Stream Types Research Articles

Potential business model for a European vaccine R&D infrastructure and its estimated socio-economic impact.

Research infrastructures are facilities or resources that have proven fundamental for supporting scientific research and innovation. However, they are also known to be very expensive in their establishment, operation and maintenance. As by far the biggest share of these costs is always borne by public funders, there is a strong interest and indeed a necessity to develop alternative business models for such infrastructures that allow them to function in a more sustainable manner that is less dependent on public financing. In this article, we describe a feasibility study we have undertaken to develop a potentially sustainable business model for a vaccine research and development (R&D) infrastructure. The model we have developed integrates two different types of business models that would provide the infrastructure with two different types of revenue streams which would facilitate its establishment and would be a measure of risk reduction. For the business model we are proposing, we have undertaken an ex ante impact assessment that estimates the expected impact for a vaccine R&D infrastructure based on the proposed models along three different dimensions: health, society and economy. Our impact assessment demonstrates that such a vaccine R&D infrastructure could achieve a very significant socio-economic impact, and so its establishment is therefore considered worthwhile pursuing. The business model we have developed, the impact assessment and the overall process we have followed might also be of interest to other research infrastructure initiatives in the biomedical field.

Taxonomy and Distribution of the Genus Sellaphora Mereschowsky (Bacillariophyceae: Sellaphoraceae) in Aquatic Ecosystems of Mongolia.

During our investigation, 28 species belonging to the genus Sellaphora Mereschowsky were found in different types of water bodies and streams in Mongolia. Of these, 14 species have already been described and/or shown earlier in the flora of Mongolia, and we found 14 species for the first time. One new taxonomic combination has been proposed: Sellaphora glomus (J.R. Carter and A.E. Bailey-Watts) Glushchenko and Kulikovskiy comb. nov. One species is proposed for description as new to science: Sellaphora dorofeyukae Glushchenko and Kulikovskiy sp. nov. All species were illustrated with original light micrographs, and a number of species were also illustrated with scanning electronic photographs. The distribution of the identified species within Mongolia and the world is discussed.

Large eddy simulation of spray combustion using the spray flamelet/progress variable model: Further extension and validation

The classical flamelet combustion model assumes that the combustion system consists of two homogeneous inlet streams for oxidizer and fuel. It usually requires extension and validation for configurations with different types of inlet streams. In the current work, the recently developed two-phase spray flamelet/progress variable (TSFPV) model is further extended and validated on the configurations of Delft spray flame AII and Sydney piloted ethanol spray flame EtF2, representing the systems with a single inlet and three inlets, respectively. The strategies for generating the spray flamelet library are adjusted, and an extended model is developed for modeling flame AII. Large eddy simulations of these two flames are conducted to evaluate the accuracy of the TSFPV model. The results of flame AII show that some droplets penetrate into the flame zone, and significant droplets/flame interactions occur. The flame exhibits a typical double flame structure. The predictions of gas phase temperature are in good agreement with the experimental measurements, which indicates that the current model can better consider the influence of droplet evaporation and the temperature reduction caused by interphase heat loss. The results of flame EtF2 also achieve good agreement with experimental data according to radial profiles of axial droplet velocities and gas phase temperature. Overall, the TSFPV model is well validated and exhibits sound performance on different flame configurations, indicating its widespread applicability and generalizability.

Pro-ecological and conservation activities are not always beneficial to nature: a case study of two lowland streams in Central Europe

Since 1990 and in particular, after the implementation of the Water Frame Directive, many positive effects of pro-ecological projects are evident; unfortunately, examples of adverse effects have also been observed. This study aims to indicate how some ill-considered actions, called “pro-ecological”, may lead to habitat degradation and the disappearance of valuable hydrobiont species. Two watercourses, representing the lowland gravel stream and sandy stream type, were selected for the study. Literature indicated that in the past, these watercourses were characterized by an excellent ecological status and the presence of valuable rheophilic fauna and flora. Environmental parameters were recorded, macroinvertebrates and ichthyofauna were sampled and analyzed, and finally, indexes were calculated. The results were compared with literature data. In the course of studies conducted in 2011–2015, drastic habitat deterioration and extensive changes in the species structure of ichthyofauna and aquatic invertebrates were observed. Changes in the Smolnica stream have been caused by the three retention basins constructed in 2000, along the lower and middle course; while in Kiszewko, however, the factor for habitat deterioration was connected with the excessive expansion of the Eurasian beaver (Castor fiber), which created a beaver pond 20 m in width, with impoundment elevations of up to 2 m.

