CURRENT STATUS OF THE IMPLICATION OF THE CLINICAL PRACTICE PATTERN IN HEMODIALYSIS PRESCRIPTION IN REGULAR HEMODIALYSIS PATIENTS IN EGYPT (CAIRO-SECTOR C)

Abstract

SUMMARY& CONCLUSION E nd 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. 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 in APRIL,MAY 2013. Our study sample consisted of 261 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Alsanabel private hospital,masr welsudan private center,salaah eldeen private center and shebeen alkanater central hospital. 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 (Doctors,nurses,and administration orders). Results of this study demonstrated that there were many causes for ESRD in the study population,where HTN 41.4%,DM 23%,and in 14.2% the cause was unknown,this results agrees with most of the studies where HTN & DM were the main causes of renal failure. Different co morbidities in the study population were HTN in (63.6%),DM in (26.8%),chronic arthropathy in (13.8%) and IHD in (35.2%). In our study we found that most of the patients87.7% recieve 3 HD sessions per week and most of them 83.9% receive 4 hours per session. The mean value of HD period is 3.4 (± 2.5) years. The mean value of patients dry weight was 64.4 (± 15.7) Kg. In our study population (85.1%) was not working,while (14.9%) were working. Dependency status in the study population showed that (41.7%) of the patients were dependant,(58.2%) were not dependant,while (9.6%) of the dependent group were wheel chair bound. As regard Sponsoring status in the study population (62.1%) of them were sponsored by Governorate,(37.2%) of them were sponsored by health insurance,while (0.7%) were sponsored by army. In our study we found that85.4% of patients were using AVF while 5.8 % were using venous cathter,while 8.8% were using AV graft. This was in agreement with KDOQI guidelines for venous accessplacement. In our study the mean hemoglobin level of our patients was 9.55± (1.51) gm/dl,we found that according to NKF- KDOQI guidelines recommendations (60.2 %) of our patients were below the recommended level,(12.2 %) were above it. In our study the percentage of patients receiving regular erythropoietin was (91.2%),the most frequent ESA used was generic (63.2%),the other (28%) were usingoriginatorerythropiotin. while (8.8%) of patients were not on ESA therapy. Our study stated that mean PTH level was (661.7)±(573.7)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(95.7%) of them received vitamin B complex,as regard L-Carnitine (64.8%) of them received it,as regard vitamin Dthere were (80.5%)of our patients received it. History of iron injection in the study population showed that (85.8%) received iron injection,while the other (14.2%) did not receive it. We also found that the mean calcium level was (8.15) ± (1.04)mg/dl,According to KDIGO 2009 guidelines (29.1%) ofour patients were below the recommended level,(54.4%) within the recommended level and (5.4 %)above the recommended level. In our study we found that the mean phosphorus level was (5.72) ± (1.55) mg/dl. According to KDIGO 2009 guidelines 4.9% of our patients were below the recommended level,(22.6%) within the recommended level and(54.4 %) above the recommended level,while (18%) were wiyh no valid records. In our study(85.8 %) of the patients were on phosphate binders therapy.