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

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 (CKD), 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 Mars & April 2013. Our study sample consisted of 270 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Abbasyiah fever hospital, Arab contractor medical center and Mubarak police 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). Results of this study demonstrated that there were many causes for ESRD in the study population, where HTN 41.1%, DM 34.4%, and in 14% the cause was unknown, 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 (35.1%), DM in (43.4%), ISHD in (3.7%), CLD in (6.2%) of patients. In our study we found that most of the patients 98.1% 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 6.6 (± 4.7) years. The mean value of patients dry weight was 72.4 (± 16.4) Kg. In our study population (63%) were not working, while (37%) were working. Dependency status in the study population showed that (13.6%) of the patients were dependant, (81.4%) were not dependant, while (4.8%) of them were wheelchair bound. As regard sponsoring status in the study population Ministry of Health (20%), the private (19.6%), company (42.6), while army (17.8%) of the patientsof them. In our study we found that 90% of patients were using AVF, 1.4% were using AVG while 8.6% were using venous cathter. This was in agreement with KDOQI guidelines for venous access placement. In our study the mean hemoglobin level of our patients was 10.5±(1.5) gm/dl, we found that according to NKF-KDOQI guidelines recommendations (75.2 %) of our patients were below the recommended level, (24.8 %) were above it. In our study the percentage of patients receiving regular erythropoietin was (76.3%), the most frequent ESA used was Epoetin alfa (63%), Epoetin beta (3.3%), Darbepoetin alfa (21.9%), Pegylated Epoetin (3%), while (23.7%) of patients were not on ESA therapy. Our study stated that mean PTH level was (600) ± (300)pg/dl, recommendations of KDIGO guidelines 2009 was to maintain its level 2-9 times the upper normal limit of the assay.