Mortality and its predictors among patients undergoing hemodialysis in Ethiopia: A systematic review and meta-analysis

Abstract

Background: Patients are forced to discontinue therapy due to unaffordable hemodialysis costs in low-income countries, which frequently results in death.Despite numerous primary studies on the mortality rate and predictors among hemodialysis patients, their results are inconsistent.Objective: This study aims to estimate mortality and its predictors among patients undergoing hemodialysis in Ethiopia.Method: Eligible articles were selected using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist.Studies were searched in PubMed, Web of Science, Google Scholar, and the Cochrane Review database.The quality of each article was assessed for risk of bias using the Joanna Briggs Institute's checklist.A random-effects model was employed to calculate the pooled effect size of mortality.Heterogeneity was assessed with the I 2 test, and publication bias was evaluated using a funnel plot and Egger's regression test.The protocol has been registered in an international prospective register of systematic reviews (PROSPERO) under the ID CRD42024551789.Result: This review included seven primary studies, comprising a total of 1629 patients.The pooled mortality prevalence was 30.9 % (95 % CI: 25.23 %-36.56 %).Factors significantly associated with mortality among hemodialysis patients included age >60 years [adjusted hazard ratio (AHR) 3.12, 95 % CI: 2.23-4.01], the presence of a central venous catheter (AHR: 3.91, 95 % CI: 2.3-5.52), and infection (AHR: 2.89, 95 % CI: 1.8-3.98). Conclusion:The pooled mortality among hemodialysis patients was considerably high.Older age, central venous access, and infection were identified as independent predictors of mortality.Therefore, preventing infections and minimizing the use of central venous catheters are crucial to reduce associated complications and mortality.