Unexpected functional diversity of stream biofilms within and across proglacial floodplains despite close spatial proximity

AbstractHigh‐mountain streams are particularly vulnerable to climate change because they intimately interface with the cryosphere. As glaciers shrink and snowpack diminishes, proglacial streams will eventually shift from being glacier‐fed to streams fed by groundwater, snowmelt and precipitation. This shift will affect both the flow regime and physico‐chemical characteristics of streams, possibly also the structure and function of their benthic microbiome. Here, we applied genome‐resolved metagenomics to benthic biofilms from glacier‐fed streams and their groundwater‐fed tributaries within three proglacial floodplains in the Swiss Alps. Despite the close spatial proximity between both stream types, their microbiome structure differed consistently for both prokaryotes and eukaryotes. The glacier‐fed stream microbiome was taxonomically and functionally less diverse than its groundwater‐fed counterpart, and had smaller genomes, but with conservation of the central metabolic functions primarily related to nitrogen and sulfur cycling. Consequently, much higher functional variability was associated with the microbiome of tributary streams, mainly due to abundant genes involved in the transport and degradation of organic matter. Our findings suggest that glacier shrinkage will cause shifts in the functioning of benthic microbiomes of proglacial floodplains with yet unknown consequences for downstream biogeochemistry.

Economic effects of interaction. The neglected economy of connectivity

PurposeWith a start in the observation that there is a large variation in how companies interact with each other, the paper aims to anlayse the economic consequences of this variation. As the more extensive interaction is costly, the variation also indicates a variation in the economic dimension.Design/methodology/approachThis is a conceptual paper.FindingsThree different economic streams can be identified. Firstly, the interaction costs can be reduced by taking advantage of time and scope. Interaction over time give opportunity to use some of the costs as investments through creation of relationships. By using the same counterpart for several products, scope can be used to reduce interaction costs. Secondly, developed business relationships can be used to create relation revenues. The counterparts can use each other for developing better solutions and for development of knowledge. Finally, the actors can also get positive network effects. One example is the joint development with third parties such as sub-suppliers or customer’s customer.Research limitations/implicationsThe discussion ends in two major implications. One is the central role of managers and the other the crucial role of economic deals. Managers are crucial both to identify relevant cost and revenue items as well as to exploit them. Deals are important as it is only with direct counterparts where there are monetary streams. In all other relationships, there is only indirect consequences.Originality/valueIt is obvious that the type of cost and revenue streams identified above will require new and different economic tools. A base for this is given here.

Investigating the relationship between research income and research excellence in education: Evidence from the REF2021‐UoA23 data

AbstractThis paper presents and discusses the relationship between the generation of research income and the REF2021 results for universities who submitted a return to Unit of Assessment 23—Education. Research Excellence Framework exercises tend to be time intensive and come with income streams of Government Quality Research funding as well as reputational gains and risks. Based on REF2021 research environment research income data, freely available on the REF2021 website, analyses have been undertaken to investigate the strength of relationships between different types of fundings streams and grade point averages. The results demonstrate strong variation in funding capture across the different universities with Russell Group members tending to generate more income from prestigious funders such as UK Research and Innovation. However, several post‐1992 universities managed to capture significant income from funders like UK and EU governments, without this necessarily translating into higher grade point averages or 4* scores. While generating research income is perceived as an important part of academic life, the paper concludes that achieving research excellence seems more complicated than just following the money.

Thermal regimes of groundwater‐ and lake‐fed headwater streams differ in their response to climate variability

AbstractStream thermal regimes are being altered by climate change with consequences for aquatic organisms. Most documented long‐term changes in stream temperature are from large rivers. We know less about water temperature trends for small headwater streams, especially those found in northern landscapes that contain small lakes. We analyzed 36 yr of stream temperature observations from a long‐term watershed study in Ontario, Canada, to understand how headwater streams are responding to climate variability. We found that groundwater‐fed (GWF) and lake‐fed (LF) streams exhibit contrasting responses, as GWF streams warmed in the spring (0.19–0.60°C per decade) and LF streams warmed in the fall (0.39–0.72°C per decade). Both stream types exhibited weak temperature trends in summer and winter. These results highlight that a stream network perspective that includes headwater streams and small lakes, and accounts for seasonal changes in thermal regimes, is important for understanding aquatic ecosystem response to climate variability.

