Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Giza {Sector F})

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. Healthcare officials 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 hemodialysis patients in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University. This study was done between November 2013 and July 2014. Our study sample consisted of 317 clinically stable chronic patients on regular thrice weekly HD. Patients were collected from AlSherouk Hospital, Agouza Hospital, International Hospital for Nephrology and Urology, Sheikh Zayed Specialized Hospital and Misr Kidney Center. 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 hemodialysis prescription (Doctors, nurses, and administration orders). Results of this study demonstrated that there were many causes for ESRD in the study population, but mainly due to HTN (44.8%), DM (23%), and in (14.5%) the cause was unknown, this result 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 (38.2%), ISHD in (22.7 %), DM in (3.8%), and CLD in (6%) of patients. In our study we found that most of the patients (98.7%) were recieving 3 HD sessions /week each lasting 4 hours , this was with KDOQI guidelines recommendations for HD adequacy. The mean time on HD was 5.77 (± 4.7) years. The mean value of patients dry weight was 73.18 (± 15.6) Kg. In our study, (55.3%) of valid patients had a Kt/V value of more than or equal to 1.2 (i.e: adequate HD according to most GL). In our study population, (74.1%) were not working, while (25.9%) were working. Dependency status in the study population showed that (7.8%) of the patients were dependant, (87.4%) were not dependant, while (4.8%) of them were wheelchair bound. As regard Sponsoring status in the study population (59.6%) of them were sponsored by Government, (17.4%) were covered by Insurance, (15.8%) were sponsored by companies while (7.3%) were private cases. In our study we found that (98.7%) of patients were using AVF, while (1.3%) were using venous catheter. This was in agreement with KDOQI guidelines for venous access placement. Our study showed that (17.7%) of our study population had a history of vascular access failure. In our study the mean hemoglobin level of our patients was 10.39± (1.27) gm/dl, we found that according to NKF- KDOQI guidelines recommendations (53.6%) of our patients were below the recommended level, (20.6%) were above it. In our study the percentage of patients receiving regular ESA was (95.6%), the most frequent ESA used was Epoetinalfa (89.3%), Epoetin beta (6.9%), Darbepoetinalfa (5.7%), while (4.4%) of patients were not on ESA therapy. In our study the mean PTH level was (580.8) ± (535.02) pg/dl. (57.2%) of valid patients had PTH levels from 150-600 pg/dl (within the KDIGO 2009 GL recommendations). As regard vitamins and adjuvants use in the study population; (100%) of them received vitamin B complex, (89%) of them received L-Carnitine, (89.3%) of our patients received vitamin D. History of iron injection in the study population showed that (4%) received iron injection, while the other (96%) did not receive it. TSAT levels in the study population showed that: (37.5%) were with level above 30%(within KDIGO 2012 GL recommendations). Ferritin levels in the study population showedthat: (41.4%) had a level above 500 ng/ml(within KDIGO 2012 GL recommendations). We also found that the mean calcium level was (8.35) ± (1.05)mg/dl, according to KDIGO 2009 guidelines(30.6 %) of patients were below the recommended level, (63.5 %) within the recommended level and (5.8 %) above the recommended level. In our study we found that the mean phosphorus level was (5.37) ± (1.34) mg/dl. According to KDIGO 2009 guidelines, (13.2 %) of our patients were below the recommended level, (52.3 %) within the recommended level and (34.5%) above the recommended level. In our study (99.4%) of the patients were on phosphate binders therapy. Calcium phosphorus product level was above 55 in (19.7%), while in (80.3%) was below 55. The percentage of HCV positive Pts was (51.1%), HBV positive Pts percentage was (1.9%), while (47%) of Pts were negative. All HBV positive Pts