Predictors of in-hospital mortality among adults with chronic kidney disease at a national tertiary hospital in Sierra Leone

In-hospital outcomes among adults with chronic kidney disease (CKD) in low-resource settings are poorly characterized. We evaluated predictors of in-hospital mortality among adults admitted with CKD to Sierra Leone's national tertiary hospital, which houses the country's only public dialysis unit. We retrospectively reviewed case notes for all adults with CKD admitted to Connaught Hospital, Freetown, from January 1, 2022, through December 31, 2024. CKD stage was assigned according to KDIGO estimated glomerular filtration rate (eGFR) categories. The primary outcome was in-hospital death. Multivariable logistic regression was used to examine prespecified predictors of mortality. Among 385 admissions (median age, 48 years [interquartile range, 38 to 57]; 57.1% men), 64.2% presented with KDIGO G5 CKD and 41.0% received dialysis. In-hospital death occurred in 95 patients (24.7%). Each 10 mL/min/1.73 m² lower eGFR was associated with higher odds of death (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.42 to 2.66), as were heavier proteinuria (aOR, 2.23; 95% CI, 1.39 to 3.58 per one-category increase on dipstick) and diabetes (aOR, 1.97; 95% CI, 1.10 to 3.52). Receipt of dialysis was associated with lower adjusted odds of death (aOR, 0.55; 95% CI, 0.31 to 0.95). Age, sex, and hypertension were not statistically significant. Hospitalized adults with CKD in Sierra Leone typically present with advanced disease and heavy proteinuria, and approximately one in four died during hospitalization. Lower eGFR, greater proteinuria, and diabetes identify patients at highest risk, and access to dialysis was associated with lower short-term survival in this low-resource setting.