Early Mortality (120 Days) amongst Incident Hemodialysis with End Stage Kidney Disease: A 5-Year Retrospective Study

Abstract

Background: End stage kidney failure (ESKF) is a major public health problem worldwide. Haemodialysis is the principal method in its management, and is associated with high mortality mostly owing to cardiovascular disease (CVD). In Cameroon, data on its predictors is lacking. Objectives: This study aimed at determining the 120 day mortality, causes of death and its predictors and amongst incident haemodialysis patients with end stage kidney disease in Cameroon. Methods: We retrospectively reviewed medical records of patients admitted for ESKF who started haemodialysis between January 2016 and December 2020 (5 years) and who died within 120 days. For these patients, the variables collected were: age, gender, comorbidities, dialysis parameters, para-clinical parameters, cause of death. The causes of death were registered as stated by the attending physician. Data were analysed using SPSS 20. A p-value < 0.05 was considered significant. Results: Out of 1012 incident patients, 258 died giving a mortality rate of 25.5%. Of these, 59.7% were males. The mean age (SD) was 46.52 (15.6) years. The main causes of death included sepsis (45.61%), CVD (12.86%), and severe anaemia (9.94%); and were comparable between males and females except for anaemia which was more prevalent in females (p = 0.003). Catheters related infections (77.9%), and chest infections (9.0%) were the main sources of sepsis while sudden death (76.2%), myocardial infarction (9.5%), and heart failure (9.5%) were the main cardiovascular causes of death. Hypertension (65%), CVD (35.6%), and diabetes (9.19%) were the main comorbidities associated to death. The main vascular access was central venous catheter 96%. CVD (p = 0016, aOR; 4.107), Albumin ≤ 3.5 g/dl (p = 0.015, aOR; 23.083), and Creatinine > 20 mg/dl (p = 0.024, aOR; 5.649) were independent predictors of mortality. Conclusion: One in four patients on haemodialysis died early. CVD, hypoalbuminemia and late initiation were predictors of mortality. Majority of patients die from preventable causes, with sepsis from catheter being the most frequent.