Current Status of the Implication of the Clinical Practice Pattern in Hemodialysis Prescription in Regular Hemodialysis Patients in Egypt (El-Fayoum – sector [a])

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 in March, April, May and June of 2014. Our study sample consisted of 408 clinically stable chronic patients on regular HD. Patients were collected from Fayoum University, Fayoum General , Fayoum Insurance hospitals, and Sheikh Mousa Society 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 HD prescription (Doctors, nurses, administration orders). In this study, the commonest known cause of ESRD among the study population was hypertension (25.5%), followed by Chronic Pyelonephritis (19.1%), but DM (14%), comes in the third place, which agrees with Data from several renal databases regarding systemic hypertension but it seems that Chronic Pyelonephritis replaced Diabetes mellitus as the second most common cause of ESRD in this governorate. While the cause was unknown in 29.2%. Different comorbidities in the study population were HTN in (61.5%), chronic arthropathy in (37.5), DM in (11.5%), Ischemic heart disease in (7.4%), PVD as well as COPD in (2.9%) of patients. In our study we found that all patients recieve 3 HD sessions per week, each lasting 4 hours except one case (3 hours), this was consistent with KDOQI guidelines recommendations for HD adequacy. In our study population (77.9%) were not working, while (22.1%) were working. Most of the patients were dependent (77.0%), and only (23%) of the patients were not dependent, (7.4%) were wheelchair bound. Sponsoring status in the study population showed that 58.1% were sponsored by Government, while 40.0% were sponsored by health insurance, while 2.0% were sponsored by their company. In our study, 91.7% had AVFs with a frequency of access failure of 52.2%. While 2.7% had AVGs, 5.6% had venous catheters. Regarding Hgb level, we found that according to NKF-K/DOQI guidelines, 94.1% of our patients were below the recommended level, while 5.9% were above that level. In our study the percentage of patients who received iron injections was 89.2%. While, Ferritin levels and TSAT category are not measured in Fayoum at all. In our study the percentage of patients receiving regular erythropoietin was 100%, the most frequent ESA used was Epoetin alfa (99.3%). Our study stated that mean PTH level was not originally done for any patient. In our study, 88.2% of our patients were on vitamin B complex, 14.5% were on folic acid supplements, 97.3% were on oral vitamin D therapy and 52.7% received L-Carnitine. In our study we found that the mean phosphorus and calcium levels were not routinely done for all the patients. Calcium phosphorus product level was not routinely done for all the patients. In our study, 99.5 % of patients were on phosphate binders.