Annual Mortality Rate and Causes of Death in a Hemodialysis Unit at a Rural Community Hospital in Chile: A Retrospective Cohort Study

Introduction: Mortality among patients receiving chronic hemodialysis remains substantially higher than in the general population, with cardiovascular and infectious diseases as the leading causes of death. Data from rural, low-complexity community hospitals are limited. In geographically remote areas, factors such as long distances to higher-complexity referral centers and potential delays in access to specialized care may influence patient outcomes. This study aimed to determine the annual mortality rate and causes of death in a cohort of chronic hemodialysis patients treated at a rural community hospital in Chile. Methods: We conducted a retrospective cohort study including all adult patients receiving maintenance chronic hemodialysis at our center between January 1, 2025, and January 31, 2026, corresponding to a 13-month observation period. Transient patients who were temporarily dialyzed at our unit for less than two months before returning to their original dialysis center were excluded. Total patient-years were calculated, and mortality was expressed as deaths per 100 patient-years with 95% confidence intervals. Results: A total of 59 patients were included (mean age 65 ± 14.7 years; 69.4% male). During follow-up, 13 patients died, accounting for 53.45 patient-years. The overall mortality rate was 24.3 deaths per 100 patient-years (95% CI: 13.0-41.6). Cardiovascular causes accounted for 61.5% of deaths, infectious causes for 30.7%, and traumatic causes for 7.6%. Six patients initiated dialysis during the study period; in this subgroup, the mortality rate was 56.5 deaths per 100 patient-years. Conclusion: The observed mortality rate was slightly higher than rates reported in large international registries. Although limited by the small number of patients in a single rural dialysis unit, these findings underscore the importance of continued outcome monitoring in rural dialysis units and suggest that structural and geographic factors may influence patient survival.