Abstract Background Metabolic syndrome (MetS) is an emerging complication among people living with HIV (PLHIV) receiving long-term antiretroviral therapy (ART), particularly with protease and integrase inhibitor regimens. Early identification of high-risk individuals remains challenging, and predictive tools are limited in African settings. This study evaluated nine machine learning (ML) algorithms for predicting MetS in ART-treated adults. Methods We analysed a retrospective cohort of 1,027 PLHIV without baseline MetS, followed for 144 weeks; 854 with complete data were included. Nine ML algorithms, including logistic regression, support vector machines, random forest, and XGBoost, were trained on 70% of the data using stratified repeated 10-fold cross-validation with hyperparameter tuning. Performance was assessed on a 30% test set using discrimination (AUC), calibration, and predictor importance. Results Age, sex, viral load, and alcohol use were the strongest predictors of metabolic syndrome in ART-treated individuals. Discrimination was modest across models (AUC 0.49–0.64), with radial SVM and logistic regression performing best (AUC ≈ 0.64). Calibration was generally acceptable (Brier score 0.16–0.19). Sensitivity–specificity trade-offs varied: XGBoost favored sensitivity (85.2%) but had low specificity (34.4%), whereas logistic regression and random forest achieved higher specificity (~ 75%). Overall, complex models offered limited gains over logistic regression. Conclusions Although internally validated ML models demonstrated acceptable calibration and modest discrimination, predictive performance remains insufficient for standalone clinical deployment and should be considered supportive rather than definitive for risk stratification in HIV care. Logistic regression and random forest provided the most consistent balance of discrimination and calibration, while complex approaches offered limited gains. Age, sex, viral load, and alcohol use emerged as key predictors. External validation and prospective evaluation are essential to establish generalisability, clinical impact, and feasibility before integration into routine practice.

Zambia experienced the largest cholera outbreak in the country history in 2023-2024 in the capital, Lusaka. This study aimed to identify the clinical characteristics of the adult patients hospitalized at the community and referral cholera treatment centers (CTCs) to determine factors associated with their severe clinical outcomes during the outbreak. Clinical information on the adult patients with cholera in the community and referral CTCs was retrospectively analyzed. Clinical factors associated with the fatal outcome were explored by multivariate analysis, using Firth's penalized logistic regression. A total of 6578 adult cases were identified. The overall case fatality rate was 1.0% (51 of 5020), and it was highest in a referral CTC specializing in patients with underlying conditions (4.1% [32 of 772]). In the multivariate analysis, age (odds ratio, 1.05 [95% confidence interval, 1.02-1.09]), human immunodeficiency virus infections (5.68 [2.12-15.30]), diabetes mellitus (8.21 [1.38-34.00]), and severe dehydration at admission (5.97 [1.29-56.94]) were independently correlated with fatal outcomes. Clinical factors, including age, underlying conditions, and disease severity at admission, were shown to be associated with severe clinical outcomes in adult patients with cholera. Enhanced case management strategies targeted for such high-risk groups might be beneficial in reducing the case fatality rate during cholera outbreaks.

Background Zambia declared a cholera outbreak on 18th October 2023 and as at 31th June 2024 had recorded 23,381 cases and 740 deaths. Of the patients seen at the two main Cholera Treatment Centers (CTCs) in the capital Lusaka, a third of them were children aged 0 to 15years of age. Despite the significant paediatric cholera burden, risk factors for mortality and prolonged hospitalization still remained unknown. Methods A retrospective data review was conducted by looking at clinical characteristic of patients aged 0-15years hospitalized at the two CTCs between October 15, 2023 and March 31, 2024. Descriptive analysis was conducted for patient characteristics and penalized logistic regression (PLR) was used to analyses risk factors for the outcomes. Results A total of 1,891 patients were identified, among which 1.4% (18/1,253) had fatal outcomes and 47.9% (399/833) had hospitalization >2days. By the PLR, factors including the human immunodeficiency virus (HIV) infections (odds ratio: OR 6.89, 95% confidence interval: CI 1.32-71.9), severe acute malnutrition (SAM) (OR 10.8, 95% CI 2.91-61.1), and treatment plans B (OR 3.93, 95% CI 1.80-9.27) and C (OR 7.54, 95% CI 2.71-22.9) were independently correlated with hospitalization >2days. For the fatal outcome, none of them independently showed any significant correlations by the PLR, although younger age and SAM were positively associated by bi-variate analysis. Conclusions Comorbidities such as SAM and HIV, being on plan B or C and, deteriorating and requiring more intense treatment are associated with longer hospitalization. Risk factor for mortality needs to be further investigated.

