Clinical Indications for Dialysis: A study of patient Demographics and Outcomes at Hargeisa Group Hospital

Clinical Indications for Dialysis: A study of patient Demographics and Outcomes at Hargeisa Group Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Indications for Dialysis: A study of patient Demographics and Outcomes at Hargeisa Group Hospital Naema Ibrahim, Abdikani Abdikadir, Abdirahman Omer Ali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5301809/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Chronic kidney disease (CKD) is a significant global health concern, with end-stage renal disease (ESRD) requiring dialysis or transplantation for survival. Data on clinical indications for dialysis initiation in resource-limited settings like Somaliland are scarce. This study aimed to identify the primary clinical indications for dialysis at Hargeisa Group Hospital in Somaliland. Methods: A retrospective cross-sectional study was conducted using medical records of 123 patients undergoing hemodialysis from May 2022 to August 2024. Demographic and clinical data, including indications for dialysis initiation, were analyzed using descriptive statistics. Results: Uremic syndromes, particularly uremic gastritis and uremic encephalopathy, were the most prevalent reasons for dialysis initiation. These findings differed from previous studies in developed countries, highlighting potential regional variations in CKD presentation and access to care. Significant disparities in dialysis indications across regions were observed, with Maroodijeex accounting for the majority of cases. Discussion: The study highlights the significant burden of CKD in Somaliland and the need for improved early detection and management. The findings have important implications for strengthening primary care services, investing in infrastructure and personnel, promoting equitable access to dialysis, and fostering collaborative partnerships to address the growing burden of CKD. Conclusion: This study provides valuable insights into the clinical indications for dialysis in Somaliland, emphasizing the need for a multifaceted approach to address the growing burden of CKD in the region. Strengthening primary care, investing in infrastructure, promoting equitable access, and fostering partnerships are crucial for improving kidney care and achieving better health outcomes for patients. Chronic kidney disease End-stage renal disease Dialysis Public health Introduction and Background Chronic kidney disease (CKD) is a significant global health issue. The Kidney Disease Improving Global Outcomes (KDIGO) defines CKD as an abnormality in kidney function or structure, often assessed using estimated glomerular filtration rate (eGFR) [ 1 ]. CKD is characterized by a progressive and irreversible loss of kidney function or damage that occurs over months to years. The final stage of CKD, known as end-stage renal disease (ESRD), involves a severe decline in kidney function, requiring renal replacement therapy (RRT) such as dialysis or transplantation for survival [ 2 ]. Many CKD patients advance to kidney failure, necessitating permanent RRT or transplantation [ 3 ]. Geographic disparities exist in CKD [ 4 ]. Epidemiological research on CKD faces three primary challenges: inconsistency in formulas for estimating incidence and prevalence in early stages, defining CKD solely by eGFR without considering albuminuria, and limited data on advanced CKD due to reliance on ESRD registries that only track populations undergoing RRT [ 5 ][ 6 ][ 7 ]. In the United States, CKD is increasingly prevalent, affecting approximately 24–28 million people, with an additional 20 million undiagnosed or at risk [ 8 ][ 9 ]. In Sub-Saharan Africa, CKD prevalence is estimated at around 13.9% [ 10 ]. Annually, over 115,000 patients with chronic kidney failure begin maintenance dialysis therapy in the U.S. This transition is a particularly vulnerable period, with annual mortality rates for CKD stage 5 patients reaching 20% during the first year of dialysis [ 11 ]. Understanding risk factors for adverse outcomes during this critical phase is essential [ 12 ]. The rise in type 2 diabetes mellitus and other CKD risk factors has underscored CKD as a global public health concern [ 13 ]. In Somalia, due to war and poverty, healthcare facilities are underdeveloped, and most people lack basic services, resulting in high morbidity and mortality rates [ 14 ]. Hypertension and diabetes mellitus are the main CKD risk factors in both developed and developing countries [ 15 ]. Extreme poverty exacerbates the burden of ESRD [ 16 ] [ 17 ]. Without early detection and proper management, kidney function can rapidly decline to failure [ 18 ]. Preventative care before kidney failure onset is crucial to mitigate progression and associated mortality [ 19 ][ 20 ]. In Somalia, premature mortality significantly affects individuals with kidney failure [ 21 ]. The threshold for the estimated glomerular filtration rate (eGFR) at which individuals begin to experience symptoms and signs of kidney dysfunction varies widely. However, severe symptoms typically do not manifest until the eGFR declines below 10 mL/min/1.73 m². Symptoms can be categorized into absolute and common indications for initiating dialysis. Absolute indications encompass conditions such as uremic pericarditis, uremic encephalopathy, and bleeding diathesis. Common indications for starting dialysis include malnutrition, persistent fluid overload, significant fatigue and weakness, impaired cognitive function, refractory acidosis, hyperkalemia, and hyperphosphatemia.