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

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. in Al Behera governate (sector B) which includes Delingate general hospital, Kom Hamada general hospital and Badr center general hospital participated in this study. These units included 450 patients on regular hemodialysis. The study was conducted during the period from December 2012 to January 2013 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 leads to dialysis was hypertension represented by 135 cases (30%) and diabetes mellitus 52 cases (11.6%). The mean age of our patients was 52.5 ± 13.37 years, 248 patients (55.1%) were males & 202 patients (44.9%) were females. 395 patients (88%) of studied population weren't working while only 55 patients were working (12%)The mean of dialysis period was 4.24 years 436 patients (96.8%) of our studied population underwent dialysis 3 times/week. In studied group 282 patients (62.7%) spent 4 hours per session, 98 patients (21.8%) spent 3.5hours per session, while 70 patients (15.5%) spent 3 hours per session. As regard sponsoring status in the study population (76%) of them were sponsored by governorate while (23.1%) of them were sponsored by health insurance, (0.7%) sponsored by company, (0.2%) sponsored by army and (8.8%) of them were private cases. AVF was the preferred vascular access. 419 patients (93.1%) had been dialyzed from A.V. F. Failure of access was in 110 cases (24.4%) of study population. There were not cases of HBV or HIV positive. 45.8% of patients were HCV positive in the studied group. The mean HB level was 7.05 ± 0.63 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. All most of patients did not perform s.ferritin or TSAT tests. In the current study 68.4% of patients used iron injection. (7.6%) of patients had s.Ca within the target level (8.4-10.2 mg/dl) and (9.3%) had s.Ca below the target while 82.4 % of patients did not have Ca. (0.4%) of patients had s.Po4 within the target level (3.5-5.5mg/dl), (0.2%) had s.Po4 above the target, and 99.3% of patients did not have po4 test While mean s.PTH was 355.03 pg/ml. done for 3 patient iPTH levels should be maintained in the range of approximately two to nine times the upper normal limit for the assay In the studied group: 335 patients (74.4%) used phosphate binder (calcium containing only). 249 patients (55.3%) used Vitamin D supplement. In the studied group we searched for the common complication of dialysis and we found that hypotention represented 224 cases (49.8%), cramps represented 49.1% (221 cases), itching present in 37.6% (169 cases), bony aches represented by 195 cases (43.3%) and Fractures 16 cases (3.6%). In the current study Bicarbonate dialysate was used as the buffer in 98.4 % of patients.100% of patients were using dialysate Ca 1.75 mmol/l. 100% of patients were using dialysate K 2 mmol/l. Synthetic and low flux dialysers were used for 99% of the study population.