Background:Zambia declared a cholera outbreak on 18 October 2023 and, as of 31 June 2024, had recorded 23 381 cases and 740 deaths. Of the patients seen at the 2 main cholera treatment centers in the capital Lusaka, a third of them were children aged 0 to 15 years. Despite the significant pediatric cholera burden, risk factors for mortality and prolonged hospitalization remain unknown. Methods:A retrospective data review was conducted by examining the clinical characteristics of patients aged 0 to 15 years hospitalized at the 2 cholera treatment centers between 15 October 2023 and 31 March 2024. Descriptive analysis was conducted for patient characteristics, and penalized logistic regression (PLR) was used to analyze risk factors for the outcomes. Results:A total of 1891 patients were identified, among which 1.4% (18/1253) had fatal outcomes and 47.9% (399/833) had hospitalization >2 days. By the PLR, the following factors were independently correlated with hospitalization >2 days: HIV infection (odds ratio [OR], 6.89; 95% CI, 1.32-71.9), severe acute malnutrition (SAM; OR, 10.8; 95% CI, 2.91-61.1), and dehydration treatment plans B (OR, 3.93; 95% CI, 1.80-9.27) and C (OR, 7.54; 95% CI, 2.71-22.9). For the fatal outcome, none of them independently showed any significant correlations by the PLR, although younger age and SAM were positively associated by bivariate analysis. Conclusions:Comorbidities such as SAM and HIV, being on plan B or C, and deteriorating and requiring more intense treatment are associated with longer hospitalization. Risk factors for mortality need to be further investigated.

Background:Zambia experienced the largest cholera outbreak in the country history in 2023-2024 in the capital, Lusaka. This study aimed to identify the clinical characteristics of the adult patients hospitalized at the community and referral cholera treatment centers (CTCs) to determine factors associated with their severe clinical outcomes during the outbreak. Methods:Clinical information on the adult patients with cholera in the community and referral CTCs was retrospectively analyzed. Clinical factors associated with the fatal outcome were explored by multivariate analysis, using Firth's penalized logistic regression. Results:A total of 6578 adult cases were identified. The overall case fatality rate was 1.0% (51 of 5020), and it was highest in a referral CTC specializing in patients with underlying conditions (4.1% [32 of 772]). In the multivariate analysis, age (odds ratio, 1.05 [95% confidence interval, 1.02-1.09]), human immunodeficiency virus infections (5.68 [2.12-15.30]), diabetes mellitus (8.21 [1.38-34.00]), and severe dehydration at admission (5.97 [1.29-56.94]) were independently correlated with fatal outcomes. Conclusions:Clinical factors, including age, underlying conditions, and disease severity at admission, were shown to be associated with severe clinical outcomes in adult patients with cholera. Enhanced case management strategies targeted for such high-risk groups might be beneficial in reducing the case fatality rate during cholera outbreaks.

IntroductionHuman immunodeficiency virus (HIV) infection is linked to myocardial fibrosis. Observational studies using cardiac magnetic resonance (CMR) have explored this relationship but scarcity of data synthesis limits our understanding. Our systematic review and meta-analysis aimed to synthesize associations between HIV and myocardial fibrosis from CMR-based observational studies in adults.MethodsWe identified 12 studies (2013–2024) with 1,769 participants [1,117 people with HIV (PWH)]. Three studies were cohort and nine were cross-sectional. Meta-analysis included seven studies on late gadolinium enhancement (LGE) (1,081 participants: 669 PWH), eight on native T1 mapping (840 participants: 467 PWH), and ten on ECVF (1,603 participants: 992 PWH). We examined myocardial fibrosis prevalence via the prevalence difference in LGE, and severity by mean differences in native T1 mapping values [milliseconds (ms)] and global extracellular volume fraction (ECVF,%) between PWH and HIV-uninfected individuals, using random effects model.Results and discussionPooled analyses showed PWH had a 33% higher prevalence of LGE (95% CI: 12.0%–54.0%, I2 = 94.5%, p < 0.001), a mean native T1 mapping difference of 27.30 ms (95% CI: 11.21–43.39 ms, I2 = 88.2%, p < 0.001), and a mean ECVF difference of 1.85% (95% CI: 0.63%–3.08%, I2 = 90.5%, p < 0.001), respectively. Meta-regression showed no significant associations between ECVF and demographic, HIV-related, or cardiac factors. LGE and native T1 mapping analyses lacked sufficient data for meta-regression. In conclusion, PWH exhibit significantly higher prevalence and severity of myocardial fibrosis compared to HIV-uninfected individuals. But standardized methodologies and further research are essential to enhance consistency.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=533379, CRD [42024533379].