Inter-annual and habitat variation of the mayfly assemblage in grassland and pine afforested headwater streams (Córdoba, Central Argentina)

Mayflies are widely used as indicators of stream conditions since their presence and abundance are closely associated with changes in environmental characteristics. We aim to analyze the richness and abundance patterns of mayflies in headwater streams of the Ctalamochita river basin in central Argentina, where some sub-basins have been fully afforested with exotic pines. We sampled 3 grassland streams and 3 pine afforested streams in 2008, 2012, 2014, and 2015. We took Surber samples in riffles and in 2012 we also sampled 2 additional habitats: pools and macrophyte patches. We found ten mayfly genera. Americabaetis and Leptohyphes were the most frequent and abundant and Cloeodes and Tricorythodes were rare, with a relative frequency < 3%. Richness and abundance were higher in grassland streams (ANOVA, p < 0.05), but the abundance pattern of different mayfly genera varied. In 2012 mayfly abundance was higher in pools and macrophytes in the afforested streams (ANOVA, p < 0.05), but it was similar among habitats in grassland streams. Different species dominated different habitats and stream types, and some shared the same habitat. In riffles and pools, the dominant genera was similar for afforested and grassland streams, while in macrophyte the dominance varied according to the riparian vegetation. Distribution patterns are influenced by microhabitat characteristics, which may be conditioned by changes in riparian land uses.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review.

Techno-economic feasibility of hybrid hydro-FPV systems in Sub-Saharan Africa under different market conditions

Floating photovoltaic (FPV) systems are an emerging and increasingly competitive application of solar PV, especially in land area-constrained countries. This study focuses on the optimal dimensioning and scheduling of a grid-connected hybrid hydro-FPV system. The case study is based on a cascade hydropower system located in Sub-Saharan Africa. The techno-economic feasibility of the hybrid system is analysed under different types of revenue streams and load commitments. Moreover, the resource complementarity between solar irradiation and reservoir water inflow in different weather years is analysed. A linear programming model for optimal dimensioning/scheduling of a hybrid hydro-FPV system is proposed. The results indicate that hybridisation with FPV can under the proposed PPA and spot market structure increase the annual producer profits by 18–21% and 0–4%, respectively compared to a hydro-only system. Furthermore, it is estimated that the CAPEX of FPV should be around 42–57% lower than that of ground-mounted PV (GPV) with single-axis tracking for the hydro-FPV system to reach the same annual producer profit as the hydro-GPV system. Considering improved efficiency by cooling the FPV modules, the revenues increase by 0–3% depending on the selected weather year and market scheme.

Promoting Sustainable Fruit and Vegetable Biowaste Management and Industrial Symbiosis through an Innovative Web Platform

Sustainable bioeconomy is a promising pathway towards the transition to a circular and climate-neutral economy. The valorization of biowaste is a key player in this direction. This paper presents the design and development of the AgriPLaCE Platform, which aims to promote synergies that enable the utilization of biowaste from the fruit and vegetable supply chain. The platform consists of the AgriPLaCE Waste Management Database, which provides users with an extended list of potential utilization methods for various types of fruit and vegetable biowaste streams, and the AgriPLaCE Synergies Tool, which facilitates synergies between different actors involved in the biowaste-to-resource value chain from agricultural waste production to waste treatment and new valuable products’ exploitation. Initially, the conceptual design of both tools took place based on analysis of user needs and services alongside the system architecture. Following this, the AgriPLaCE Platform was developed with the implementation of all the necessary subsystems. The results of the platform’s implementation demonstrated its potential to generate multiple collaborations and synergies while users can also deepen their knowledge about alternative and emerging treatment technologies and valuable products from a wide range of fruit and vegetable biowaste streams.

Hydrochemical and Seasonally Conditioned Changes of Microbial Communities in the Tufa-Forming Freshwater Network Ecosystem.