[ 22 ] In resource-limited settings like Somaliland, particularly at Hargeisa Group Hospital, dialysis is crucial for managing renal failure as renal transplantation is unavailable. Despite increasing demand for this life-saving intervention, data on clinical conditions necessitating dialysis in the region are scarce. Understanding these indications is vital for revealing disease patterns, enhancing patient management, and optimizing resource allocation. This study aims to identify the primary clinical indications for dialysis at Hargeisa Group Hospital, focusing on conditions like metabolic acidosis, pulmonary edema, and uremic syndromes. By analyzing this data, the research seeks to uncover common causes for dialysis, highlight regional variations, and identify gaps in early detection and management of renal complications. This information will aid health authorities in developing appropriate kidney care services, improving care protocols, and achieving better health outcomes for renal disease patients in the region. Methods This study aimed to assess the clinical indications for dialysis among patients treated at Hargeisa Group Hospital in Somaliland, a key healthcare facility serving a diverse population with varying health needs. The study utilized a cross-sectional design, collecting data from May 2022 to August 2024. Study Population, settings and design The study was conducted at Hargeisa Group Hospital, a major healthcare facility in Somaliland. It employed a cross-sectional design, collecting data from patients receiving hemodialysis during the study period. Sample Size The study included a total of 123 patients. Inclusion Criteria: Patients were eligible for inclusion if they were : Diagnosed with kidney failure. On regular hemodialysis. Over 18 years old. Exclusion Criteria: Patients were excluded if they : Had known acute kidney injury (AKI) on dialysis. Were under 18 years old. Had incomplete medical records. Had undergone a failed kidney transplant and were on dialysis. Data collection Method Data were collected retrospectively through a review of patient medical records. Data Collection Form A standardized data collection form was used to extract information about Demographic details : Age, gender and location Clinical conditions : Specific conditions necessitating dialysis, including metabolic acidosis, pulmonary edema, and uremic syndromes. Dialysis indications : Detailed reasons for initiating dialysis based on patient records. Data Analysis Data were analyzed using descriptive statistics to summarize patient demographics and clinical characteristics. Frequencies, means, and standard deviations were used to describe continuous variables, while percentages were used for categorical variables. Ethical Considerations: The study received ethical approval from the ethics committee at Hargeisa Group Hospital and adhered to the principles of the Declaration of Hargaisa Group Hospital. Patient confidentiality was maintained throughout the study, and all data were anonymized. Result Indications of Dialysis Table 1. There are a total of 123 cases, with males (73) having a higher count than females (50). The most common condition leading to dialysis in females is Uremic Encephalopathy (22 cases), while in males, it is Uremic Gastritis (37 cases). Metabolic Acidosis and Refractory Hyperkalemia have the lowest counts in both genders, indicating they are less frequently the primary reason for dialysis. Males show a higher prevalence in conditions like Uremic Gastritis and Pulmonary Edema, while females have a notably high count in Uremic Encephalopathy. Count of Indication of Dialysis Column Labels Row Labels Metabolic Acidosis Pulmonary Edema Refractory Hyperkalemia Uremic encephalopathy Uremic Gastritis Uremic Pericarditis Grand Total Female 1 9 1 22 17 50 Male 2 14 5 14 37 1 73 Grand Total 3 23 6 36 54 1 123 Table 1 indication of dialysis by gender Table 2: There seems to be a more even distribution of dialysis cases across age groups, through Uremic Gastritis and Uremic Encephalopathy affects a broader range of ages. The data suggests that most of the affected patients fall within the 45 TO 74 age range with a few younger patients also affected by these conditions. Uremic Gastritis are common at age between 55-64 and 44-54 respectively. Uremic encephalopathy are common at age between 45-54 and 55-64 respectively. Pulmonary edema are common indication at age 45-54 age.While border line ages 15-24 age and 75-88 are similar with Pulmonary edema and uremic gastritis. Count of Indication of Dialysis Indication of Dialysis Age Metabolic Acidosis Pulmonary Edema Referecatory Hyperkalemia Uremic encephalopathy Uremic Gastritis Uremic Pericarditis Grand Total 15-24 2 1 2 2 7 25-34 3 2 2 3 10 35-44 4 5 9 18 45-54 1 10 3 16 14 1 45 55-64 1 1 9 15 26 65-74 1 1 2 9 13 75-85 2 2 4 Grand Total 3 23 6 36 54 1 123 Table 2: age distribution of indication dialysis. Table 3: The distribution of dialysis indications across various regions highlights significant disparities in medical needs or reporting: Maroodijeex: With an overwhelming 92.68% of indications, this region is the primary focus for dialysis services. This could suggest a higher prevalence of kidney-related health issues or more comprehensive reporting and diagnostic facilities. Awdal, Saaxil, and Sanaag: Each of these regions accounts for only 0.81% of indications. This may indicate underreporting, limited healthcare access, or genuinely lower incidence rates of conditions necessitating dialysis. Togdheer: Contributes 4.88% to the total, suggesting a moderate level of dialysis need compared to other regions. Loacation Count of Indication of Dialysis Awdal 0.81% Maroodijeex 92.68% Saaxil 0.81% Sanaag 0.81% Togdheer 4.88% Grand Total 100.00% Table3: The distribution of dialysis indications across various regions Discussion This study provides valuable insights into the clinical indications for dialysis at Hargeisa Group Hospital in Somaliland, a resource-limited setting with limited access to renal transplantation. Our findings highlight the significant burden of kidney disease in the region, with uremic syndromes, particularly uremic gastritis and uremic encephalopathy, emerging as the most prevalent reasons for dialysis initiation. This contrasts with previous studies in developed countries, where metabolic acidosis and refractory hyperkalemia are more commonly reported as primary dialysis indications (Rivara et al., 2017). This disparity likely reflects the unique healthcare challenges faced by Somaliland, including limited access to early diagnosis and treatment for CKD, and potential differences in underlying disease profiles. The study's findings have significant implications for improving healthcare delivery in Somaliland. The high prevalence of uremic syndromes suggests a pressing need for greater emphasis on early detection and management of CKD. This requires increased public awareness campaigns, improved access to basic diagnostic services like blood pressure monitoring and glucose testing, and effective management of underlying risk factors such as hypertension and diabetes. The uneven distribution of dialysis indications across different regions highlights the need for a more equitable distribution of resources and services, addressing the disparities in healthcare accessibility and ensuring that individuals in underserved areas have adequate access to dialysis. This study also contributes