Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Qena) (sector A)

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. In the healthcare sector in Egypt, trials for establishing guidelines have been lead by the MOH. This work is a part of a project aiming at assessment of the current status of dialysis patients in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University. This study was done in October 2013. Our study sample consisted of 358 clinically stable chronic patients on mostly regular thrice-weekly HD. Patients were collected from public hospitals and one private center in Qena 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 HD prescription.

Results of this study demonstrated that there were many causes for ESRD in the study population .HTN was responsible for 22.3% of these cases, obstructive uropathy in 13.7%, and DM was responsible for 5.3% of these cases. Figures of both Hypertension and Diabetes Mellitus as causes of ESRD are below the international rates in developed countries, probably because the avoidable causes of ESRD are still prevalent in Egypt. The cause was unknownand in 48 % of cases. Different co-morbidities were found in the study population, mainly HTN in 41% and DM in 8.3%of patients. Our study showed that most of the patients (89.4%)were receiving3 HD sessions /week, only 55% of patients were strictly bound to a full 4 hour HD session. The mean value of patients' dialysis period was 3.85 (±3.5) years, while the mean value of patients dry weight was 62.9 (± 14.1) Kg. In our study population 84.6 % were not working, while 15.4% were working.Dependency status in the study population showed that 43.6% of the patients were dependant, 56.4% were not dependant, while none of them were wheelchair bound. As regardssponsoringstatus in the study population 75.1% of them were sponsored by Government,23.1% were sponsored by insurance, 0.84% for both army and company sponsorship respectively, none of them were private cases.

In our study we found that 93.3 % of patients were using AVF, 0.6 % were using AVG while 6.1% were using venous catheter. In our study the mean hemoglobin level of our patients was 8.4(±1.6) gm /dl. We found that according to NKF- KDOQI guidelines recommendations 88% of our patients were below the recommended level, while 12 % were within or above it.

In our study 69.6% of the total study population received an ESA therapy. Their distribution were as follows: the percentage of patients receiving regular erythropoietin alfa "generic" was 96.4 %,the most frequent originator ESA used was epoetin alfa Eprex® (2.8%), epoetin beta Recormon®(0.4%), darbepoetin alfa Aranesp® (0.4%), while 30.4 % of patients were not on any ESA therapy. As regards vitamins use in the study population 33.5% of them received vitamin B complex, 9.2 % of them were receiving L-Carnitine, while 78.5 % of our patients were receiving vitaminD. History of iron injection in the study population showedthat 70.4%were receiving iron injection, while the other 29.6% did not receive it. As regards Calcium, Phosphorus, and PTH levels, there were no available values in our study population.In our study 76.8% of the patients were on phosphate binders therapy mainly calcium salts, the rest of the patients did not receive any phosphate binder of any kind. Our study showed that 76.8% of patients took phosphate binders. All of them took calcium carbonate, while the other 33.2% did not take any phosphate binder of any kind.