PRESCRIPTION IN REGULAR HEMODIALYSIS PATIENTS IN QALUBIA GOVERNORATE (SECTOR B1)
Mohammed Abd E1 Aleem Abd El Monaem;
Abstract
SUMMARY
E
nd-stage renal disease (ESRD) is one of the main health problems in Egypt. Currently, hemodialysis represents the main mode for treatment of ESRD. However, no HD practice guidelines are available in Egypt. Healthcare facilities lead by the MOH are seeking nowadays to develop practice guidelines for the sake of improving healthcare services.
This work is a part of project aiming at assessment of the current status of HD patient in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University. This study included regular HD patients from Qalubia Governorate Sector B1 and was conducted in January & February 2013.
The questionnaire sheet covers etiology of renal disease and associated complications, full review of all medical and laboratory records over the last 6 months and details of HD prescription.
Our study sample consisted of 150 clinically stable chronic patients on regular HD. Patients were collected from 3 HD centers; Benha University Hospital, Benha Fever Hospital, and one private center.
Results of this study demonstrated that all patients were under regular 4 hours thrice weekly HD sessions using bicarbonate dialysate as base buffer, high calcium dialysate concentration (1.75 mmol/L) and conventional high molecular weight heparin as the standard anticoagulant. All used dialysate with same K concentration (2mmol/L). All dialyzers were of synthetic Polysulphone, low flux and steam sterilized with most (85.3 %) of them of 1.3 m2 surface area and few (14.7%) of surface area 1.4 m2. The main vascular access was native AV fistula (99.3% ).
The majority of HD patients are under sponsorship of the government (86%) with the main burden on ministry of health (75.3%) followed by military (14.7%) then health insurance (8.7%).
The mean age of our dialysis patients was 46.04±10.94 years; two thirds were males and were under dialysis for a mean period of years 4.8± 3.7 years.
None of the HD centers included in the study were performing tests of HD adequacy whether the simple urea reduction rate or the more complex Kt/V. This may lead to under recognition of efficiency of’ dialysis and poor general quality of life of our patients.
Results of this study demonstrated that the main causes of ESRD in our patients are similar to other regions of the world. Hypertension was the first cause (32.7%) and DM was the main second cause (15.3%). Most of our HD patients had associated co-morbidites as hypertension (58.7 %), diabetes (24. %) cardiovascular diseases (33.3 %) as ischemic heart disease, cerebrovascular and peripheral vascular disease.
The majority of our dialysis patients were not working (80.7%) although most of them were independent on the help of others (89.3%).This may reflect the bad quality of life of most of our patients and may point to lack of social or psychological support.
The majority of our patients were hepatitis B or C negative (76%) with only 13.3% HBV positive and 9.3% HCV positive. HBV patients were isolated while there was no isolation for HCV positive from HCV negative patients.
In our study the mean hemoglobin level of our patients was 9.49 gm/dl. This level was less than the lower cutoff level recommended by K/DOQI guidelines which set a lower Hb limit of 11.0 g/Dl and suggested an upper limit of 12 g/dL without intentionally exceeding 13 g/dL . Moreover, the target hemoglobin recommended by most guidelines was reached in only 18 % of study population, while the majority of patients (82%) had mean Hb less than 10.5 g/dl much lower than the level recommended by both K/DOQI and KDIGO guidelines.
The low target Hb occurs despite the fact that most of our patients were receiving parenteral iron, B- vitamins, L carnitine and erythropoietin.
Unfortunately, most our patients did not undergone regular Hb and iron profile testing in most of the patients. This may explain the lower target Hb and frequent need for blood transfusion and might explain the poor response to ESA which is used in all of our patients. Our Hb levels do not agree with K/DOQI anemia guidelines that recommend that during the initiation of erythropoietin treatment, iron status be tested every month in patients not receiving ongoing iron repletion.
