Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Cairo) Sector A2

Abstract

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 JULY & August 2012. Our study sample consisted of 249 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Al Moneera hospital, Al Rahmah center, Al Hayaa center, Faisal center and Al SayedaZeinab 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 HD prescription (Doctors, nurses, administration orders). In our study we found that most of the patients recieve 3 HD sessions /week each lasting 4 hours, this was with KDOQI guidelines recommendations for HD adequacy. This study showed that the commonest known cause of ESRD among the study population is hypertension (36.9%), followed by DM (17.3%) which agrees with Data from several renal databases that identifies systemic hypertension & Diabetes mellitus as the most common causes for ESRD. Different comorbidities in the study population were HTN (70.3%), DM (22.1%), Ishemic heart disease (26.5%), Peripheral vascular disease (0.8%), Chronicarthropathy (34.9%). Work status in the study population showed that 212 of them were not working (85.1 %), while the other 37 patients were working (14.9%). Dependancy status in the study population was showed that 49 of them were dependant (19.7%), 200 were not dependant (80.3 %) with a wheel chair pound 14 cases. Sponsoring status in the study population showed that Out of 249 patients, 158 of them were sponsored by Governorate (62.7%), 59 of them by health insurance (23.7%) and 34 of them by company (13.7%). In our study we found that 85.9% of the study population use AVF with a frequency of access failure of30.1% , 3.2% of them use AVG ,10% use venous catheter and 0.8% use long term catheter. The AVF has the best long-term primary patency rate and requires the fewest interventions of any type of access. As regard vitamins use in the study population 69.5% of our patients were receivingvitamin B complex,1.6 % werereceiving folic acid supplements and 51% were receiving vitamin D. In our study we found that the mean hemoglobin was 10.7 ± 1.4 g/dL which is rela¬tively low consi¬dering the recommended target ranges and surveys from other parts of the world. In our study the percentage of patients receiving regular erythropoietin was 74.3%&the percentage of patients who receivedIV iron was 48.2% and a mean serum ferritin of 556.36.