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Abstract
Introduction. End-stage kidney disease imposes a growing burden in Sub-Saharan Africa. Data from newly established regional hemodialysis units are absent from the literature. The hemodialysis unit of the Ngaoundéré Regional Hospital, inaugurated in December 2022, is the only public renal replacement therapy facility for approximately two million inhabitants in Adamawa region (Cameroon). Methods. Retrospective longitudinal descriptive study covering 2023–2025, compliant with the STROBE statement. Data were extracted through systematic triangulation of three independent institutional administrative sources. Annual comparisons of proportions used two-sample z-tests; crude annual mortality rates (deaths per 100 enrolled patients) and mortality rate ratios were compared using Poisson's exact test with Byar confidence intervals; the monthly distribution of deaths was tested using the chi-square goodness-of-fit test. A p<0.05 was the significance threshold. Results. Total dialysis sessions increased from 1,500 (2023) to 3,873 (2025; +158%). The session completion rate improved from 86.9% to 99.3% (p<0.001). The crude annual mortality rate fell from 32.5% (2023) to 23.6% (2025). Expressed per 100 patient-years, mortality decreased from 67.6 to 25.9 (rate ratio 0.38; 95% CI: 0.23–0.65). Patient retention improved from 75.3% to 90.6% (p=0.014). AVF use among chronic dialysis patients increased from 27.0% to 52.6%. AVF infections were eliminated (p=0.040, Fisher exact). Male predominance was consistent (sex ratio 2.36:1 in 2025); patients aged ≥46 years represented 50% of new admissions and 90% of deaths. Triple comorbidity (CKD+hypertension+diabetes) nearly doubled (28→55 cases; p<0.001) in 3 years. Conclusion. A Cameroonian regional hemodialysis unit in a constrained setting can achieve consistent improvement from its first year of operation across all major clinical indicators, while tripling its chronic patient load. Seasonal mortality clustering and increasing comorbidity burden (hypertension and diabetes) require structured prospective surveillance.
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References
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- 2. Stanifer, J. W., Muiru, A., Jafar, T. H., & Patel, U. D. (2016). Chronic kidney disease in low-and middle-income countries. Nephrology Dialysis Transplantation, 31(6), 868-874.
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- 4. Mambap, A. T., Ngum, S. C., Teuwafeu, D. G., & Ashuntantang, G. E. (2021). Clinical Spectrum and Outcome of Renal and Urine Tract Disease among Medical Admissions at the Bamenda Regional Hospital-Cameroon: A 2-Years Review. Health Sciences and Disease, 22(11).
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- 8. Cheuyem, F. Z. L., Ajong, B. N., Amani, A., Boukeng, L. B. K., Ngos, C. S., Nkongo, F. K., ... & Mouangue, C. (2024). Sustainable Development Goals and Health Sector Strategic Indicators Assessment in Cameroon: A Retrospective Analysis at Regional and National Levels. medRxiv, 2024-11.
- 9. Smart, N. A., & Titus, T. T. (2011). Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. The American journal of medicine, 124(11), 1073-1080.
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- 11. Kaze, F. F., Kengne, A. P., Mambap, A. T., Halle, M. P., Mbanya, D., & Ashuntantang, G. (2015). Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting. African health sciences, 15(1), 253.
- 12. Flythe, J. E., Kimmel, S. E., & Brunelli, S. M. (2011). Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney international, 79(2), 250–257.
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- 14. Fouda, H., Ashuntantang, G., Kaze, F., & Halle, M. P. (2017). Survival among chronic hemodialysed patient in Cameroon. The Pan African medical journal, 26, 97.
- 15. Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., & Foundation, N. K. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4), S1-S164.
- 16. Halle, M. P., Tsinga, L., Fottsoh, A. F., Kaze, F. F., Sone, A. M., & Ashuntantang, G. (2017). Does timing of nephrology referral influence outcome among patients on maintenance hemodialysis in Cameroon?. Health Sciences and Disease, 18(3).
- 17. Teuwafeu, D. G., Sehbing, M., Halle, M. P., Mahamat, M., Fouda, H., & Ashuntantang, G. (2024). Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon. BMC nephrology, 25(1), 335.
