Addisu MelkieMihiretu Gebreegziabher2026-06-222026-06-222024-12-15https://etd.aau.edu.et/handle/123456789/8442Background: Acute kidney injury (AKI) requiring dialysis is a serious and potentially fatal entity that places a significant burden on healthcare systems. Limited data is available on the factors contributing to higher mortality rates among AKI patients requiring dialysis, particularly in low- and middle-income countries including Ethiopia. Objective: To assess the in-hospital mortality rate and associated factors among acute kidney injury patients requiring dialysis in Addis Ababa, Ethiopia. Methods: This institution-based retrospective study evaluated patients who underwent hemodialysis for acute kidney injury (AKI) from January 1, 2019, to December 30, 2024, at a major public hospital in Addis Ababa, Ethiopia. A total of 147 patients were screened, and 128 patients fulfilled the inclusion criteria and were included in the study . Data were collected from medical charts and electronic records using a structured tool. Data were analyzed using SPSS version 26. Survival analysis was conducted using the Kaplan-Meier Curve, while Cox regression was used to assess the association between variables (e.g., age, comorbidities) and in hospital mortality. Results: The mean age of the study population was 49.5 ± 14.6 years, with a female proportion of 42.2%. The overall in-hospital mortality rate was 16.4% (95% CI: 10.4–24.0%), with a mortality incidence of 7.42 deaths per 1000 person-days. The majority of deaths (66.7%) occurred within the first 15 days of hospitalization. Significant factors associated with increased mortality included low Glasgow Coma Scale (GCS) scores (AHR: 11.93, 95% CI: 2.45–58.03), septic shock (AHR: 26.21, 95% CI: 6.79–117.21), increased the number of dialysis sessions (AHR = 0.86, 95% CI: 0.67–0.89, p = 0.03) and increased serum albumin, (AHR = 0.04, 95% CI: 0.002–0.80, p = 0.04). Conclusion: The in-hospital mortality rate for patients with AKI requiring hemodialysis in our study was 16.4%, which is significantly lower than both the global average and findings from other studies conducted in Africa. This discrepancy may be attributed to several factors, including the strength of the local healthcare infrastructure, the relatively younger age of our patient population, a lower prevalence of sepsis, and differences in the timing of dialysis initiation. Keywords: Acute Kidney Injury, Mortality rate, Dialysisen-USAcute Kidney Injury Mortality rate DialysisThesis