Early mortality in patients with kidney failure starting chronic dialysis in Zambia: a retrospective cohort analysis

Abstract

Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality.

Burden of chronic kidney diseases and underlying causes in Zambia: evidence from the global burden of disease study 2019

“…Even though existing international hypertension guidelines have been shown effective, lack of adaptation to the Zambian setting and subsequent gaps in protocol implementation may be key drivers in poor hypertension care and resultant early-onset ESKD in Zambia [7,37,38]. Similar to our ndings, hypertension in Africa is resulting in much younger adults needing end of life care with dialysis, compared to high-income countries (HICs) [23,39]. Lack of screening for CKD/ESKD in hypertension and diabetes are missed opportunities for improving care as similar to hypertension, kidney disease often does not present with symptoms until very late stages.…”

“…Most concerning is the disparities seen in our analyses in number of DALYs for CKD by age group, with the highest burden occurring among adolescents aged 15-19 years. This is re ected as well at the young age of dialysis patients in Zambia; 66% of the Zambian dialysis population is < 50 years (compared to high income countries like the United States where < 20% of the dialysis population is < 50 years of age) [23][24][25][26]. One DALY represents the loss of the equivalent of one year of full health.…”