Unplanned Hemodialysis Initiation inTunisia: Clinical Profile and Predictors of Early Mortality in a Prospective Cohort

AIM: Unplanned hemodialysis (HD) initiation is associated with increased mortality. This study aimed to characterize clinical profiles and identify predictors of early mortality in Tunisian HD patients. METHODS: A prospective cohort study was conducted at Tahar Sfar University Hospital, Mahdia, Tunisia, between June 2022 and June 2023, with follow-up until June 2024. A total of 125 adult patients initiating chronic HD were enrolled. Data on demographic, clinical, biochemical, and dialysis-related parameters were collected. Survival analysis was performed using Kaplan-Meier and Cox regression methods. RESULTS: The mean age was 59 ± 15years, with male predominance (57.6%). Diabetic nephropathy (36.8%) and chronic tubulointerstitial nephropathy (26.4%) were the leading causes of ESRD. Only 13.2% of patients-initiated HD in a planned manner; 50.4% started due to uremic symptoms and 28.1% due to volume overload. Vascular access was predominantly central venous catheters(70.4%), with only 20% having a mature arteriovenous fistula (AVF). The mean eGFR at HD initiation was 6.2 ± 2.4 mL/min/1.73 m². During follow-up (median: 15 months), 20.8% of patients died, with 34.6% of deaths occurring within the first three months. On univariate analysis, heart failure, AVF thrombosis, fewer than three HD sessions per week, and lack of prior nephrology referral were associated with higher mortality. Multivariate analysis identified dialysis frequency