Chronic hemodialysis is a well-established supportive therapy for patients with end-stage kidney disease. However, this therapy is rarely implemented in low-income countries because of its high cost. We herein report a single-center experience in one of the poorest countries in the world, i.e., Niger, involving patients in whom hemodialysis was initiated. This cross-sectional study included all incident patients presenting with serum creatinine levels greater than 1000 µmol/L between January 2018 and December 2022. All patients agreed to undergo self-funded chronic hemodialysis. Survival was assessed 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 either lost to follow-up or decided to discontinue hemodialysis. Only 121 patients (22.2%) who had undergone hemodialysis for the first 3 months were able to embark on a chronic hemodialysis program; most were male (sex ratio, 2.7). Their mean age was 48 years. Most patients (62%) were from rural areas. Additionally, 66% had low income, and 52% lived very far from the dialysis facility. Vascular access was predominantly a central venous catheter (75%). Non-adherence to hemodialysis was observed in 76% of patients. Dropouts and loss 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. These findings call into question the utility of chronic hemodialysis in very low-income countries given its high cost and substantial mortality. When feasible, kidney transplantation abroad should be considered as supportive therapy as soon as the absence of renal recovery is established.
Diongolé. et al. (Thu,) studied this question.