INTRODUCTION:Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia. METHODS:We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR). RESULTS:In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3-23.6), 26.7% (CI: 25.5-27.9) and 12.5% (CI: 11.6-13.4), respectively. In the multivariable model, being 30-44 (PR = 2.1; CI: 1.5-2.9), 45-49 (PR = 3.3; CI: 2.4-4.7) and 60 years or older (PR = 4.7; CI: 3.3-6.8) compared to those aged 18-29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2-1.5) and obese (PR = 1.9; CI: 1.6-2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3-3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4-3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1-1.6) and obese (PR = 1.6; CI: 1.3-2.0), compared to those with normal weight, showed a significant association with diabetes mellitus. CONCLUSIONS:The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate the high prevalence of hypertension and diabetes mellitus, along with their associated risk factors, particularly within this vulnerable demographic.

Kidney transplantation is an effective form of kidney replacement therapy with the best outcomes and quality of life. However, despite Sub-Saharan Africa having a large share of the burden of chronic kidney disease, kidney transplantation programs are essentially nonexistent. Zambia, a country in sub-Saharan Africa, with a population of 19,610,759 has a prevalence of chronic kidney disease ranging between 20 and 30%. With the launch of its transplant program in 2018, fourteen patients had been documented to have received kidneys from living-related donors as of 2022.

Background: Reduced bone mineral density (BMD) is a common complication of people living with Human Immunodeficiency Virus (HIV) on antiretroviral therapy (ART). However, there is lack of information on the factors associated with reduced BMD in people living with HIV and on ART. We assessed the prevalence of reduced BMD and its associated determinants in people living with HIV and were on antiretroviral therapy. Methods: A cross-sectional study on people living with HIV and on ART was conducted at the largest tertiary teaching adult hospital, in Lusaka Zambia from August 1, 2019 December 31, 2020. Included in the study were participants aged between 50 and 69 years of age. A Dual-energy X-ray Absorptiometry scan was employed to assess Bone Mineral Density. Low Bone Mineral Density was defined as both osteoporosis and osteopenia. Logistic regression analysis was employed to establish determinants associated with BMD. Results: Of the 315 participants, 43.8% were females and the median age was 55.0 years (IQR 60-51). The overall prevalence of reduced bone mineral density was 82.6% and of these, 34.0% had osteopenia and 48.6% osteoporosis. After adjusting for confounders, age 55 years and older (AOR 5.87, 95% CI 3.34-10.30, p=<0.001) was independently associated with osteoporosis while CD4 count ≥ 500 cells/mm3 (AOR 0.21, 95% CI 0.08-0.55, p=<0.001) and an increase in Body Mass Index (AOR 0.94, 95% CI 0.90-0.99, p=0.008) were associated with decreased odds of osteoporosis. Conclusions: Our study highlights a high prevalence of low Bone Mineral Density. Older age was positively associated with osteoporosis while a high CD4 count and high body Mass Index revealed a decreased odds for osteoporosis.

