Introduction: End-stage renal disease (ESRD) represents a growing public health challenge in sub-Saharan Africa, with limited access to renal replacement therapy and high mortality rates. This study aimed to assess the survival of chronic hemodialysis patients in Burundi and to identify factors associated with mortality. Methods: We conducted a retrospective cohort study including all patients undergoing hemodialysis during the study period (n = 367). Socio-demographic, clinical, and therapeutic data were collected. Survival probabilities were estimated using the Kaplan-Meier method and compared across groups. Factors associated with mortality were identified using logistic regression and Cox proportional hazards models. Results: The mean age of patients was 51.46 ± 14.45 years, with a male predominance (73.57%). Hypertension (97.55%) and diabetes (51.23%) were the most common comorbidities. Only 11.44% of patients received at least three dialysis sessions per week. The median survival was 684 days. Death was the main outcome (86.55%), with infections (35.80%) and cardiovascular diseases (32.92%) as the leading causes. In multivariate analysis, fewer than three dialysis sessions per week (aOR = 2.81; p = 0.003), hypertension (aOR = 2.34; p = 0.033), and diabetes (aOR = 1.70; p = 0.027) were significantly associated with mortality. In the Cox model, diabetes was an independent predictor of death (HR = 2.21; 95% CI [1.70 - 2.87]; p < 0.001). Conclusion: Mortality among hemodialysis patients in Burundi remains high, with limited survival. Diabetes and inadequate dialysis frequency are major determinants of poor outcomes. Improving access to adequate dialysis and better management of comorbidities are critical to enhancing patient survival in low-resource settings.
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