Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Cairo Sector D6)

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. This effort aimed to study current status of clinical practice of hemodialysis in Egypt using questionnaire. Seven hemodialysis units in Cairo participated in this study. These units included 320 patients on regular hemodialysis. The study was conducted during the period from January to June 2014. 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. In this study, we found that the common causes of the chronic renal failure which lead to dialysis was hypertension represented by 87 cases (27.2%) and diabetes mellitus 65 cases (20.3%). The mean age of our patients was 53.13 ± 13.81 years, 177 patients (55.3%) were males & 143 patients (44.7%) were females. 284 patients (88.8%) of studied population weren't working while only 36 patients were working (11.3%). The mean of dialysis period was 4.57 ± 3.86 years 398 patients (97.5%) of our studied population underwent dialysis 3 times/week. In studied group 293 patients (91.6%) spent 4 hours per session, 12 patients (3.8%) spent 3.5hours per session, while 15 patients (4.7%) spent 3 hours per session. As regard sponsoring status in the study population (55.9%) of them were sponsored by governorate while (17.2%) of them were sponsored by health insurance, (1.6%) sponsored by company, (16.6%) sponsored by army and (8.8%) of them were private cases. AVF was the preferred vascular access. 300 patients (93.8%) had been dialyzed from A.V. F. Failure of access was in 99 cases (30.9%) of study population. There were not cases of HBV or HIV positive. 36.56% of patients were HCV positive in the studied group. The mean HB level was 9.7 gm/dl which below the target level (11-12g/dl) according to NKF-DOQI guideline (2007). Most of HD units in our study did not measure iron status routinely. 15.3% of patients had s.ferrtin>500 and 34.7% of patients had s. ferritin <500 32.2% of patients had TSAT <30 % and 17.8% had TSAT>30 %. 50% of patients (160 cases) did not perform s.ferritin or TSAT tests. In the current study 70.6% of patients used iron injection. According to KDIGO, (2009), (31.6%) of patients had s.Ca within the target level (8.4-10.2 mg/dl) and (9.7%) had s.Ca below the target while 58.8 % of patients did not do Ca labs. According to KDIGO (2009), (26.6%) of patients had s.Po4 within the target level (3.5-5.5mg/dl), (11.6%) had s.Po4 above the target, (1.9%) had s.P below the target and 60% of patients did not do po4 test In the present study, mean s.PTH was 618.4 pg/ml. According to KDIGO guidelines 2009 iPTH levels should be maintained in the range of approximately two to nine times the upper normal limit for the assay