Current Status of the Implication of the Clinical PracticePattern in Hemodialysis Prescription in Regular HemodialysisPatients in Egypt (Dakahlia Governorate- sector D)

Abstract

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 universitythis study was done In October 2013 to December 2013. Our study sample consisted of 418 clinically stable chronic patients on regular thrice-weekly HD. Patients were collected from Al-Gamaleya C.H, Dekernes C.H, Meet Salsil C.H, BaniAbeed C.H, Al-Refae C and Abou Al-Khair C. 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 (Doctors, nurses, administration orders). Results of this study demonstrated that there were many causes for ESRD in the study population ,where HTN (41.6%) , DM (17.7%) and in (4.1%) the cause was unknown and other, 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 (38.5%), DM in (17.7%), ISHD in (24.9 %). In our study we found that most of the patients (100 %) receive 3 HD sessions /week .(67.2 %) of them lasting 4 hours, this was with K/DOQl guidelines recommendations for HD adequacy. The mean value of HD period was 3.9 (± 2.9) years. The mean value of patients dry weight was 76(± 11.2) Kg. In our study population (75.4%) were not working, while (24.6%) were working. Dependency status in the study population showed that (40.7%) of the patients were dependant, (59.3%) were independant, while (10.5%) of them were wheelchair bound. As regard Sponsoring status in the study population (78.7%) of them were sponsored by Governorate , while (21.3 %) of them were insurance cases . In our study we found that (97.1 %) of patients were using AVF , 1.4 % were using AVG while 1.4% were using venous catheter. In our study the mean hemoglobin level of our patients was 9.1 ±(1.26)gm/dl , we found that according to NKF- K/DOQI guidelines recommendations the mean HB is below recommended level. In our study the percentage of patients receiving regular erythropoietin was (99.7%), the most frequent ESA used was Epoetinalfa (99.5%), Darbepoetinalfa(0.2%) ,while (0.2%) of patients were not on ESA therapy Our study stated that median PTH level was 392.5 ± pg/dl, recommendations of KDIGO guidelines 2009 was to maintain its level 2-9 times the upper normal limit of the assay. As regard vitamins use in the study population (97.4%) of them received vitamin B complex, as regard L-Carnitine (99.5%) of them received it , as regard vitamin D there were (98.8%) of our patients received it. History of iron injection in the study population showed that (86.1%) received iron injection, while the other (13.9%) did not receive it . We also found in our study that The mean value of S.ca is 8.65(± 0.75 ) mg /dl, while The mean value of phosphorus is 4.79 (±0.65 ) mg/dl, The mean value of Calcium Phoshorus product is42.198 (±8.447 ). In our study 96.7% of -the patients were on phosphate binders therapy. The percentage of HCV positive patientswas (63.6%), HBV positive patientspercentage was (0.2%), while (36.4%) of patients are negative. All HBV positive patientsare totally isolated from HCV positive. Criteria of dialyzer used in the study population showed that all 418 patients (100%) were using a dialyzer with surface area 1.3m, of synthetic (polysulfone) material, sterilized by steam, low flux(Fresenius F6HPS). Criteria of dialysate used in the study population showed that the 418 (100%) patients were, using dialysate with K concentration1.5mmol/L Ca concentration 1.25/L, Mg 0.75 mmol/L and bicarbonate based, While 203 patients (48.6%) were using dialysate with Na137.0mmol/L,125 patients (29.9%) were using dialysate with Na135mmol/L and the other 90 patients (21.5%) with Na 138 mmol/L.