الفهرس | Only 14 pages are availabe for public view |
Abstract End-stage renal disease (ESRD) is one of the main health problems in Egypt. Currently, hemodialysis represents the main mode for treatment of chronic kidney disease stage 5 (CKD5), previously called ESRD or chronic renal failure. Although hemodialysis is often used for treatment of ESRD, no practice guidelines are available in Egypt. Healthcare facilities are seeking nowadays to develop practice guidelines for the sake of improving healthcare services. In the healthcare sector in Egypt, trials for establishing guidelines have been lead by the MOH. This work is a part of project aiming at assessment of the current status of dialysis patient in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University. This study was done in June 2013. Our study sample consisted of 319 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Mubarak university hospital, Infectious disease hospital, Medical complex hospital, Al labara hospital, American hospital , El-Farouk hemodialysis center, and Delta international hospital. In all patients we recorded full history and clinical examination stressing on etiology of renal disease and associated complications, Full review of all medical records over the last 6 months ,and details of HD prescription . Results of this study demonstrated that there were many causes for ESRD in the study population .HTN was responsible for 21.6% of these cases , DM was responsible for 15% of these cases ,and in 38.2% the cause was unknown. Different comorbidities in the study population were HTN in (70.8%), DM in (18.2%), ISHD in (13.5 %), and CLD in (1.6%) of patients. In our study we found that most of the patients( 99.7%) were receiving 3 HD sessions/week .(85.89%) of them lasting for 4 hours . The mean value of patients dry weight was 76.4 (± 17.33) Kg.In our study population (78.4%) were not working , while (21.6%) were working . Physical dependency status in the study population showed that (16.9%) of the patients were dependant, (83.1%) were not dependant , while (4%) of them were wheelchair bound . As regard Sponsoring status in the study population (42.63%) of them were sponsored by Governorate , (50.16%) of them were sponsored by insurance, (6.9%) were sponsored by company, while (0.31%) were a private cases . In our study we found that( 94.04 %) of patients were using AVF , (1.57 %) were using AVG while (4.39%) were using venous catheter . In our study the mean hemoglobin level of our patients was 5.57(±1.73)gm/dl, we found that according to NKF- KDOQI guidelines recommendations(86.21%) of our patients were below the recommended level, (13.79 %) were above it. In our study the percentage of patients receiving regular erythropoietin was (83.39%) , the most frequent ESA used was Epoetin alfa (81.5%), Recormon (0.63%),while(16.61%) of patients were not on ESA therapy. As regard vitamins use in the study population (66.46%) of them received vitamin B complex , as regard LCarnitine(87.8%) of them were receiving it , as regard vitamin D there were ( 60.82%) of our patients were receiving it. History of iron injection in the study population showed that (46.70%) were receiving iron injection, while the other (53.30%) did not receive it. We also found that the mean calcium level was (8.8) ± (0.7)mg/dl , According to KDIGO 2009 guidelines (1.6 %) of patients were below the recommended level , ( 71.5 %) within the recommended level and (1.3 %) above the recommended level and (25.7%) have no available results. In our study we found that the mean phosphorus level was (5.2) ± (1.5)mg/dl. According to KDIGO 2009 guidelines (55.2 %) of our patients were below the recommended level, and (18.8 %) above the recommended level and (26%) have no available results. In our study ( 83.70 %) of the patients were on phosphate binders therapy mainly calcium salts, the other ( 16.30%) were not receiving.Calcium phosphorus product level was above 55 in (3.45%) ,while in (96.55%)was below 55. The percentage of HCV positive Patients was (53.6%), HBV positive Patients percentage is (4.1%), while (46.4%) of Patients were negative. all HBV positive Patients are not isolated from HCV positive.HCV positive patients were isolated from HCV negative patients. Our study showed that out of 319 patients (52.35 %) were using a dialyzer with surface area 1.3m, (36.99%) were using one with surface area 1.6 m, ,(1.25%) of them were using one with surface area 1.8m,(0.31%) of them were using one with surface area 1.5,(9.09%) of them were using one with surface area 1.1m, All of these filters were synthetic material ,low flux sterilized by ethylene oxide. As regard dialysate used in the study population that 212 (66.46%) patients were using dialysate with K concentration 2mmol/L, Ca concentration 1,50 mmol/L ,Na 140 mmol/L, Mg 0.50 mmol/L and bicarbonate based. while the other 107 ( 33.54%) were using dialysate with K concentration 1.5 mmol/l, Ca concentration 3 mmol/l ,Naconcentration 135 mmol/l, and Mg concentration 1.5 mmol/l and acetate based. K/DOQI guidelines recommendations for HD patients treated 3 times per week with minimal residual renal function (less than 2 mL/min per 1.73 m2) stated that minimally adequate dose should be a Kt/V of 1.2 (or a URR of 65 %) and target recommended dose should be a Kt/V of 1.4 (or a URR of 70 %) .(NKF K/DOQI guidelines, 2006 2006 K/DOQI guidelines recommended that the delivered dose of HD should be measured at regular intervals not less than monthly. Less frequent measurements may compromise the timeliness with which deficiencies in the delivered dose of HD are detected and hence may delay implementation of corrective action. (K/DOQI guidelines, 2006) Unfortunately, in our study, methods for measurement of HD adequacy were only done in 2 units ,not done for all patients because of financial limitation. |