Freshwater network ecosystems consist of interconnected lotic and lentic environments within the same catchment area. Using Plitvice Lakes as an example, we studied the changes in environmental conditions and microbial communities (bacteria and fungi) that occur with downstream flow. Water samples from tributaries, interlake streams, connections of the cascading lakes, and the Korana River, the main outflow of the system, were characterized using amplicon sequencing of bacterial 16S rRNA and fungal ITS2 genes. Our results show that different environmental conditions and bacterial and fungal communities prevail among the three stream types within the freshwater network ecosystem during multiple sampling seasons. Microbial community differences were also confirmed along the longitudinal gradient between the most distant sampling sites. The higher impact of "mass effect" was evident during spring and winter, while "species sorting" and "environmental selection" was more pronounced during summer. Prokaryotic community assembly was majorly influenced by deterministic processes, while fungal community assembly was highly dominated by stochastic processes, more precisely by the undominated fraction, which is not dominated by any process. Despite the differences between stream types, the microbial community of Plitvice Lakes is shown to be very stable by the core microbiome that makes up the majority of stream communities. Our results suggest microbial community succession along the river-lake continuum of microbial communities in small freshwater network ecosystems with developed tufa barriers. IMPORTANCE Plitvice Lakes represent a rare freshwater ecosystem consisting of a complex network of lakes and waterfalls connecting them, as well as rivers and streams supplying water to the lake basin. The unique geomorphological, hydrological, biogeochemical, and biological phenomenon of Plitvice Lakes lies in the biodynamic process of forming tufa barriers. In addition to microbial communities, abiotic water factors also have a major influence on the formation of tufa. Therefore, it is important to understand how changes in environmental conditions and microbial community assembly affect the functioning of the ecosystem of a freshwater network with developed tufa barriers.

Investigations on nonlinear processes of a Gifford-McMahon type orifice pulse tube refrigerator

The target of this investigation is to illustrate the nonlinear fluid flow, heat transfer, and vortex formation phenomena in an orifice pulse tube refrigerator by numerical simulation. Numerical results confirm that jet streaming is generated at the low-temperature end of the pulse tube in between the junction of U-shaped tube and pulse tube. The primary vortex, which is generated due to the minor loss, continuously grows because of velocity change and eventually leads to the formation of secondary eddy. Consequently, flow straighteners have been adopted at the hot side of the regenerator, hot heat exchanger, and both sides of U-shaped tube. It is noticed that, jet streaming has been suppressed at the cold end of the pulse tube. Nevertheless, the streaming effect generated due to the oscillating flow of the gas parcels within the pulse tube, and third type of streaming have not been suppressed with the flow-straightener. Additionally, the numerical simulation shows different gas flow behaviors within the pulse tube that occurs due to the oscillating pressure pulse. An experimental investigation is conducted to compare experimental results with the numerical results and a valid agreement is observed between them.

Long-term trends and drivers of biological invasion in Central European streams

Rates of biological invasion continue to accelerate and threaten the structure and function of ecosystems worldwide. High habitat connectivity, multiple pathways, and inadequate monitoring have rendered aquatic ecosystems vulnerable to species introductions. Past riverine invasion dynamics were largely restricted to large rivers, leaving out smaller rivers that commonly harbour high freshwater biodiversity. Moreover, biodiversity time series have rarely been used to investigate invasions across larger spatial-temporal scales, limiting our understanding of aquatic invasion dynamics. Here, we used 6067 benthic invertebrate samples from streams and small rivers from the EU Water Framework Directive monitoring program collected across Central Europe between 2000 and 2018 to assess temporal changes to benthic invertebrate communities as well as non-native species. We assessed invasion rates according to temperature, precipitation, elevation, latitude, longitude, and stream type. Overall, average daily temperatures significantly increased by 0.02 °C per annum (0.34 °C in total) while annual precipitation significantly decreased by 0.01 mm per annum (−67.8 mm over the study period), paralleled with significant increases in overall species richness (12.3 %) and abundance (14.9 %); water quality was relatively stable. Non-native species richness increased 5-fold and abundance 40-fold, indicating an ongoing community shift from native to non-native species. The observed increase in invasions was stronger in low mountain rivers compared to low mountain streams, with the share of non-native species abundance and richness declining with increasing elevation and latitude but increasing with temperature. We found thermophilic non-native species invasion success was greatest in larger sized streams, at lower latitudes, lower elevations and higher temperatures. These results indicate that widespread environmental characteristics (i.e., temperature) could heighten invasion success and confer refuge effects (i.e., elevation and latitude) in higher sites. High altitude and latitude environments should be prioritised for prevention efforts, while biosecurity and management should be improved in lowland areas subject to greater anthropogenic pressure, where non-native introductions are more likely.

