Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Ismailia – Sector A)

Abstract

End-stage renal disease (ESRD) is one of the main health problems in Egypt .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 led 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. A descriptive analytic study among 552 clinically stable chronic patients on regular thrice- weekly hemodialysis sessions collected from Ismailia-Sector (A) area. Full history, Full review of all medical records over the last 6 months with stress on the following data: Average hemoglobin level, Investigation (specifically complete blood picture, iron study Blood transfusion, and the frequency of these studies.),Use of hematinics (iron & folic acid),Use of ESAs and their brands, Bone markers, Details of HD prescription (Doctors, nurses, administration orders) were noted and compared to K/DIGO guidelines .Causes for ESRD was HTN 29.53%, DM 5.07% , APKD 1.63% and in 61.23% the cause were unknown .Comorbidities were HTN 34.4%, DM 7.2%, IHD 3.8 %, Chronic liver disease 2.2%,Cerebrovascular stroke 0.5%, Chronic arthropathy 0.5%, Peripheral vascular disease 0.2% and Chronic obstructive pulmonary disease 0.2%. complications during HD session was itching 16.8%, hypotension 8.3%,bony aches 6.7%,fructures 1.8%,cramps (1.4%). mean hemoglobin level was 9.1 (±1.9) gm/dl. patients receiving regular erythropoietin was (92%) ,the most frequent ESA used was Epoetin alfa (100%),while (8%) of patients were not on ESA therapy. 57.2%received iron injection , 42.8%did not receive it .conclusions , the most of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Ismailia – Sector A) was agree with K/DIGO guidelines. We need to develop practice guidelines in Egypt for the sake of improving healthcare services.

Keywords: CKD chronic kidney disease ,HD hemodialysis , MBD mineral bone disease,CRF chronic renal failure ,ESAs Erythropoiesis-stimulating agents ,IHD ischemic heart disease , K/DOQI the Kidney Disease Outcomes Quality Initiative