to the broader understanding of CKD in developing countries, a health issue often overlooked in global health research. The high burden of ESRD in Somaliland, observed in this study, aligns with the global trends in emerging economies, where poverty and limited access to healthcare exacerbate the impact of CKD (Sachs et al., 2001). This underscores the need for greater international collaboration and resource allocation to address the growing burden of CKD in these regions. The findings of this study can be contextualized within the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). By identifying the key clinical indications for dialysis in Somaliland, the study provides valuable data for developing evidence-based interventions to improve kidney care and reduce the burden of ESRD, aligning with SDG 3's goals of ensuring healthy lives and promoting well-being for all at all ages. Additionally, addressing the disparities in access to dialysis services and promoting equitable healthcare access is crucial for achieving SDG 10's goal of reducing inequality within and among countries. Limitations It is important to acknowledge some limitations of this study. The retrospective design and reliance on medical record data may have introduced biases due to potential inaccuracies or missing information. The relatively small sample size may limit the generalizability of the findings. Future prospective studies with larger sample sizes are needed to further validate these findings and explore the specific factors contributing to the observed disparities. Future Directions Future research should focus on: Investigating the impact of socioeconomic factors on CKD prevalence and outcomes in Somaliland. Developing and implementing targeted interventions to improve early detection and management of CKD in the region. Evaluating the effectiveness of different dialysis modalities and exploring the feasibility of kidney transplantation programs. Conducting studies to understand the barriers to accessing healthcare and dialysis services in Somaliland and how these barriers can be overcome. Conclusion The study provides compelling evidence for the significant burden of CKD and the need for enhanced kidney care services in Somaliland. The findings reveal a unique clinical presentation of dialysis indications, driven by uremic syndromes, and underscore the importance of early detection, improved access to basic diagnostic services, and equitable resource allocation to address the disparities in healthcare accessibility. The study calls for a multifaceted approach, including strengthening primary care services, investing in infrastructure and personnel, promoting equitable access, and fostering collaborative partnerships to effectively address the growing burden of CKD in Somaliland. Policy Implications: Strengthening Primary Care Services : Focus on increasing access to early diagnosis and management of CKD through primary care services. This includes improving public awareness campaigns, expanding access to basic diagnostic tests, and integrating CKD screening into routine healthcare practices. Investing in Infrastructure and Personnel : Enhance the capacity of hospitals and healthcare facilities by investing in equipment, training healthcare professionals in nephrology, and establishing dedicated dialysis units in underserved areas. Promoting Equitable Access : Implement measures to ensure equal access to dialysis services regardless of geographical location or socioeconomic status. This includes developing a national dialysis program that addresses the unique needs of Somaliland and its diverse population. Strengthening Collaboration : Foster partnerships with international organizations, research institutions, and neighboring countries to improve CKD management in Somaliland. This could involve sharing expertise, providing technical assistance, and facilitating access to resources and technologies. Investing in Research and Data Collection : Support ongoing research and data collection efforts to gain a better understanding of CKD trends, risk factors, and outcomes in Somaliland. This will enable more targeted interventions and policy decisions based on evidence. Declarations Declarations We declare that this work has not been submitted as a manuscript to any other journal. Competing interests: The authors affirm that there are no conflicts of interest pertaining to the publication of this article. Conflicts of Interest: The authors affirm that there are no conflicts of interest pertaining to the publication of this article Funding Not applicable Author Contribution Naema Ibrahim and Abdikani Abdikadir individuals wrote and collected the main manuscript. Additionally, Dr. Abdirahman Omer Ali contributed to the development of the manuscript. References Rage HI, Ers SA, Kahin AY, Elmi MM, Mohamed AA, Kumar Jha P. Causes of kidney failure among patients undergoing maintenance hemodialysis in Somalia: a multi-center study. BMC Nephrol. 2023;24(1):1–6. 10.1186/s12882-023-03402-z . Trillini M, Perico N, Remuzzi G. Epidemiology of End-Stage Renal Failure: The Burden of Kidney Diseases to Global Health. Elsevier Inc.; 2017. 10.1016/B978-0-12-801734-0.00001-1 . Hashmi MF, Benjamin O, Lappin SL. End-stage renal disease, 2018. Hsu C-Y, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol. 2003;14(11):2902–7. Levin A, Stevens PE. Early detection of CKD: the benefits, limitations and effects on prognosis. Nat Rev Nephrol. 2011;7(8):446–57. Whaley-Connell A, Nistala R, Chaudhary K. The importance of early identification of chronic kidney disease. Mo Med. 2011;108(1):25. Anand S, Bitton A, Gaziano T. The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS ONE. 2013;8(8):e72860. Coresh J, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47. Renal DUS. System. USRDR 2004 Annual Data Report. Bethesda, MD, National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2004. Stanifer JW, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Heal. 2014;2(3):e174–81. Sharief S, Hsu C. The transition from the pre-ESRD to ESRD phase of CKD: Much remains to be learned. Am J kidney Dis Off J Natl Kidney Found. 2017;69(1):8. Rivara MB, Chen CH, Nair A, Cobb D, Himmelfarb J, Mehrotra R. Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study. Am J Kidney Dis. 2017;69(1):41–50. 