الفهرس 
History of HemodialysisOnly 14 pages are availabe for public view
 |  | from | 241 |  |  |
| | | from | 241 | | |
Abstract
The incidence and prevalence of renal replacement therapies (RRT) is increasing worldwide. As well as being a large and growing clinical problem, it consumes a considerable proportion of health care resources in both developed and developing countries. Ideally, every ESRD patient should have access to dialysis. The reality is that there is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. Efforts should be made to have the cost of peritoneal dialysis fluids reduced and to increase the availability of transplantation.
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 led by the MOH.
This effort aimed to study current status of clinical practice of hemodialysis in Egypt using questionnaire. Four hemodialysis units in Qalyubia governorate (Sector A2) participated in this study. These units included 435 patients on regular hemodialysis.
The study was conducted during the period from March to May 2013.
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.
In this study, we found that the common causes of the chronic renal failure which lead to ESRD were hypertension represented by 181 cases (41.6%) and diabetes mellitus 116 cases (26.7%).
The mean age of our patients was 55.8 ± 9.9 years, 274 patients (63.0%) were males & 161 patients (37.0%) were females.
427 patients (98.2%) of studied population weren’t working.
The mean period on HD was 6.02 (±4.02) years. The mean value of patient’s dry weight was 81.47± 7.0 Kg.
In our study, the percentage of patients receiving regular erythropoietin therapy was (71.8%).
As regard vitamins use in the study population, 54 patients (12.4%) used L-carnitine, 362 patients (83.2%) used folic acid & 178 received vitamin B complex (40.9%).
Out of 435 patients, 243 (56%) received intravenous iron therapy.
418 patients (96%) received thrice weekly HD.
368 patients (85%) spent 4 hours on session, 56 patients (13 %) spent 3.5hours, while 11 patients (2 %) spent 2 hours only.
(36%) of patients were sponsored by governorate, (56%) were sponsored by health insurance and (8%) were private cases.
AVF was the preferred vascular access. 425 patients (98%) had A.V. F. Failure of access was in 108 cases (24.8%).
There were no HIV positive cases. 49.4% of patients were HCV positive & 1.6 % of patients were HBV positive.
The mean Hb level was 9.5 gm. /dl [below the target level (11-12g/dl) according to NKF-DOQI guideline (2007)].
All HD units in our study did not measure iron status routinely.
In the current study 70.8 % of patients used ESAs. 55.9 % of them used iron injection.
According to KDIGO, (2009), (44.4 %) of patients had s.Ca within the target level (8.4-10.2 mg/dl), (45.1 %) had s.Ca below target & (10.6 %) had s .Ca above target.
According to KDIGO (2009), (62.5 %) of patients had s.P within the target level (3.5-5.5mg/dl), (34.9 %) had s.P above target and (2.5 %) had s.P below target .
In the studied group almost all patients used phosphate binders (calcium only). 389 patients (89.42%) used a Vitamin D supplement.
In the studied group we searched for common intradialitic complications. Bone aches were the commonest, 159cases (37%), cramps 66 cases (15%) ,Hypotension 76cases (18%), Itching 96 cases (23%) and Fractures 29 cases (7%).
In the studied group, dry weight of patients ranged from 60.00- 99.00 (mean 81.4736kg).Average interdialitic weight gain (IWG) was 0.50- 4.00kg.
All studied HD units did not measure urea reduction nor e Kt/V ratio as a measure of adequacy of dialysis.
In the current study, Bicarbonate dialysate was used as the buffer in 61.1% of patients.41.5% of patients used dialysate Ca 1.25 mmol/l. 82% of patients used dialysate K 2 mmol/l.
Synthetic low or high flux dialyzers were used for study population.