Combining Statewide Surveys and Classification to Support Management of Streams

Data from agency‐based inventory programs could be very useful for local fishery management if appropriately summarized and served, but data are often accessible to few. Fundamental management questions at regional and local scales center around resource status and trends, highlighting the need for decision support tools operating at multiple scales. As stream classifications are developed for regions, survey programs become standardized, and innovations for serving spatially and temporally extensive data publicly become common, opportunities arise for developing locally relevant management decision support tools. We describe simple public‐facing tools that use information from a statewide stream inventory program to increase understanding of local and regional trends in important fish populations, describe benchmark conditions for all stream types at various spatial scales, and provide empirical support for local and broader scale management of stream fishes and habitat. We provide examples demonstrating their utility to encourage development of similar tools elsewhere.

Homogeneous Environmental Selection Structures the Bacterial Communities of Benthic Biofilms in Proglacial Floodplain Streams.

In proglacial floodplains, glacier recession promotes biogeochemical and ecological gradients across relatively small spatial scales. The resulting environmental heterogeneity induces remarkable microbial biodiversity among proglacial stream biofilms. Yet the relative importance of environmental constraints in forming biofilm communities remains largely unknown. Extreme environmental conditions in proglacial streams may lead to the homogenizing selection of biofilm-forming microorganisms. However, environmental differences between proglacial streams may impose different selective forces, resulting in nested, spatially structured assembly processes. Here, we investigated bacterial community assembly processes by unraveling ecologically successful phylogenetic clades in two stream types (glacier-fed mainstems and non-glacier-fed tributaries) draining three proglacial floodplains in the Swiss Alps. Clades with low phylogenetic turnover rates were present in all stream types, including Gammaproteobacteria and Alphaproteobacteria, while the other clades were specific to one stream type. These clades constituted up to 34.8% and 31.1% of the community diversity and up to 61.3% and 50.9% of the relative abundances in mainstems and tributaries, respectively, highlighting their importance and success in these communities. Furthermore, the proportion of bacteria under homogeneous selection was inversely related to the abundance of photoautotrophs, and these clades may therefore decrease in abundance with the future "greening" of proglacial habitats. Finally, we found little effect of physical distance from the glacier on clades under selection in glacier-fed streams, probably due to the high hydrological connectivity of our study reaches. Overall, these findings shed new light on the mechanisms of microbial biofilm assembly in proglacial streams and help us to predict their future in a rapidly changing environment. IMPORTANCE Streams draining proglacial floodplains harbor benthic biofilms comprised of diverse microbial communities. These high-mountain ecosystems are rapidly changing with climate warming, and it is therefore critical to better understand the mechanisms underlying the assembly of their microbial communities. We found that homogeneous selection dominates the structuring of bacterial communities in benthic biofilms in both glacier-fed mainstems and nonglacier tributary streams within three proglacial floodplains in the Swiss Alps. However, differences between glacier-fed and tributary ecosystems may impose differential selective forces. Here, we uncovered nested, spatially structured assembly processes for proglacial floodplain communities. Our analyses additionally provided insights into linkages between aquatic photoautotrophs and the bacterial taxa under homogeneous selection, potentially by providing a labile source of carbon in these otherwise carbon-deprived systems. In the future, we expect a shift in the bacterial communities under homogeneous selection in glacier-fed streams as primary production becomes more important and streams become "greener".

Coarse sediment mobility and fluxes in wide mountain streams: Insights using the virtual velocity approach

The investigation of coarse sediment transport in wide mountain streams is very challenging because of limitations that affect the adoption of direct and indirect field monitoring techniques. Such river type represents then a stream typology for which quantitative knowledge of coarse sediment mobility, dynamics and fluxes is poor. This study uses tracer particles and a virtual velocity approach to gain insights about sediment mobility and coarse bed material transport in a wide mountain stream. Monitoring at the study area was conducted by tagging two types of tracer clasts, installing scour chains, and collecting data on water levels, transport processes, particle travel distances, and active layers over a period of 19 months and five transporting floods in the Tegnas Torrent (the Dolomites, Italy). Bed sediment was mobilized during a limited number of hydrological events (i.e. 6 to 9 per year), taking place in 50 to 400 h and inducing a total coarse sediment flux of about 1200 to 1400 m3 yr−1. The mobilization of coarse particles forming the streambed begins in response to a dimensionless shear stress (τ*c = 0.018) that is lower than thresholds commonly reported in the literature for mountain rivers and the estimated unit bed material transport was remarkably higher compared with those obtained in other mountain streams or gravel-bed rivers. The high mobility of streambed material can be related to the availability of fresh and unstructured sediment transported and deposited in the active channel by a high-magnitude event that occurred a few months before monitoring was conducted in this work, suggesting that sediment fluxes in a stream recently affected by a large flood could be considerably higher than those normally expected in a specific context. Finally, despite the existence of some application constraints, the experiment generated satisfactory results as regards the applicability of the virtual velocity approach in investigations of this stream type. This new quantitative knowledge of sediment fluxes and dynamics is also crucial for management of wide mountain streams.

