title: Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome.
abstract: BACKGROUND
  Nephrologists are faced with enormous challenges in the management of patients with end-stage renal disease, especially in sub-Saharan Africa, where hemodialysis is the most common modality of renal replacement therapy in the region. Therefore, we reviewed our 3 years of experience with hemodialysis services in a tertiary hospital located in a rural community of South West Nigeria. This was with a view to presenting the profile of hemodialysis patients and the challenges they face in sustaining hemodialysis.
  
  
  METHODS
  We reviewed the case records and hemodialysis registers for 176 patients over the 3 years from November 2010 to December 2013. The data were analyzed using Statistical Package for the Social Sciences version 20 software.
  
  
  RESULTS
  Of the 176 patients, 119 (66.9%) were males. The mean age of the patients was 44.87±17.21 years. Most were semiskilled or unskilled (111; 63.5%) and 29 (16.5%) were students. Twenty-six (14.8%) had acute kidney injury in the failure stage. Chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy accounted for 45.3%, 23.3%, and 12.1%, respectively, of patients with end-stage renal disease. Only 6.8% of patients could afford hemodialysis beyond 3 months.
  
  
  CONCLUSIONS
  Sustainability of maintenance hemodialysis is poor in our environment. Efforts should be intensified to improve other modalities of renal replacement therapy, in particular kidney transplantation, which is cost-effective in the long-term. Also, preventive measures such as education for affected patients and the general population would assist in reducing the prevalence and progression to end-stage renal disease.
authors.affiliation: Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria.
authors.forename: Rotimi
authors.initials: R
authors.lastname: Oluyombo
authors.affiliation: Renal Unit, Department of Internal Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
authors.forename: Oluyomi O
authors.initials: OO
authors.lastname: Okunola
authors.affiliation: Renal Division, Internal Medicine Department, Faculty of Health Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Olanrewaju
authors.affiliation: Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Soje
authors.affiliation: Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria.
authors.forename: Omotola O
authors.initials: OO
authors.lastname: Obajolowo
authors.affiliation: Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Ayorinde
keywords: end-stage renal disease; hemodialysis; outcome; sustainability