#3833 Access to hemodialysis in Haiti, a low-income, conflict-affected country

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Abstract Background and Aims Low-resource countries face significant challenges in providing kidney replacement therapies (KRT), particularly for patients with end-stage kidney disease (ESKD). ESKD patients in Haiti, a country affected by ongoing armed conflicts, face even greater struggles regarding access to KRT. Port-au-Prince, the country's capital, has a population of 1.2 million as of 2021, with at least 65% of residents over the age of 18 years. The reported average annual salary is equivalent to $1,760 USD, with 69% of the population living in extreme poverty with less than $1 USD per/day. Despite the absence of formal registries, a recent population-based study estimated a 2% prevalence of chronic kidney disease (CKD), defined as an eGFR <60 mL/min/1.73 m² [Nicholas S Robert et al. CJASN 2023, PMID 37081617]. Currently, neither peritoneal dialysis nor kidney transplantation are available, leaving hemodialysis (HD) as the only available option of KRT. In Port-au-Prince, seven centers provide HD. Given the difficult circumstances, no comprehensive overview of HD resources exist. We attempted to mitigate this knowledge gap by collecting data from some of the HD centers located in Port-au-Prince. Method We developed a short questionnaire using Microsoft Forms, consisting of 16 questions. Between September 1, 2024, and January 15, 2025, the questionnaire was distributed via mobile phones to the primary nephrologists and internists at healthcare centers around Port-au-Prince that offer HD. The questions focused on gathering information about the HD equipment, patient demographics, and available human resources. Center identifiers were anonymized. Responses were extracted into an Excel file and analyzed descriptively. Results We are reporting four of seven HD centers in Port-au-Prince, three private and one public. Currently, the three private centers provide HD treatments. An armed conflict has forced the fourth center to close since physical access was no longer possible (see Table 1). The three accessible centers each have a median of six functional HD machines, with a median of 13 patients per center. The youngest patients have a median age of 18 years. The cost per HD session at private centers is $200 USD, while at the currently closed public center, it is $20 USD, as the Health Ministry covers the remaining costs. Two of the private centers offer erythropoiesis-stimulating agent (ESA) treatment. The number of weekly HD sessions depends on patient's ability to pay, most patients receive twice weekly HD. The most common vascular access is the arteriovenous fistula (AVF), though jugular and femoral catheters are also regularly used. Overall, the three functional centers report an average patient duration on HD of 12 months. Internal medicine doctors and nurses are the primary healthcare providers. Conclusion With an estimated adult population of 780,000 in Port-au-Prince and a previously reported chronic kidney disease (CKD) prevalence of 2%, at least 15,000 adults in the metropolitan area may have CKD. Our partial report reveals a total of 18 machines across three out of four HD centers in Port-du-Prince, the most populated area in Haiti. Given this limited capacity, meeting the needs of the Haitian ESKD patients seems far from achievable. Pediatric patients, in particular, face even fewer opportunities for KRT, neither for acute nor chronic conditions. Urgent action is needed, including data collection and the establishment of registries, to better understand the disease burden in Haiti, especially within the context of an ongoing armed conflict. Support from international non-governmental organizations (NGOs) is crucial to address this significant unmet need.

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