الفهرس 
Global Facts: About Kidney DiseaseOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: CKD is a growing worldwide epidemic. The incidence and prevalence of ESRD are expected to continue to increase. Home hemodialysis has been available as a modality of renal replacement therapy since the 1960s. The interest in home hemodialysis has been increasing over the last years owing to its flexibility and benefits. Over the last several years, some forms of home hemodialysis are available in some countries in the Middle East especially UAE, Kuwait and Saudi Arabia. Very little data are available regarding the overall outcome, morbidities, and mortalities in this selected group of patients treated with this modality.Aim of the Work: This study was done to evaluate the current status of home hemodialysis in the Middle East, then to study the perspectives and future possibilities of home hemodialysis in Egypt. It was carried out during the last 2 years; 2019 and 2020. Patients and Methods: It included 2 parts (a retrospective and a prospective). The study included 131 patients who were adult ESRD patients, either had been treated and maintained on home hemodialysis during the last 5 years or treated and maintained on home hemodialysis during the period from march 2019 to march 2020. Results: The mean URR% was 56 and 63 for those in the retrospective and prospective parts, respectively. Also, the mean KT/V was 1.1 for patients in the retrospective part and 1.18 for patients in the prospective part. The 1st year mortality was significantly high in all involved patients, about 36% . It was also significantly higher in patients of the retrospective part as it was 40.7% while it was 28% for those of the prospective part. Some meaningful correlations were detected and some mortality predictors were unmasked because of their significant correlations. These mortality predictors were classified as either with a +ve correlation or a –ve correlation. Both of them can be either numerical on non-numerical variables. Conclusion: In the Middle East, home HD was chosen as an alternative to in-center HD, to manage only a highly compromised group of ESRD patients rather than healthy ones. The inclusion criteria were patients who are bed-ridden, wheel-chair-bound, demented or having CVA, amputations or non-union fractures …… etc, and having a great difficulty to get HD in centers/hospitals. It is a benign mode of HD with less reported intra-dialytic complications. Excessive UF was better tolerated in patients with volume overload or cardio-renal syndrome with home HD. SLED and SCUF modes were also very effectively managed with these simple machines. The psychological status was significantly improved in those patients. Even new ESRD patients who were too reluctant to start HD, were better convinced to start home HD. The loss of residual renal functions in new HD patients, was significantly low with the use of home HD. These benefits were related to less dialysate exposure other than the use of ultrapure dialysate. Nevertheless, Home HD is expensive and less efficient for most patients if done thrice weekly. It is effective in only underweight patients with low BMI. Owing to certain technical merits, clearance rates were found higher with using the DIMI machine, if compared to the NxStage one, with the same HD parameters.