Background: Kidney failure is one of the leading causes of morbidity and mortality worldwide. The incidence of kidney failure in Somalia has been increasing in recent years. There is no data available on the causes of chronic kidney disease (CKD) leading to kidney failure in Somalia., Methods: This is a multicentre, descriptive cross-sectional study designed to determine the aetiology of kidney failure among patients receiving haemodialysis in four major demographic areas of Somalia. The study was conducted over a one-year period, from June 2021 to June 2022. Participants were eligible for inclusion if they had been diagnosed with kidney failure, were on regular haemodialysis, and were over 18 years of age., Results: A total of 127 patients were evaluated, 84 (66.1%) were males and 43 (33.9%) were female. The mean age of kidney failure patients was 49.3 ± 12.2 years. They originated from various regions, 5.6% from the south, 29.9% from the north-eastern, and 64.5% from the northwest. The mean duration of haemodialysis was 4.4 ± 2.2 years. The most common cause of kidney failure in our study was hypertension (33.1%), followed by diabetes mellitus (27.6%), uncertain aetiology (24.4%), glomerulonephritis (7.1%), obstructive uropathy (3.8%), renovascular hypertension (1.6%), neurogenic bladder, polycystic kidney disease, congenital and hereditary diseases (0.8%)., Conclusions: Our study showed the leading cause of kidney failure among maintenance haemodialysis patients was hypertension, followed by diabetes mellitus. To reduce the burden of kidney failure in Somalia, primary prevention of hypertension and diabetes and early detection and prompt management of chronic kidney disease (CKD) in high-risk populations should be a fundamental focus., (© 2023. The Author(s).)