Effects of Deadwood on Macroinvertebrate Assemblages in Three Sand-Type Lowland Streams

The objective of the manuscript was to study the effects of dead wood on macroinvertebrates (MI) assemblages occupying different habitat patches. Three streams were studied, with control and wooded sections in each stream from which MI were sampled for all substrate types (wood, fine detritus, gravel, sand). This contribution deals with three German streams Ihle, Nieplitz, and Verlorenwasser, which belong to the stream type 14 (sand-dominated lowland stream) and are located in the landscape unit Fläming. This type of stream, where large wood could be most influential, has been relatively understudied. This study focused on quantifying substrate distribution and macroinvertebrate taxonomy and performing statistical analysis of MI densities with regard to substrate type. The area-specific invertebrate assemblages were differentiated for MI density, dry matter density and taxonomic richness of invertebrates. In addition to macroinvertebrates, a special focus was on aquatic and semi-aquatic insects. There were significant differences between the control and wooden sections. The macroinvertebrate assemblages (individual density, dry matter density and species richness) of the detritus of the wood sections only in the Verlorenwasser was significantly and positively affected (two or three times) by the deadwood. Detritus in the wood sections of the Nieplitz and Verlorenwasser contained more sensitive species like EPT than detritus from the control sections. On the other hand, no significant difference in MI populations were determined for the sand of the wood sections compared to the sand of the control sections. In all water bodies, the wood substrate promoted all investigated indicators of macrozoobenthos as compared to sand of the wood sections. Detritus significantly promoted macrozoobenthos colonization in the wood sections as compared to sand of the Nieplitz and the Verlorenwasser. The MI density and dry matter density in the Ihle was also significantly promoted by detritus, although not significantly with regard species richness. Two significant correlations were also identified. The more sand that was present in the Ihle and the Verlorenwasser, the more the macroinvertebrate assemblages were inhibited. Additionally, the larger the area of detritus in the Ihle and the area of wood in the Nieplitz, the more MI populations were encouraged. The influence of the deadwood position on MI was also investigated, but there was no significant difference. Incline bridges, flow guides and parallel wood position types were settled in similar quality and quantity.

Survival Analysis and Its Predictors Among Hemodialysis Patients at Saint Paul Hospital Millennium Medical College and Myungsung Christian Medical Center in Addis Ababa, Ethiopia, 2021.

Diabetes mellitus and hypertension are the most prominent conditions causing chronic kidney disease and eventually end-stage renal disease. Renal replacement therapy, particularly hemodialysis (HD), is the mainstay of treatment. The aim of this study is to assess the overall survival status of HD patients and potential survival predictors at Saint Paul hospital millennium medical college (SPHMMC) and Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. A retrospective cohort study was conducted on HD patients at SPHMMC and MCM general hospital from January 1, 2013 to December 30, 2020. Kaplan Meier, Log-rank, and Cox proportional regression models were used for the analysis. Estimated risks were reported as hazard ratios with 95% confidence intervals and P<0.05 was considered as having a significant association. A total of 128 patients were included in the study. Median survival time was 65 months. The predominant co-morbid condition was found to be diabetes mellitus with hypertension (42%). The total risk time for these patients was 143,617 person years. The overall incidence rate of death was 2.9 per 10,000 person years (95% CI=2.2-4). Patients who developed blood stream infection were 2.98-times more likely to die than those without infection. Those using an arteriovenous fistula were 66% less likely to die than those using a central venous catheter. Additionally, patients treated in a government-owned facility were 79% less likely to die. The study identified that the median survival time of 65 months was comparable with developed nations. Significant predictors of death were found to be blood stream infection and type of vascular access. Government-owned treatment facilities showed better patient survival.