<i>Retrospective Cohort Study: </i>Predictors of One-Year Mortality in Hemodialysis Patients with End-Stage Renal Disease at a Kenyan County Hospital

BACKGROUND In Kenya, end-stage renal disease is a significant public health burden treated primarily with hemodialysis in county hospitals, yet comprehensive outcome data from these routine settings are 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 hospital electronic medical records and dialysis unit records. Cox proportional hazards regression was used to identify factors associated with one-year mortality. RESULTS Of 79 patients analysed (median age 62.0 years, IQR 48.0-74.0; 65.8% male), the one-year all-cause mortality rate was 34.2% (27/79). The cohort demonstrated a heavy reliance on central venous catheters (89.9%, 71/79) rather than arteriovenous fistulas (10.1%, 8/79). 3 Non-survivors were significantly older (median 73.0 vs 58.0 years, p&lt;0.001) and had lower baseline haemoglobin (7.1 vs 8.6 g/dL, p=0.008). In multivariable analysis, older age (aHR 1.05 per year, 95% CI 1.01-1.09, p=0.012) and central venous catheter use (aHR 3.12, 95% CI 1.08-9.01, p=0.036) remained independent predictors of mortality. Lower eGFR and hemoglobin were significant in univariate analysis but not in the adjusted model. Comorbidities, including HIV and diabetes, did not reach statistical significance. CONCLUSION This study found high one-year mortality in Kenyan hemodialysis patients, with older age and catheter use showing strong associations with death. The near-universal use of CVCs is a marker of systemic challenges in pre-dialysis care, underscoring the urgent need for vascular access programs and improved care strategies to improve survival.