Current Status of the Implication of the Clinical Practice Pattern in Hemodiatysis Prescription in Regular Ilemodialysis Patients in Egypt (Kafr El-Shikh)

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 Statement 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 OCT.2013. Our study sample consisted of 375 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from both Al-obour Insurance Hospital , Fewa Central Hospital , Qalen Central Hospital & Baltem Central Hospital (Kafr-Elshiekh Governorate). 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 H D prescription. Results of this study demonstrated that there were many causes for ESRD in the study population ,where HTN was responsible for (34.1%) of these cases , DM was responsible for (12.8 %) of these cases ,and in ( 20.8%) of cases the cause was unknown, this results agrees with most of the studies where HTN & DM were the main causes of renal failure . Different comorbidities in the study population were HTN in (51.7%), DM in (13.1%), ISHD in (37.9 %), CLD in (41.3 %), Chronic Arthropathy in (11.2%) of patients. In our study we found that most of the patients (99.5) % were recieving 3 HD sessions /week, each lasting 4 hours in (56.5%) of patients , 3.5 hours in (30.1%) of patients , 3 hours in (13.3%) of patients . In our study ,The mean value of time on HD was 3.8 (± 3.4) years. The mean value of Pts dry weight was 72.4 (±11.9) Kg. Work status in the study population showed that (77.3 %) of them were not employed, while the other (22.7%) were employed. Dependency status in the study population was showed that (20%) of them were dependant patients ( (7.5%) of them were wheelchair bound), while ( 80%) were not dependant. Sponsoring status in the study population showed that (50.4%) of patients were sponsored by Government,(49.3%)were sponsored by Health Insurances, while (0.3%) of them were sponsored by Company . In our study we found that (92.8) of patients were using AVF , (1.1) % were using AVG while (6.1) % were using venous cathter as a vascular access to HD. In our study the mean hemoglobin level of our patients was was 9 (± 1.6) gm/dl. Comparing the results of mean Hemoglobin level in the study population to the recommeneded level by NKF-KDOQI guidelines 2012 ,it showed that (79.5 %) of our patients were below the recommended level while (20.5 %) were above it. In our study the percentage of patients receiving regular erythropoietin was (99.2%) all of them were receiving Epoetin alfa while (0.8%) of patients were not on ESA therapy. The mean value of PTH is 194.55 (± 221.56) pg/dl in our study. As regard vitamins use in the study population ( 77.3 %) of them were receiving vitamin B complex , as regard L-Carnitine (62.9 %) of them were receiving it.as regard vitamin D there were ( 96.8 %) of our patients were receiving it. History of iron injection in the study population showed that ( 70.9 %) received iron injection , while the other (29.1%) did not receive it. We also found that the mean calcium level was 8.4(± 1) mg /dl. Calcium Phosphorus product levels in the study population showed that Out of 162 patients, (96.3 %) of them was below 55 while (0.7%) of them were with level above 55. Viral status in the study population showed that the percentage of HCV positive patients was (39.7%), HBV positive was (0.5 %), while (59.7%) of patients were negative. All HCV&HBV positive patients are totally isolated . Criteria of dialyzer surface area used in the study population showed that (37.1%) of patients were using a dialyzer with surface area 1.3m , (31.2% ) were using a dialyzer with surface area 1.4 m , (22.7%) were using a dialyzer with surface area 1.6 m, (9.1%)were using a dialyzer with surface area 1.8m. All of them were using low flux dialyzer of synthetic material sterilized with steam . Criteria of dialysate used in the study population showed that (89.9%) of them were using dialysate with K concentration 2mmol/L, Ca concentration 1,75 mmol/L, Na 140 mmol/L, Mg 0.50 mmol/L and bicarbonate based, While the other (10.1 %) were using dialysate with K concentration 1.5 mmol/L, Ca concentration 1,25 mmol/L, Na 138 mmol/L, Mg 0.75 mmol/L and acetate based . Criteria of anticoagulation over HD session showed that (80.5%) of patients received HMWH ,while (19.5%) of them received LMWH.