10.1053/j.ajkd.2016.06.024 . Whaley-Connell A, Nistala R, Chaudhary K. SCIENCE OF MEDICINE of Chronic Kidney Disease. Sci Med. 2011;108(1):25–8. Warsame AA. Somalia’s Healthcare System: a baseline study & human capital development strategy. Mogadishu HIPS Herit Inst Policy Stud City Univ Mogadishu, 2020. Erfanpoor S et al. Diabetes, hypertension, and incidence of chronic kidney disease: is there any multiplicative or additive interaction? Int J Endocrinol Metab, 19, 1, 2021. Crews DC, Charles RF, Evans MK, Zonderman AB, Powe NR. Poverty, race, and CKD in a racially and socioeconomically diverse urban population. Am J kidney Dis. 2010;55(6):992–1000. Sachs JD et al. Investing in Health for Economic Development, WHO, Scaling up response to Infect. Dis. (Geneva WHO , 2001), vol. 2, 2001. Locatelli F, Del Vecchio L, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transpl, 17, 2002. Stack AG. Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis. 2003;41(2):310–8. Hallan SI, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol. 2006;17(8):2275–84. Ojo A. Addressing the global burden of chronic kidney disease through clinical and translational research. Trans Am Clin Climatol Assoc. 2014;125:229. Chen T, Lee VWS, Harris DC. When to initiate dialysis for end-stage kidney disease: evidence and challenges. Med J Aust. 2018;209(6):275–9. 10.5694/MJA18.00297 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Oct, 2024 Editor assigned by journal 25 Oct, 2024 Submission checks completed at journal 25 Oct, 2024 First submitted to journal 21 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5301809","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371096162,"identity":"45d4498d-c93d-46ed-af95-28e058545668","order_by":0,"name":"Naema Ibrahim","email":"","orcid":"","institution":"Golis University","correspondingAuthor":false,"prefix":"","firstName":"Naema","middleName":"","lastName":"Ibrahim","suffix":""},{"id":371096163,"identity":"3351f9b8-9682-4d27-b2ab-754026900b2e","order_by":1,"name":"Abdikani Abdikadir","email":"","orcid":"","institution":"Burao University","correspondingAuthor":false,"prefix":"","firstName":"Abdikani","middleName":"","lastName":"Abdikadir","suffix":""},{"id":371096165,"identity":"d1957f4a-94fd-46a3-acd2-c7840a77ee99","order_by":2,"name":"Abdirahman Omer Ali","email":"data:image/png;base64,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","orcid":"","institution":"Amoud University","correspondingAuthor":true,"prefix":"","firstName":"Abdirahman","middleName":"Omer","lastName":"Ali","suffix":""}],"badges":[],"createdAt":"2024-10-21 06:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5301809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5301809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68345966,"identity":"d5a15ad7-0f05-4208-90db-6eacbd43550d","added_by":"auto","created_at":"2024-11-06 09:40:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":540275,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5301809/v1/76cc7192-17be-4573-83fc-58fc0fa9a266.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Indications for Dialysis: A study of patient Demographics and Outcomes at Hargeisa Group Hospital","fulltext":[{"header":"Introduction and Background","content":"\u003cp\u003eChronic kidney disease (CKD) is a significant global health issue. The Kidney Disease Improving Global Outcomes (KDIGO) defines CKD as an abnormality in kidney function or structure, often assessed using estimated glomerular filtration rate (eGFR) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. CKD is characterized by a progressive and irreversible loss of kidney function or damage that occurs over months to years. The final stage of CKD, known as end-stage renal disease (ESRD), involves a severe decline in kidney function, requiring renal replacement therapy (RRT) such as dialysis or transplantation for survival [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Many CKD patients advance to kidney failure, necessitating permanent RRT or transplantation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Geographic disparities exist in CKD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Epidemiological research on CKD faces three primary challenges: inconsistency in formulas for estimating incidence and prevalence in early stages, defining CKD solely by eGFR without considering albuminuria, and limited data on advanced CKD due to reliance on ESRD registries that only track populations undergoing RRT [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the United States, CKD is increasingly prevalent, affecting approximately 24\u0026ndash;28\u0026nbsp;million people, with an additional 20\u0026nbsp;million undiagnosed or at risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Sub-Saharan Africa, CKD prevalence is estimated at around 13.9% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Annually, over 115,000 patients with chronic kidney failure begin maintenance dialysis therapy in the U.S. This transition is a particularly vulnerable period, with annual mortality rates for CKD stage 5 patients reaching 20% during the first year of dialysis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Understanding risk factors for adverse outcomes during this critical phase is essential [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The rise in type 2 diabetes mellitus and other CKD risk factors has underscored CKD as a global public health concern [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Somalia, due to war and poverty, healthcare facilities are underdeveloped, and most people lack basic services, resulting in high morbidity and mortality rates [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Hypertension and diabetes mellitus are the main CKD risk factors in both developed and developing countries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Extreme poverty exacerbates the burden of ESRD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Without early detection and proper management, kidney function can rapidly decline to failure [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Preventative care before kidney failure onset is crucial to mitigate progression and associated mortality [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e][\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In Somalia, premature mortality significantly affects individuals with kidney failure [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe threshold for the estimated glomerular filtration rate (eGFR) at which individuals begin to experience symptoms and signs of kidney dysfunction varies widely. However, severe symptoms typically do not manifest until the eGFR declines below 10 mL/min/1.73 m\u0026sup2;. Symptoms can be categorized into absolute and common indications for initiating dialysis. Absolute indications encompass conditions such as uremic pericarditis, uremic encephalopathy, and bleeding diathesis. Common indications for starting dialysis include malnutrition, persistent fluid overload, significant fatigue and weakness, impaired cognitive function, refractory acidosis, hyperkalemia, and hyperphosphatemia.