Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Qalyubia)

Abstract

Studies examining the link between research evidence and clinical practice have consistently shown gaps between the evidence and current practice, 30-40% of patients do not receive evidence-based care, while in 20% of patietn care may be not needed or potentially harmful. However, relatively little information exists about how to apply evidence in clinical practice, and data on the effect of evidence-based guideliens on knowledge uptake, proces sof care or patient outcomes is limited. In recnet years, specific clinical guideliens have been developed to optimize the quality of anemia management secondary to Chronic Kidney Diseases (CKD). As a result, the National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines and the renal- European Dialysis and Transplantation Association best practice guidelines have been published in USA and Europe. Therefore, clinical practice guidance help individual physician and physicians as group to improve their clinical performance and thus raise standard of patient care towards optimum levels, they may also help to insure that all institution provide an equally good baseline standard of care. Guidelines practiced on anemia and actual practices are much different with different places and patients according to treatment. Moreover, in individual countries and individual units within countries local circumstances relating to economic conditions; organization of healthcare delivery or even legal constraints may render the immediate implementation of best practice guideliens difficult or impossible. Summery&conclusion 87 Nevertheless, they provide a goal against which progress can be measured. Dialysis Outcomes and Practice Patterns Study (DOPPS) have observed a large variation in anemia management among different countries. The main hemoglobin concentration in hemodialysis patient varied widely across the studied countries ranging between 8 gm/dl to 11 gm/dl. The percentage of prevalent hemodialysis patient receiving Erythropoietin Stimulating Agent (ESA) has increased from 75% to 83%. The percentage of HD patient receiving iron varies greatly among DOPPS countries range from 38% to 89%. There are challenges in implanting clinical guidelines in medical practice. Overall DOPPS data which showed that despite the availability of practice guidelines for treatment of renal anemia, wider variation in anemia management exists as gap between what is recommended by the guideliens and is accomplished in every day clinical practice. Compliance with clinical gudelines is an importance indicator of quality and efficcy of patient care at the same time their adaptation in clinical practice may be initiated by numerous factors including: clinical experts, patient performance, constraints of public health policiies, community standard, .budgetary limitation and methods of feeding back information concerning current practice.