Introduction Chronic kidney disease (CKD) has been a global public health problem and a major source of suffering and poor quality of life for those afflicted. Using data from the global burden of disease (GBD) study 2019, we estimated the magnitude of the burden of CKD as well as the underlying causes of CKD in the Zambian population. Method The data used for this study were extracted from the GBD 2019 study. The GBD 2019 provides estimates of several metrics of disease burden including the commonly used disability-adjusted life year (DALYs) for over 369 diseases and injuries, and 87 risk factors and combinations of these in 204 countries and territories from 1990 to 2019. We estimated the burden of CKD as the number and rates (per 100,000 population) of DALYs, disaggregated by year, sex, and age group. We examined the underlying causes of CKD by estimating the population attributable fraction as the percentage contributions of risk factors to CKD DALY. Results The number of DALYs for CKD was estimated as 76.03 million (95% UI: 61.01 to 93.36) in 2019 compared to 39.42 million (95% UI: 33.09 to 45.90) in 1990, representing 93% increase whereas the DALYs rate per 100,000 population was estimated as 416.89 (95% UI: 334.53 to 511.93) in 2019 compared to 496.38 (95% UI: 416.55 to 577.87) in 1990, representing 16% reduction. CKD due to hypertension accounted for 18.7% of CKD DALYs and CKD due to diabetes (types 1 and 2) accounted for 22.7%, while CKD from glomerulonephritis accounted for the most DALYs at 33%. The age group most impacted from CKD were adolescents and young adults. Conclusion The burden of CKD remains high in the Zambian population with diabetes, high blood pressure, and glomerulonephritis as important causes. The results highlight the need to develop a comprehensive action plan to prevent and treat kidney disease. Increasing the awareness of CKD among the public as well as adaptation of guidelines for treating patients with end stage kidney disease are important considerations.

The human gut microbiota environment is constantly changing and some specific changes influence the host’s metabolic, immune, and neuroendocrine functions. Emerging evidence of the gut microbiota’s role in the development of cardiovascular disease (CVD) including hypertension is remarkable. There is evidence showing that alterations in the gut microbiota and especially the gut-dependant metabolite trimethylamine N-oxide is associated with hypertension. However, there is a scarcity of literature addressing the role of trimethylamine N-oxide in hypertension pathogenesis. In this review, we discuss the impact of the gut microbiota and gut microbiota dependant trimethylamine N-oxide in the pathogenesis of hypertension. We present evidence from both human and animal studies and further discuss new insights relating to potential therapies for managing hypertension by altering the gut microbiota.

Background: Tenofovir regimens remain the preferred formulations in the HIV guidelines for adolescents and young adults in Zambia and globally. However, some adolescents and young adults are maintained on abacavir by clinicians because of anxiety about possible proximal tubular dysfunction from tenofovir. We assessed the effect of two regimens on proximal tubular function in adolescents and young adults living with HIV. Methods: This was a cross-sectional study involving 180 participants with HIV receiving either tenofovir or abacavir for ≥12 months at the largest tertiary teaching hospital. Two first-morning urine and blood specimens were collected and analyzed for proximal tubular markers, glomerular function, electrolytes, and routine monitoring tests. Proximal tubular function was determined by measuring the fractional excretion of phosphate (FePO4). Proximal tubular dysfunction was defined by FePO4 ≥20% regardless of serum phosphate and FePO4 ≥10-20% when serum phosphate was below 0.81mmol/L. Results: The prevalence of proximal tubular dysfunction was 6% and was higher in the tenofovir group than the abacavir (10% vs. 2%, p<0.058). However, after adjusting for potential confounders, tenofovir was not associated with worse proximal tubular function. Age, urine b2-microglobulin: creatinine ratio, C-reactive protein, and urine protein: creatinine ratio was all associated with worsening proximal tubular dysfunction. Reduced estimated glomelurar filtration rate (eGFR) was found in four (2.2%) participants; three of which were on tenofovir. Conclusions: Proximal tubular dysfunction defined by FePO4 was more prevalent in the tenofovir group than the abacavir group, but not after adjusting for age. Our findings should be interpreted with caution as age differences between the two groups confounded the results.

