Date of Award

12-2025

Degree Type

Thesis

Degree Name

Master of Science in Advanced Practice Nurs​ing (MSc-APN)​

First Advisor

Dr Eunice Muthoni

Second Advisor

Dr Wesley Too

Department

School of Nursing and Midwifery, East Africa

Abstract

Introduction: Emergency hospitalizations among End Stage Kidney Disease (ESKD) is a major global health burden, with low- and middle-income countries in sub-Saharan Africa (SSA), experiencing the highest rates of morbidity and mortality. Limited resource, economic burden, and insufficient health infrastructure were the main challenges. Emergency hospitalizations at Kenyatta National Hospital remains high due to systemic gaps and poor continuity of care. Prerenal, intrarenal, post-renal injuries, as well as any combination of these, are the primary causes of ESKD. There are stipulated guidelines for ESKD patients’ management however, realization of these goals has not been achieved leading to hospitalization KDIGO (2021) Criteria. Identifying factors associated with emergency hospitalizations is important in improving patient outcomes.

Purpose: To identify factors that were associated with emergency hospitalizations among ESKD patients receiving maintenance hemodialysis at Kenyatta National Hospital.

Method: A retrospective cohort study design, employing census technique with a sample size of 120 ESKD patients on maintenance hemodialysis in the Renal Department diagnosed between January 1, 2022, to December 31, 2022. Data was explored descriptively. Chi-square or Fisher’s exact test was performed to assess the associations, and relationships were evaluated using univariable and multivariable logistic regression models.

Results. Medical records of patients studied showed that patients presenting with chest pain had a 65% lower likelihood of being hospitalized within 30 days (aOR: 0.35; 95% CI: 0.12–0.91; p=0.035). Conversely, patients with three or more prior hospitalizations were 10% higher, with odds of rehospitalization compared to those with only one admission (aOR: 10.7; 95% CI: 3.02 44.4; p< 0.001). Elevated creatinine levels showed a borderline association with higher hospitalization risk (aOR: 1.00; p=0.059). Overall, prior hospitalization frequency and chest pain emerged as the strongest independent risk factors for 30-day emergency hospitalizations.

Conclusions: Prior hospitalizations frequency and presentation with chest pain were significant factors emergency hospitalizations, while elevated creatinine showed a borderline association. Therefore, there is need for close monitoring of these patients and timely interventions to reduce the likelihood of emergency hospitalizations.

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1

Last Page

82

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