Epidemiology of End-Stage Renal Disease in Mogadishu, Somalia: First Report at a Tertiary Care Hospital

Abstract

Background End-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis. Patients and methods This cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed. Results The mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825–5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507–13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%. Conclusion The prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.

Relationship Between Nutritional Parameters and Quality of Life in Patients With End-Stage Kidney Disease on In-Centre Haemodialysis in Al-Ahsa, Saudi Arabia

“…In the Middle East, the overall combined prevalence of ESKD was calculated as 360 per million individuals. In Saudi Arabia, the prevalence is 540 per million individuals, of which 92.8% are on HD therapy [ 8 ].…”

HBV, HCV, and HIV Seroprevalence in Hemodialysis Patients Admitted to a Tertiary Care Hospital in Mogadishu, Somalia

“…Information on the prevalence of CKD and infection rates is limited in Somalia [5,11]. In a rare study conducted in Somalia and including 135 patients, among the dialysis-related factors associated with hospital readmission, the most common reason was reported to be uremic complication due to missed HD session in 40% of the cases (n=54), and the second most common cause was vascular access/catheter infection, which occurred in 20% of the patients (n=27) [5].…”

“…Limitations of the study include the possibility of missing seronegative patients due to the absence of molecular diagnostic tests and possible statistical errors associated with the comparison of very large and very small rates. The important risks were as follows; limitations in diagnosis and treatment opportunities [13,14], emergency responses to injuries related to ongoing conflict across the country [20], invasive procedures performed outside the hospital and under unsuitable conditions, missed HD sessions (insufficient information, incorrect social beliefs high costs of each HD session) [5].…”

Prevalence and Determinants of Hypothyroidism in Patients on Routine Hemodialysis in Somalia: A Cross-Sectional Study

“…2 The definition of end-stage kidney disease (ESKD) is glomerular filtration rate less than 15mL/min and a considerable decline in the kidney's capacity are both indicators of ESKD. 3 In ESKD patients, primary hypothyroidism is on the rise, and several changes in thyroid function have been well documented. Primary hypothyroidism can only be diagnosed with confidence if a plasma TSH level are elevated; testing for free T4 may be helpful, but is not always trustworthy.…”