- 18. Afkarian, M., Sachs, M. C., Kestenbaum, B., Hirsch, I. B., Tuttle, K. R., Himmelfarb, J., & de Boer, I. H. (2013). Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology, 24(2), 302-308.
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References
1. Yi, T., O'Hara, D. V., & Levin, A. (2026). Global kidney health: Are we failing the silent pandemic?. Journal of Internal Medicine.
2. Stanifer, J. W., Muiru, A., Jafar, T. H., & Patel, U. D. (2016). Chronic kidney disease in low-and middle-income countries. Nephrology Dialysis Transplantation, 31(6), 868-874.
3. Aseneh, J. B., Kemah, B. L. A., Mabouna, S., Njang, M. E., Ekane, D. S. M., & Agbor, V. N. (2020). Chronic kidney disease in Cameroon: a scoping review. BMC nephrology, 21(1), 409.
4. Mambap, A. T., Ngum, S. C., Teuwafeu, D. G., & Ashuntantang, G. E. (2021). Clinical Spectrum and Outcome of Renal and Urine Tract Disease among Medical Admissions at the Bamenda Regional Hospital-Cameroon: A 2-Years Review. Health Sciences and Disease, 22(11).
5. Halle, M. P., Takongue, C., Kengne, A. P., Kaze, F. F., & Ngu, K. B. (2015). Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon. BMC nephrology, 16(1), 59.
6. Halle, M. P., Ashuntantang, G., Kaze, F. F., Takongue, C., & Kengne, A. P. (2016). Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon. BMC nephrology, 17(1), 165.
7. Naicker, S. (2003). End-stage renal disease in sub-Saharan and South Africa. Kidney International, 63, S119-S122.
8. Cheuyem, F. Z. L., Ajong, B. N., Amani, A., Boukeng, L. B. K., Ngos, C. S., Nkongo, F. K., ... & Mouangue, C. (2024). Sustainable Development Goals and Health Sector Strategic Indicators Assessment in Cameroon: A Retrospective Analysis at Regional and National Levels. medRxiv, 2024-11.
9. Smart, N. A., & Titus, T. T. (2011). Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. The American journal of medicine, 124(11), 1073-1080.
10. Moussa, O., Hamza, G., Ariane, E., Sandrine, C., Lionel, T., Atikou, I., & Mathurin, N. (2026). World Kidney Day as a Platform for Action: Early Outcomes of a Vascular Access Mission in Sub-Saharan Africa. Cureus, 18(3).
11. Kaze, F. F., Kengne, A. P., Mambap, A. T., Halle, M. P., Mbanya, D., & Ashuntantang, G. (2015). Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting. African health sciences, 15(1), 253.
12. Flythe, J. E., Kimmel, S. E., & Brunelli, S. M. (2011). Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney international, 79(2), 250–257.
13. Halle, M. P., Nelson, M., Kaze, F. F., Jean Pierre, N. M. O., Denis, T., Fouda, H., & Ashuntantang, E. G. (2020). Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: an example from Cameroon. Renal Failure, 42(1), 1022-1028.
14. Fouda, H., Ashuntantang, G., Kaze, F., & Halle, M. P. (2017). Survival among chronic hemodialysed patient in Cameroon. The Pan African medical journal, 26, 97.
15. Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., & Foundation, N. K. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4), S1-S164.
16. Halle, M. P., Tsinga, L., Fottsoh, A. F., Kaze, F. F., Sone, A. M., & Ashuntantang, G. (2017). Does timing of nephrology referral influence outcome among patients on maintenance hemodialysis in Cameroon?. Health Sciences and Disease, 18(3).
17. Teuwafeu, D. G., Sehbing, M., Halle, M. P., Mahamat, M., Fouda, H., & Ashuntantang, G. (2024). Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon. BMC nephrology, 25(1), 335.
18. Afkarian, M., Sachs, M. C., Kestenbaum, B., Hirsch, I. B., Tuttle, K. R., Himmelfarb, J., & de Boer, I. H. (2013). Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology, 24(2), 302-308.
19. Arogundade, F. A., & Barsoum, R. S. (2008). CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental, and community support. American Journal of Kidney Diseases, 51(3), 515–523.