AK were responsible for data curation and formal analysis; Mark MM, Parsimei MW, Kanyi WC, Emma OA, and Sheikh IA participated in investigation and methodology; Omullo FP wrote the original draft; Omullo FP, Kitheghe TK, Gitumu JM, Gakuya AM, Gitonga GK, Ndung’u JA, and Nyaro EM participated in the review and editing of the manuscript; all authors reviewed and approved the final manuscript.

AI contribution statement: The advanced version of Grammarly and ChatGPT (GPT-4, used as an advanced grammar/language optimization tool) were employed. They were solely utilized for language polishing and writing assistance. Grammarly was used for checking grammar, punctuation, and conciseness. ChatGPT was only used to rephrase certain sentences to enhance readability, clarity, and academic quality. These operations were carried out after the author completed the draft of the manuscript. No artificial intelligence tools were used for data analysis (all statistical analyses were completed by the author in R software). No AI image generation tools were used.

Institutional review board statement: The study was reviewed and approved by the Murang’a County Referral Hospital Ethics Committee.

Informed consent statement: Informed consent was waived for this study due to its retrospective design and the use of anonymized patient data, as approved by the ethics committee.

Conflict-of-interest statement: All authors have no conflicts of interest to disclose relevant to this study.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The de-identified datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Felix Pius Omullo, MD, Senior Researcher, Department of Internal Medicine and Critical Care, Murang’a County Referral Hospital, Kiharu Township, Murang’a 69-10200, Central, Kenya. piuskirasia@gmail.com

Received: December 26, 2025
Revised: February 9, 2026
Accepted: April 22, 2026
Published online: June 25, 2026
Processing time: 172 Days and 1.5 Hours

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.

Keywords: End-stage renal disease; Hemodialysis; Central venous catheter; Kenya; Predictors; Vascular access

Core Tip: This retrospective cohort study from a Kenyan county hospital identifies a high one-year mortality rate (34.2%) among incident hemodialysis patients. Advanced age and central venous catheter (CVC) use were the only independent predictors of mortality. With CVC use exceeding 89%, our findings reveal a critical “catheter-first” systemic failure. This underscores an urgent need for decentralized vascular access programs and earlier nephrology referrals to shift toward arteriovenous fistulas and improve patient survival in resource-limited settings.