Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Cairo) sector B5
Basma mahmoud ibrahim;
Abstract
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 in July & August 2013.
Our study sample consisted of 277 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Horus center, El Moalemeen hospital, El Ganzori hospital, El Nile center, Salah El din center, El shefa center, Amr Aiad center and San Beter 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, administration orders).
In our study we found mostly all of the patients recieve 3 HD sessions /week each lasting 4 hours, this was with KDOQI guidelines recommendations for HD adequacy.
This study showed that the commonest known cause of ESRD among the study population is hypertension (38.3%), followed by DM (21.3%) which agrees with Data from several renal databases that identifies systemic hypertension & Diabetes mellitus as the most common causes for ESRD.
Different comorbidities in the study population were Chronic arthropathy (44.0 %), CLD (38.6%), HTN (29.6 %), Ishemic heart disease (17%), cerebrovascular disease (1.1%), COPD (1.1%), DM (0.7%).
Work status in the study population showed that 258 of them were not working (93.1%), while the other 19 patients were working (6.9%).
Dependancy status in the study population was showed that 93 of them were dependant (33.6%), 184 were not dependant (66.4 %) with a wheel chair pound 39 cases.
Sponsoring status in the study population showed that Out of 277 patients, 147 of them were sponsored by Governorate (53.1%), 79 of them by health insurance (28.5%), 42 of them by company (15.2%) and 9 of them private (3.2%).
In our study we found that 83.4% of the study population use AVF with a frequency of access failure of 31.8%, 6.9% of them use AVG and 9.7% use venous catheter.
The AVF has the best long-term primary patency rate and requires the fewest interventions of any type of access.
As regard vitamins use in the study population 97.5% of our patients were receiving vitamin B complex, 4.7% were receiving folic acid supplements and 83.8% were receiving vitamin D.
In our study we found that the m`ean hemoglobin was 10 ± 1.7 g/dL which is rela¬tively low consi¬dering the recommended target ranges and surveys from other parts of the world.
In our study the percentage of patients receiving regular erythropoietin was 91.0% & the percentage of patients who received IV iron was 83.4% and a mean serum ferritin of 793.25. In our study we found that the mean calcium level was 8.4 ± 0.9 mg/dl, 43.0% of the patients were within the recommended level of serum calcium (8.4-10.2mg/dl) according to KDIGO 2009 guidelines. And that the mean phosphorus level 5.47 ± 1.7 mg/dl, 31.8% of the patients were within the recommended level (3.5-5.5mg/dl).
The commonest complication during HD session in the study population were bone aches (61.4%), cramps (56.3%) then hypotension (46.6 %). & the mean interdialytic weight gain was 2.15%.
In our study the percentage of patients who received blood transfusion was 32.9 % &Viral status in the study population showed that the percentage of HCV positive patients was (39.4%), HBV positive was (1.1%), while (60.6%) of patients were negative.
Dialysate calcium used in the study population showed that out of 277 patients 177 of them were using dialysate calcium 1.50 (63.9%) and 100 of them were using dialysate calcium 1.25 (36.1%).
In our study methods for measurment of HD adequacy were not routinely done for most of the patients. The mean Kt/V in 74 patients was 1.22, the mean Urea reduction ratio in 74 patients was 65.47.
Anticoagulation type used in the study population showed that out of 277 patients, 272 of them were using HMWH (98.2), while 5 of them was using clexane (1.8%).
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 July & August 2013.
Our study sample consisted of 277 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Horus center, El Moalemeen hospital, El Ganzori hospital, El Nile center, Salah El din center, El shefa center, Amr Aiad center and San Beter 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, administration orders).
In our study we found mostly all of the patients recieve 3 HD sessions /week each lasting 4 hours, this was with KDOQI guidelines recommendations for HD adequacy.
This study showed that the commonest known cause of ESRD among the study population is hypertension (38.3%), followed by DM (21.3%) which agrees with Data from several renal databases that identifies systemic hypertension & Diabetes mellitus as the most common causes for ESRD.
Different comorbidities in the study population were Chronic arthropathy (44.0 %), CLD (38.6%), HTN (29.6 %), Ishemic heart disease (17%), cerebrovascular disease (1.1%), COPD (1.1%), DM (0.7%).
Work status in the study population showed that 258 of them were not working (93.1%), while the other 19 patients were working (6.9%).
Dependancy status in the study population was showed that 93 of them were dependant (33.6%), 184 were not dependant (66.4 %) with a wheel chair pound 39 cases.
Sponsoring status in the study population showed that Out of 277 patients, 147 of them were sponsored by Governorate (53.1%), 79 of them by health insurance (28.5%), 42 of them by company (15.2%) and 9 of them private (3.2%).
In our study we found that 83.4% of the study population use AVF with a frequency of access failure of 31.8%, 6.9% of them use AVG and 9.7% use venous catheter.
The AVF has the best long-term primary patency rate and requires the fewest interventions of any type of access.
As regard vitamins use in the study population 97.5% of our patients were receiving vitamin B complex, 4.7% were receiving folic acid supplements and 83.8% were receiving vitamin D.
In our study we found that the m`ean hemoglobin was 10 ± 1.7 g/dL which is rela¬tively low consi¬dering the recommended target ranges and surveys from other parts of the world.
In our study the percentage of patients receiving regular erythropoietin was 91.0% & the percentage of patients who received IV iron was 83.4% and a mean serum ferritin of 793.25. In our study we found that the mean calcium level was 8.4 ± 0.9 mg/dl, 43.0% of the patients were within the recommended level of serum calcium (8.4-10.2mg/dl) according to KDIGO 2009 guidelines. And that the mean phosphorus level 5.47 ± 1.7 mg/dl, 31.8% of the patients were within the recommended level (3.5-5.5mg/dl).
The commonest complication during HD session in the study population were bone aches (61.4%), cramps (56.3%) then hypotension (46.6 %). & the mean interdialytic weight gain was 2.15%.
In our study the percentage of patients who received blood transfusion was 32.9 % &Viral status in the study population showed that the percentage of HCV positive patients was (39.4%), HBV positive was (1.1%), while (60.6%) of patients were negative.
Dialysate calcium used in the study population showed that out of 277 patients 177 of them were using dialysate calcium 1.50 (63.9%) and 100 of them were using dialysate calcium 1.25 (36.1%).
In our study methods for measurment of HD adequacy were not routinely done for most of the patients. The mean Kt/V in 74 patients was 1.22, the mean Urea reduction ratio in 74 patients was 65.47.
Anticoagulation type used in the study population showed that out of 277 patients, 272 of them were using HMWH (98.2), while 5 of them was using clexane (1.8%).
Other data
| Title | Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (Cairo) sector B5 | Other Titles | الوضع الحالى لأشكال الممارسه الاكلينكيه المتبعه لوصفات الاستصفاء الدموى لدى مرضى الاستصفاء الدموى فى مصر (القاهرة) قطاع B5 | Authors | Basma mahmoud ibrahim | Issue Date | 2014 |
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