Predictors of in-hospital survival of patients initiated on hemodialysis at a tertiary hospital in a low income country: a retrospective study.

 

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Predictors of in-hospital survival of patients initiated on hemodialysis at a tertiary hospital in a low income country: a retrospective study.

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Survival rates in low-income countries remain poor, with scarce data on the predictors of in-hospital mortality, particularly during the early days of initiating hemodialysis therapy. We purposed to identify the in-hospital survival and predictors of hospital survival among patients initiated on hemodialysis in Uganda.
We retrospectively analyzed 172 medical records of adult patients who started hemodialysis (HD) at St. Francis Hospital, Nsambya between 2015 and 2022. We excluded those with renal transplants, missing records, or early referrals. We collected demographic, clinical, laboratory and treatment data. Survival analysis and Cox regression were used to estimate in-hospital survival and hazard ratios among variables respectively.
The overall in-hospital survival was 59.5% (102 out of 172 patient charts). Notably, 70.75% of all deaths occurred within the first two weeks after initiation oh hemodialysis. Patients were more likely to survive if they were younger with an age <60 years (HR 0.51, p=0.006), ward admission (HR 0.21, p<0.001), and had received a blood transfusion (HR 0.34, p<0.001). Patients were less likely to survive if they had reduced level of consciousness (HR 17.74, p<0.001), on mechanical ventilation (HR 2.46, p<0.001), and vasopressor use (HR 2.56, p<0.001)
There`s low in-hospital survival among patients initiated on hemodialysis especially in the first 2 weeks. Critically ill patients (on mechanical ventilation, vasopressors, or with altered consciousness) are less likely to survive. There`s an urgent need to optimize early management and critical care support for patients initiating hemodialysis to improve early in-hospital survival outcomes among hemodialysis patients in low-income countries.
Kewords