Single-center cross-sectional study of outcomes in hemodialysis patients in Niger: experience from the hemodialysis center at Zinder National Hospital

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.