Access to Hemodialysis in a Low-Income, Conflict-Affected Caribbean Country. Updated Report from Haiti

Low-resource countries face significant challenges in providing kidney replacement therapies (KRT), particularly for patients with end-stage kidney disease (ESKD). ESKD patients in Haiti, a country affected by ongoing armed conflicts, face even greater struggles regarding access to KRT. Port-au-Prince, the country’s capital, has a population of 1.2 million as of 2021, with at least 65% of residents over the age of 18 years. The reported average annual salary is equivalent to $ 1,760 USD, with 69% of the population living in extreme poverty with less than $1 USD per/day. Despite the absence of formal registries, a recent population-based study estimated a 2 % prevalence of chronic kidney disease (CKD), defined as an eGFR <60 mL/min/1.73m² [Nicholas S Robert et al. CJASN 2023, PMID 37081617]. Currently, neither peritoneal dialysis nor kidney transplantation are available, leaving hemodialysis (HD) as the only available option of KRT. In Port-au-Prince, seven centers provide HD. Given the difficult circumstances, no comprehensive overview of HD resources exist. We attempted to mitigate this knowledge gap by collecting data from some of the HD centers located in Port-au-Prince.

We developed a short questionnaire using Microsoft Forms, consisting of 16 questions. Between September 1, 2024, and October 20, 2025, the questionnaire was distributed via mobile phones to the primary nephrologists and internists at healthcare centers around Port-au-Prince that offer HD. The questions focused on gathering information about the HD equipment, patient demographics, and available human resources. Center identifiers were anonymized. Responses were extracted into an Excel file and analyzed descriptively.

There are six HD centers in Port-au-Prince, and Cap-Haitien. Currently, five centers provide private service for HD treatments.  An armed conflict has forced the sixth public center to close since physical access was no longer possible. The five accessible centers each have an average of six functional HD machines, with a mean of 14 patients per center. The youngest patients have a mean age of 23 years. The average out of pocket cost per HD session is $110 USD, while at the currently closed public center, it is $20 USD, as the Health Ministry covers the remaining costs. One of the centers offer erythropoiesis-stimulating agent (ESA) treatment. The number of weekly HD sessions depends on patient’s ability to pay, ranging between 1 to 3 times weekly. The most common vascular access is the arteriovenous fistula (AVF), though jugular and femoral catheters are also regularly used. Overall, the five functional centers report an average patient duration on HD of 12 months. Internal medicine doctors and nurses are the primary healthcare providers.

With an estimated adult population of 780,000 in Port-au-Prince and a previously reported chronic kidney disease (CKD) prevalence of 2%, at least 15,000 adults in the metropolitan area may have CKD. Our partial report reveals a total of 29 machines across five functional HD centers in Port-au-Prince and Cap-Haitien in the north of the country, with Port-au-Prince being the most populated area in Haiti. Given this limited capacity, meeting the needs of the Haitian ESKD patients seems far from achievable. Pediatric patients, in particular, face even fewer opportunities for KRT, neither for acute nor chronic conditions. Urgent action is needed, including data collection and the establishment of registries, to better understand the disease burden in Haiti, especially within the context of an ongoing armed conflict. Support from international non-governmental organizations (NGOs) is crucial to address this significant unmet need.

A previous version of this abstract was presented at the ERA 2025 meeting in Vienna. This is an updated report.