Outcome of hemodialysis patients in one poorest country in the world: the Zinder experience.

Background/Objectives Chronic hemodialysis therapy is a well-recognized supportive therapy for patients with end-stage kidney disease. However, this therapy is poorly implemented in low-income countries due to its high cost. We herein report a single-center experience in one of the poorest countries in the world, i.e., Niger. Patients and methods: This is a cross-sectional study that included all incident patients presenting with serum creatinine greater than 1000 µmol/L (January 2018 to December 2022). They all agreed to be treated with self-funded chronic hemodialysis. Survival was evaluated as of December 2024. A total of 544 patients-initiated hemodialysis therapy. Among them, 423 (77.8%) underwent hemodialysis for less than 3 months: 240 (57%) died; 57 (13.5%) recovered renal function; and the others were lost to follow-up or decided to discontinue hemodialysis. Only 121 patients (22.2%) were able to embark on a chronic hemodialysis therapy program; most of them were males (sex ratio of 2.7). Their mean age was 48 years. Most (62%) were from rural areas. Additionally, 66% had low economic incomes, and 52% lived very far from our dialysis facility. Vascular access was predominantly a central venous catheter (75%). Non-adherence to hemodialysis was observed in 76% of patients. Dropouts and lost-to-follow-up occurred in 15.7% and 29% of cases, respectively. At the end of follow-up, only 10 patients (8.3%) were still alive. Conclusions These results question the utility of chronic hemodialysis in very low-income countries due to its high cost and significant mortality. Where possible, kidney transplantation abroad should be offered as supportive therapy as soon as it is known that there will be no renal recovery.