Background: Minimal change disease (MCD) has been shown to be a common histological presentation in children presenting with nephrotic syndrome (NS) in developed countries. In Africa, information on clinical and histological characteristics of paediatric NS is scarce. This study assessed the characteristics and histological subtypes of NS. Methods: This was a prospective study that consecutively indexed children aged 2-16 years with the diagnosis of NS who were referred to the largest tertiary teaching hospital, Lusaka, Zambia. Thirteen children presenting with NS were biopsied under ultrasound guidance after ethical approval. The primary outcome of the study was to describe the histological characteristics of paediatric NS. Results: Thirteen children of African descent with a median age of onset of NS of 9.25 years (2.0-15.0) were enrolled in the study. The histopathologic lesions were as follows; four had MCD, four had focal segmental glomerulosclerosis (FSGS), one had immune complex mediated glomerulonephritis (ICMN) and four were inconclusive. Haematuria was present in eight out of 13 patients (61.5%) and hypertension was present in five of 13 patients (38.0%). Three children did not have either haematuria or hypertension. Ten of the 13 participants had primary steroid resistance. Conclusion: This study has demonstrated the need to perform a pre-treatment renal biopsy in paediatric patients presenting with NS in view of the atypical presentation, variable histopathologic findings, and unpredictable response to steroid therapy.

Background: Control of antimicrobial resistance (AMR) relies on local knowledge and local intervention implementation. Effective antibiotic stewardship requires locally-suitable prescribing guidelines. We aimed to use a novel digital tool (the ZARIApp) and a participatory approach to help develop locally-relevant empiric antibiotic prescribing guidelines for two hospitals in Lusaka, Zambia. Methods: We produced an AMR report using samples collected locally and routinely from adults within the prior two years (April 2020 - April 2022). We developed the ZARIApp, which provides prescribing recommendations based on local resistance data and antibiotic prescribing practices. We used qualitative evaluation of focus group discussions among healthcare professionals to assess the feasibility and acceptability of using the ZARIApp and identify the barriers to and enablers of this stewardship approach. Results: Resistance prevalence was high for many key pathogens: for example, 73% of 41 Escherichia coli isolates were resistant to ceftriaxone. We identified that high resistance rates were likely due to low levels of requesting and processing of microbiology samples from patients leading to insufficient and unrepresentative microbiology data. This emerged as the major barrier to generating locally-relevant guidelines. Through active stakeholder engagement, we modified the ZARIApp to better support users to generate empirical antibiotic guidelines within this context of unrepresentative microbiology data. Qualitative evaluation of focus group discussions suggested that the resulting ZARIApp was useful and easy to use. New antibiotic guidelines for key syndromes are now in place in the two study hospitals, but these have substantial residual uncertainty. Conclusions: Tools such as the free online ZARIApp can empower local settings to better understand and optimise how sampling and prescribing can help to improve patient care and reduce future AMR. However, the usability of the ZARIApp is severely limited by unrepresentative microbiology data; improved routine microbiology surveillance is vitally needed. (c) 2023 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5–14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18–29 years (adjusted odds ratio [aOR] for 30–44 years: 2.6 [95% CI: 2.4–2.9]; aOR for 45–49 years: 6.4 [95% CI: 5.8–7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1–16.1]), urban areas (aOR: 1.9 [95% CI: 1.8–2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0–1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.

Background: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.

Introduction: Dialysis is the primary kidney replacement therapy for patients with kidney failure in sub-Saharan Africa. We assessed the rates and predictors of early mortality in Zambian patients starting chronic dialysis. Methods: This retrospective study included all patients who started chronic haemodialysis (HD) or peritonealdialysis (PD) between 1 January 2017 and 31 August 2020 at the three largest public dialysis centres in Zambia. Data on clinical, laboratory and dialysis characteristics were extracted from medical records. The primary outcome of interest was the mortality rate at 90 days. Results: A total of 154 patients were included in the study; 43.5% were female and 32% were 50 years or older.The main causes of kidney failure were hypertension (59%), glomerulonephritis (10%), HIV/AIDS (10%) andunknown (8%). The mortality rate at 90 days was 12.3%. Of these, 42% were cardiovascular-related mortalities and 32% died of infection related to central venous catheters. The lymphocyte percentage of total white blood cells was lower in patients who died compared to survivors (12.7 vs 20.8%) and was an independent predictor of early mortality (OR 0.914, 95% CI 0.850–0.983; P = 0.015). Conclusions: Early mortality was high in Zambian patients starting dialysis, and a low lymphocyte percentage was a predictor of mortality.