E
nd-stage renal disease (ESRD) is one of the main health problems in Egypt. Currently, hemodialysis represents the main mode for treatment of ESRD. However, no HD practice guidelines are available in Egypt. Healthcare facilities lead by the MOH are seeking nowadays to develop practice guidelines for the sake of improving healthcare services.
This work is a part of project aiming at assessment of the current status of HD patient in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University. This study included regular HD patients from Qalubia Governorate Sector B1 and was conducted in January & February 2013.
The questionnaire sheet covers etiology of renal disease and associated complications, full review of all medical and laboratory records over the last 6 months and details of HD prescription.
Our study sample consisted of 150 clinically stable chronic patients on regular HD. Patients were collected from 3 HD centers; Benha University Hospital, Benha Fever Hospital, and one private center.
Results of this study demonstrated that all patients were under regular 4 hours thrice weekly HD sessions using bicarbonate dialysate as base buffer, high calcium dialysate concentration (1.75 mmol/L) and conventional high molecular weight heparin as the standard anticoagulant. All used dialysate with same K concentration (2mmol/L). All dialyzers were of synthetic Polysulphone, low flux and steam sterilized with most (85.3 %) of them of 1.3 m2 surface area and few (14.7%) of surface area 1.4 m2. The main vascular access was native AV fistula (99.3% ).
The majority of HD patients are under sponsorship of the government (86%) with the main burden on ministry of health (75.3%) followed by military (14.7%) then health insurance (8.7%).
The mean age of our dialysis patients was 46.04±10.94 years; two thirds were males and were under dialysis for a mean period of years 4.8± 3.7 years.
None of the HD centers included in the study were performing tests of HD adequacy whether the simple urea reduction rate or the more complex Kt/V. This may lead to under recognition of efficiency of’ dialysis and poor general quality of life of our patients.
Results of this study demonstrated that the main causes of ESRD in our patients are similar to other regions of the world. Hypertension was the first cause (32.7%) and DM was the main second cause (15.3%). Most of our HD patients had associated co-morbidites as hypertension (58.7 %), diabetes (24. %) cardiovascular diseases (33.3 %) as ischemic heart disease, cerebrovascular and peripheral vascular disease.
The majority of our dialysis patients were not working (80.7%) although most of them were independent on the help of others (89.3%).This may reflect the bad quality of life of most of our patients and may point to lack of social or psychological support.
The majority of our patients were hepatitis B or C negative (76%) with only 13.3% HBV positive and 9.3% HCV positive. HBV patients were isolated while there was no isolation for HCV positive from HCV negative patients.
In our study the mean hemoglobin level of our patients was 9.49 gm/dl. This level was less than the lower cutoff level recommended by K/DOQI guidelines which set a lower Hb limit of 11.0 g/Dl and suggested an upper limit of 12 g/dL without intentionally exceeding 13 g/dL . Moreover, the target hemoglobin recommended by most guidelines was reached in only 18 % of study population, while the majority of patients (82%) had mean Hb less than 10.5 g/dl much lower than the level recommended by both K/DOQI and KDIGO guidelines.
The low target Hb occurs despite the fact that most of our patients were receiving parenteral iron, B- vitamins, L carnitine and erythropoietin.
Unfortunately, most our patients did not undergone regular Hb and iron profile testing in most of the patients. This may explain the lower target Hb and frequent need for blood transfusion and might explain the poor response to ESA which is used in all of our patients. Our Hb levels do not agree with K/DOQI anemia guidelines that recommend that during the initiation of erythropoietin treatment, iron status be tested every month in patients not receiving ongoing iron repletion.
Other data
| Title | PRESCRIPTION IN REGULAR HEMODIALYSIS PATIENTS IN QALUBIA GOVERNORATE (SECTOR B1) | Other Titles | الوضع الحالي لأشكال الممارسة الإكلينيكية المتبعة لوصفات الإستصفاء الدموي لدى مرضى الإستصفاء الدموي في محافظة القليوبية قطاع (ب1) | Authors | Mohammed Abd E1 Aleem Abd El Monaem | Issue Date | 2013 |
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