Etiology of Chronic Renal Failure in Hodeida, Yemen

Etiology of Chronic Renal Failure in Hodeida, YemenTo the Editor: The etiology of chronic kidney disease (CKD) in Yemen remains understudied, particularly in Hodeida, a conflict-affected coastal region burdened by limited health care infrastructure and a high infectious disease burden.Although global patterns are dominated by diabetes and hypertension, 1,2 we hypothesized that local environmental and socioeconomic factors might drive a different etiological profile in our region.We conducted a cross-sectional study of 272 hemodialysis patients at the Al-Sammad Medical Center, Hodeida (Supplementary Methods).Our findings revealed a striking etiological profile: unknown causes were dominant in 61.8% (n = 168), followed by obstructive or infectious uropathy in 22.4% (n = 61) (Table 1).This high prevalence of unknown etiology largely reflects the severe diagnostic limitations in our setting, including the unavailability of kidney biopsy, immunofluorescence, and genetic testing, precluding the confirmation of specific diagnoses, such as glomerulonephritis or interstitial nephritis.Traditional causes were markedly less prevalent, including hypertensive nephropathy (8.8%) and diabetic nephropathy (2.9%).The mean patient age was 42.9 13.1 years, indicating that CKD predominantly affects Yemen's economically active population (Supplementary Tables S1 andS2).Although hypertension was present in 79.4% of the cohort, it was identified as the primary etiology in only 8.8%.This discrepancy suggests that in the absence of histological confirmation, clinicians frequently classify hypertension as a secondary complication of CKD rather than the primary cause, potentially leading to underdiagnosis of hypertensive nephropathy in medical records.