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn resource-limited settings like Somaliland, particularly at Hargeisa Group Hospital, dialysis is crucial for managing renal failure as renal transplantation is unavailable. Despite increasing demand for this life-saving intervention, data on clinical conditions necessitating dialysis in the region are scarce. Understanding these indications is vital for revealing disease patterns, enhancing patient management, and optimizing resource allocation.\u003c/p\u003e \u003cp\u003eThis study aims to identify the primary clinical indications for dialysis at Hargeisa Group Hospital, focusing on conditions like metabolic acidosis, pulmonary edema, and uremic syndromes. By analyzing this data, the research seeks to uncover common causes for dialysis, highlight regional variations, and identify gaps in early detection and management of renal complications. This information will aid health authorities in developing appropriate kidney care services, improving care protocols, and achieving better health outcomes for renal disease patients in the region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study aimed to assess the clinical indications for dialysis among patients treated at Hargeisa Group Hospital in Somaliland, a key healthcare facility serving a diverse population with varying health needs. The study utilized a cross-sectional design, collecting data from May 2022 to August 2024.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population, settings and design\u003c/h2\u003e \u003cp\u003eThe study was conducted at Hargeisa Group Hospital, a major healthcare facility in Somaliland. It employed a cross-sectional design, collecting data from patients receiving hemodialysis during the study period.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample Size\u003c/strong\u003e \u003cp\u003eThe study included a total of 123 patients.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria: Patients were eligible for inclusion if they were\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDiagnosed with kidney failure.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOn regular hemodialysis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOver 18 years old.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria: Patients were excluded if they\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHad known acute kidney injury (AKI) on dialysis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWere under 18 years old.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHad incomplete medical records.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHad undergone a failed kidney transplant and were on dialysis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eMethod\u003c/strong\u003e \u003cp\u003eData were collected retrospectively through a review of patient medical records.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection Form\u003c/strong\u003e \u003cp\u003eA standardized data collection form was used to extract information about\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDemographic details\u003c/b\u003e: Age, gender and location\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eClinical conditions\u003c/b\u003e: Specific conditions necessitating dialysis, including metabolic acidosis, pulmonary edema, and uremic syndromes.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDialysis indications\u003c/b\u003e: Detailed reasons for initiating dialysis based on patient records.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using descriptive statistics to summarize patient demographics and clinical characteristics. Frequencies, means, and standard deviations were used to describe continuous variables, while percentages were used for categorical variables.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations:\u003c/h3\u003e\n\u003cp\u003e The study received ethical approval from the ethics committee at Hargeisa Group Hospital and adhered to the principles of the Declaration of Hargaisa Group Hospital. Patient confidentiality was maintained throughout the study, and all data were anonymized.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cstrong\u003eIndications of Dialysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1. There are a total of 123 cases, with males (73) having a higher count than females (50). The most common condition leading to dialysis in females is \u003cstrong\u003eUremic Encephalopathy\u003c/strong\u003e (22 cases), while in males, it is \u003cstrong\u003eUremic Gastritis\u003c/strong\u003e (37 cases). \u003cstrong\u003eMetabolic Acidosis\u003c/strong\u003e and \u003cstrong\u003eRefractory Hyperkalemia\u003c/strong\u003e have the lowest counts in both genders, indicating they are less frequently the primary reason for dialysis.\u0026nbsp;Males show a higher prevalence in conditions like Uremic Gastritis and Pulmonary Edema, while females have a notably high count in Uremic Encephalopathy.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.8284%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount of Indication of Dialysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.8686%;\"\u003e\n \u003cp\u003eColumn Labels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.941%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.7453%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.57909%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.8579%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.8284%;\"\u003e\n \u003cp\u003eRow Labels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.8686%;\"\u003e\n \u003cp\u003eMetabolic Acidosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003ePulmonary Edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.941%;\"\u003e\n \u003cp\u003eRefractory Hyperkalemia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.7453%;\"\u003e\n \u003cp\u003eUremic encephalopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.57909%;\"\u003e\n \u003cp\u003eUremic Gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.8579%;\"\u003e\n \u003cp\u003eUremic Pericarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003eGrand Total\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.8284%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.8686%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.941%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.7453%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.57909%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.8579%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.8284%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.8686%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.941%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.7453%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.57909%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.8579%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.8284%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrand Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.8686%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.7453%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.57909%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.8579%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.5898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e123\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;indication of dialysis by gender\u003c/p\u003e\n\u003cp\u003eTable 2: There seems to be a more even distribution of dialysis cases across age groups, through Uremic Gastritis and Uremic Encephalopathy affects a broader range of ages. The data suggests that most of the affected patients fall within the 45 TO 74 age range with a few younger patients also affected by these conditions. Uremic Gastritis are common at age between 55-64 and 44-54 respectively. Uremic encephalopathy are common at age between 45-54 \u0026nbsp; \u0026nbsp;and 55-64 respectively. Pulmonary edema are common indication at age 45-54 age.While border line ages \u0026nbsp;15-24 age and 75-88 are similar with \u0026nbsp;Pulmonary edema and uremic gastritis.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount of Indication of Dialysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003eIndication of Dialysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003eMetabolic Acidosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003ePulmonary Edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003eReferecatory Hyperkalemia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003eUremic encephalopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003eUremic Gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\n \u003cp\u003eUremic Pericarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003eGrand Total\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e15-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e55-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e75-85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9112%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrand Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.745%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.6074%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8968%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.6046%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.30659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e123\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: age distribution of indication dialysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e\u0026nbsp; The distribution of dialysis indications across various regions highlights significant disparities in medical needs or reporting: Maroodijeex: With an overwhelming 92.68% of indications, this region is the primary focus for dialysis services. This could suggest a higher prevalence of kidney-related health issues or more comprehensive reporting and diagnostic facilities. Awdal, Saaxil, and Sanaag: Each of these regions accounts for only 0.81% of indications. This may indicate underreporting, limited healthcare access, or genuinely lower incidence rates of conditions necessitating dialysis. Togdheer: Contributes 4.88% to the total, suggesting a moderate level of dialysis need compared to other regions.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"710\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eLoacation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003eCount of Indication of Dialysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eAwdal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e0.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eMaroodijeex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e92.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eSaaxil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e0.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eSanaag\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e0.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003eTogdheer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e4.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.1707%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrand Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68.8293%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.00%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable3:\u0026nbsp;\u003c/strong\u003e\u0026nbsp; The distribution of dialysis indications across various regions\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides valuable insights into the clinical indications for dialysis at Hargeisa Group Hospital in Somaliland, a resource-limited setting with limited access to renal transplantation. Our findings highlight the significant burden of kidney disease in the region, with uremic syndromes, particularly uremic gastritis and uremic encephalopathy, emerging as the most prevalent reasons for dialysis initiation. This contrasts with previous studies in developed countries, where metabolic acidosis and refractory hyperkalemia are more commonly reported as primary dialysis indications (Rivara et al., 2017). This disparity likely reflects the unique healthcare challenges faced by Somaliland, including limited access to early diagnosis and treatment for CKD, and potential differences in underlying disease profiles.