Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt El Gharbiya (El Mahala)

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. 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 from January to June 2015. Our study sample consisted of 303 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Mahala General Hospital, 24/24 center & Elfayrouz 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 HDx prescription (Doctors, nurses, and administration orders).

Results of this study demonstrated that there were many causes for ESRD in the study population,where HTN 27.1% and DM 17.8%, 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 (51.5%), DM in (21.5%), ISHD in (16.5%), and CLD in (4.3%) of patients. In our study we found that all of the patients recieve 3 HD sessions /week each lasting 4 hours , this was with KDOQI guidelines recommendations for HD adequacy . The mean value of HD period is 4.7 (± 3.6) years. The mean value of patients dry weight was 75 (± 14.6) Kg. In our study population (86.50%) were not working, while (13.50%) were working. Dependency status in the study population showed that (11.22%) of the patients were dependent, (88.78%) were not dependent. As regard Sponsoring status in the study population (66.01%) of them were sponsored by Governorate, (33.33%) of them were insurance cases, while (0.66%) of them were private. In our study we found that 96% of patients were using AVF, while 1.7% were using AVG & 2.3 % were using venous catheter. this was in agreement with KDOQI guidelines for venous accessplacement. In our study the mean hemoglobin level of our patients was 9.9±1.6 gm/dl, we found that according to NKF- KDOQI guidelines recommendations (67.2 %) of our patients were below the recommended level, (32.8 %) were above it. In our study the percentage of patients receiving regular erythropoietin was (41.9%), while (58.1%) of patients were not on ESA therapy. As regard vitamins use in the study population (37%) of them received vitamin B complex , as regard L-Carnitine (35.6%) of them received it , as regard vitamin D there were ( 47.5%) of our patients received it. In our study we found that the mean phosphorus level was (5.5) ± (1.4)mg/dl. In our study 74.9 % of the patients were on phosphate binder therapy. The percentage of HCV positive Pts. was (54.46%), while (45.54%) of Pts. were negative. All HCV positive Pts. were totally isolated from negative HCV pts.. Our study showed 240 out of 303 patients (79.2%) were using one with surface area 1.3m, 56 (18.5%) were using one with surface area 1.6 m, 3 (1%) were using one with surface area 1m, 1 (0.3%) were using one with surface area 1.7 m, 3 (1%) were using one with surface area 1.8 m; All dialyzers are of synthetic material, sterilized by steam, low flux. As regard dialysate used in the study population all patients were using dialysate with K concentration 2mmol/L, Ca concentration 1,75 mmol/L, Na 105 mmol/L, Mg 0.50 mmol/L and bicarbonate based.