Predictors of Mortality among Patients with End-Stage Kidney Disease without Access to Dialysis in Resource-Limited Settings.

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Predictors of Mortality among Patients with End-Stage Kidney Disease without Access to Dialysis in Resource-Limited Settings.

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Co-author 1

Mukiza Ngemera mngemera@ymail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania *

Co-author 2

Daniel Msilanga pascodanny07@gmail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 3

Ali Azim ali.azimmo@gmail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 4

Upendo Nkwera upendonkwera51@gmail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 5

Jonathan Mngumi jonawilly01@gmail.com Muhimbili National Hospital Nephrology Dar es salaam Tanzania -

Co-author 6

Jacqueline Shoo shoojacqueline@gmail.com Muhimbili National Hospital Nephrology Dar es salaam Tanzania -

Co-author 7

Elizabeth Msangi lmsangi96@gmail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 8

Gudila Valentine gvshirima@gmail.com Muhimbili National Hospital Nephrology Dar es salaam Tanzania -

Co-author 9

Ewaldo Komba kombaewaldo@gmail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 10

Jackson Mlay mlay@mail.com Muhimbili University of Health and Allied Sciences Internal Medicine Dar es salaam Tanzania -

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Tanzania, like many sub-Saharan African (SSA) countries, faces limited access to kidney replacement therapy (KRT) due to economic and infrastructural constraints. As a result, many patients with end-stage kidney disease (ESKD) receive only basic medical care that falls short of structured Conservative Kidney Management (CKM). Evidence on outcomes and mortality predictors in this group remains scarce.

To evaluate short-term outcomes and identify predictors of 90-day mortality among ESKD patients receiving non-dialysis medical management at Muhimbili National Hospital (MNH), Tanzania.

Methods

We conducted a 90-day prospective cohort study among adults (≥18 years) with ESKD who were clinically eligible for hemodialysis but were not receiving it between October and December 2024. Baseline demographic, clinical, and laboratory data were collected using a structured tool. Survival was analyzed using Kaplan–Meier methods, and predictors of mortality were determined using Cox proportional hazards regression.

Results

We enrolled 172(median age 60years) ESKD patients. Hypertension (72.7%) and diabetes (36.6%) were the most common comorbidities. Anemia was present in 88.4%, and 73.1% of those with available results had low serum albumin levels. Hyperkalemia was documented in 30.2% of participants at baseline. During the 90-day follow-up, 41 deaths were recorded, corresponding to a mortality rate of 24.3%. In multivariate analysis, independent predictors of mortality included absence of monthly income (adjusted hazard ratio [aHR] 3.68, p = 0.031), difficulty in breathing at baseline (aHR 2.59, p = 0.020), history of cancer (aHR 4.71, p = 0.002), and hyperkalemia (aHR 2.34, p = 0.030).

Conclusion

These findings indicate that both socioeconomic disadvantage and clinical complications were associated with increased short-term mortality among ESKD patients unable to access dialysis. There is an urgent need for context-specific CKM guidance and policy interventions to support this underserved population in resource-limited settings.

Kewords