\u003c/p\u003e \u003cp\u003eThe study's findings have significant implications for improving healthcare delivery in Somaliland. The high prevalence of uremic syndromes suggests a pressing need for greater emphasis on early detection and management of CKD. This requires increased public awareness campaigns, improved access to basic diagnostic services like blood pressure monitoring and glucose testing, and effective management of underlying risk factors such as hypertension and diabetes. The uneven distribution of dialysis indications across different regions highlights the need for a more equitable distribution of resources and services, addressing the disparities in healthcare accessibility and ensuring that individuals in underserved areas have adequate access to dialysis.\u003c/p\u003e \u003cp\u003eThis study also contributes to the broader understanding of CKD in developing countries, a health issue often overlooked in global health research. The high burden of ESRD in Somaliland, observed in this study, aligns with the global trends in emerging economies, where poverty and limited access to healthcare exacerbate the impact of CKD (Sachs et al., 2001). This underscores the need for greater international collaboration and resource allocation to address the growing burden of CKD in these regions.\u003c/p\u003e \u003cp\u003eThe findings of this study can be contextualized within the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). By identifying the key clinical indications for dialysis in Somaliland, the study provides valuable data for developing evidence-based interventions to improve kidney care and reduce the burden of ESRD, aligning with SDG 3's goals of ensuring healthy lives and promoting well-being for all at all ages. Additionally, addressing the disparities in access to dialysis services and promoting equitable healthcare access is crucial for achieving SDG 10's goal of reducing inequality within and among countries.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eIt is important to acknowledge some limitations of this study. The retrospective design and reliance on medical record data may have introduced biases due to potential inaccuracies or missing information. The relatively small sample size may limit the generalizability of the findings. Future prospective studies with larger sample sizes are needed to further validate these findings and explore the specific factors contributing to the observed disparities.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eFuture research should focus on:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInvestigating the impact of socioeconomic factors on CKD prevalence and outcomes in Somaliland.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDeveloping and implementing targeted interventions to improve early detection and management of CKD in the region.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEvaluating the effectiveness of different dialysis modalities and exploring the feasibility of kidney transplantation programs.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConducting studies to understand the barriers to accessing healthcare and dialysis services in Somaliland and how these barriers can be overcome.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e The study provides compelling evidence for the significant burden of CKD and the need for enhanced kidney care services in Somaliland. The findings reveal a unique clinical presentation of dialysis indications, driven by uremic syndromes, and underscore the importance of early detection, improved access to basic diagnostic services, and equitable resource allocation to address the disparities in healthcare accessibility. The study calls for a multifaceted approach, including strengthening primary care services, investing in infrastructure and personnel, promoting equitable access, and fostering collaborative partnerships to effectively address the growing burden of CKD in Somaliland.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePolicy Implications:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStrengthening Primary Care Services\u003c/b\u003e: Focus on increasing access to early diagnosis and management of CKD through primary care services. This includes improving public awareness campaigns, expanding access to basic diagnostic tests, and integrating CKD screening into routine healthcare practices.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInvesting in Infrastructure and Personnel\u003c/b\u003e: Enhance the capacity of hospitals and healthcare facilities by investing in equipment, training healthcare professionals in nephrology, and establishing dedicated dialysis units in underserved areas.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePromoting Equitable Access\u003c/b\u003e: Implement measures to ensure equal access to dialysis services regardless of geographical location or socioeconomic status. This includes developing a national dialysis program that addresses the unique needs of Somaliland and its diverse population.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStrengthening Collaboration\u003c/b\u003e: Foster partnerships with international organizations, research institutions, and neighboring countries to improve CKD management in Somaliland. This could involve sharing expertise, providing technical assistance, and facilitating access to resources and technologies.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInvesting in Research and Data Collection\u003c/b\u003e: Support ongoing research and data collection efforts to gain a better understanding of CKD trends, risk factors, and outcomes in Somaliland. This will enable more targeted interventions and policy decisions based on evidence.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDeclarations\u003c/h2\u003e\n\u003cp\u003eWe declare that this work has not been submitted as a manuscript to any other journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that there are no conflicts of interest pertaining to the publication of this article.\u003c/p\u003e\n\u003ch2\u003eConflicts of Interest:\u003c/h2\u003e\n\u003cp\u003eThe authors affirm that there are no conflicts of interest pertaining to the publication of this article\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eNaema Ibrahim and Abdikani Abdikadir individuals wrote and collected the main manuscript. Additionally, Dr. Abdirahman Omer Ali contributed to the development of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRage HI, Ers SA, Kahin AY, Elmi MM, Mohamed AA, Kumar Jha P. Causes of kidney failure among patients undergoing maintenance hemodialysis in Somalia: a multi-center study. BMC Nephrol. 2023;24(1):1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12882-023-03402-z\u003c/span\u003e\u003cspan address=\"10.1186/s12882-023-03402-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrillini M, Perico N, Remuzzi G. Epidemiology of End-Stage Renal Failure: The Burden of Kidney Diseases to Global Health. 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The importance of early identification of chronic kidney disease. Mo Med. 2011;108(1):25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnand S, Bitton A, Gaziano T. The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS ONE. 2013;8(8):e72860.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoresh J, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenal DUS. System. USRDR 2004 Annual Data Report. Bethesda, MD, National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanifer JW, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Heal. 2014;2(3):e174\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharief S, Hsu C. The transition from the pre-ESRD to ESRD phase of CKD: Much remains to be learned. Am J kidney Dis Off J Natl Kidney Found. 2017;69(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivara MB, Chen CH, Nair A, Cobb D, Himmelfarb J, Mehrotra R. Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study. Am J Kidney Dis. 2017;69(1):41\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.ajkd.2016.06.024\u003c/span\u003e\u003cspan address=\"10.1053/j.ajkd.2016.06.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhaley-Connell A, Nistala R, Chaudhary K. SCIENCE OF MEDICINE of Chronic Kidney Disease. Sci Med. 2011;108(1):25\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarsame AA. Somalia\u0026rsquo;s Healthcare System: a baseline study \u0026amp; human capital development strategy. Mogadishu HIPS Herit Inst Policy Stud City Univ Mogadishu, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErfanpoor S et al. Diabetes, hypertension, and incidence of chronic kidney disease: is there any multiplicative or additive interaction? Int J Endocrinol Metab, 19, 1, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrews DC, Charles RF, Evans MK, Zonderman AB, Powe NR. Poverty, race, and CKD in a racially and socioeconomically diverse urban population. Am J kidney Dis. 2010;55(6):992\u0026ndash;1000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSachs JD et al. Investing in Health for Economic Development, \u003cem\u003eWHO, Scaling up response to Infect. Dis. (Geneva WHO\u003c/em\u003e, 2001), vol. 2, 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLocatelli F, Del Vecchio L, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transpl, 17, 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStack AG. Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis. 2003;41(2):310\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHallan SI, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol. 2006;17(8):2275\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOjo A. Addressing the global burden of chronic kidney disease through clinical and translational research. Trans Am Clin Climatol Assoc. 2014;125:229.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen T, Lee VWS, Harris DC. When to initiate dialysis for end-stage kidney disease: evidence and challenges. Med J Aust. 2018;209(6):275\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5694/MJA18.00297\u003c/span\u003e\u003cspan address=\"10.5694/MJA18.00297\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic kidney disease, End-stage renal disease, Dialysis, Public health","lastPublishedDoi":"10.21203/rs.3.rs-5301809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5301809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Chronic kidney disease (CKD) is a significant global health concern, with end-stage renal disease (ESRD) requiring dialysis or transplantation for survival. Data on clinical indications for dialysis initiation in resource-limited settings like Somaliland are scarce. This study aimed to identify the primary clinical indications for dialysis at Hargeisa Group Hospital in Somaliland.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cross-sectional study was conducted using medical records of 123 patients undergoing hemodialysis from May 2022 to August 2024. Demographic and clinical data, including indications for dialysis initiation, were analyzed using descriptive statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Uremic syndromes, particularly uremic gastritis and uremic encephalopathy, were the most prevalent reasons for dialysis initiation. These findings differed from previous studies in developed countries, highlighting potential regional variations in CKD presentation and access to care. Significant disparities in dialysis indications across regions were observed, with Maroodijeex accounting for the majority of cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e The study highlights the significant burden of CKD in Somaliland and the need for improved early detection and management. The findings have important implications for strengthening primary care services, investing in infrastructure and personnel, promoting equitable access to dialysis, and fostering collaborative partnerships to address the growing burden of CKD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study provides valuable insights into the clinical indications for dialysis in Somaliland, emphasizing the need for a multifaceted approach to address the growing burden of CKD in the region. Strengthening primary care, investing in infrastructure, promoting equitable access, and fostering partnerships are crucial for improving kidney care and achieving better health outcomes for patients.\u003c/p\u003e","manuscriptTitle":"Clinical Indications for Dialysis: A study of patient Demographics and Outcomes at Hargeisa Group Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 09:08:04","doi":"10.21203/rs.3.rs-5301809/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-28T07:43:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T10:09:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T10:08:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-10-21T06:50:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"822e6474-7b72-4beb-8e5b-001463226b34","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T17:23:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 09:08:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5301809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5301809","identity":"rs-5301809","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}