الفهرس 
Hemodialysis in EgyptOnly 14 pages are availabe for public view
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Abstract
ESRD is a major medical and economic problem worldwide. Both incidence and prevalence of treated ESRD are increasing in the developing world . Reasons for this include an actual increase in incidence, improved survival from other diseases, and wider acceptance criteria for renal replacement therapy (RRT) The global incidence is estimated to be about 100 new patients per million population .
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 April 2013 to June 2013.
Our study sample consisted of 359 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Ahmed Maher teaching hospital , Fatemic Cairo hospital and Al Hussein university 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 H D prescription (Doctors, nurses, administration orders).
Results of this study demonstrated that there were many causes for ESRD in the study population ,where HTN 31.2% , DM and HTN 1362% ,DM 6.7% and in 17.8 % 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 (62.4%), DM in (13.4%), ISHD in (22.6 %).
In our study we found that most of the patients 98.7% 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 4.9(± 3.7) years. The mean value of patients dry weight was 75 (± 12.4) Kg.
In our study population (91.6%) were not working , while (8.4%) were working .
Dependency status in the study population showed that (33.6%) of the patients were dependant, (58.2%) were not dependant , while (8.4%) of them were wheelchair bound .
As regard Sponsoring status in the study population (88%) of them were sponsored by Governorate , while (11.1%) of them were INSURANCE cases and .8% were bprivate cases.
In our study we found that 91.1% of patients were using AVF , 1.7 % were using AVG while 7.2% 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 9.9 ±(1.7)gm/dl , we found that according to NKF- KDOQI guidelines recommendations the mean HB is below recommended level.
In our study the percentage of patients receiving regular erythropoietin was (88.4%), the most frequent ESA used was Epoetinalfa (79.4%), Epoetin beta (8.4%), Darbepoetinalfa(0.6%) ,while (11.7%) of patients were not on ESA therapy.
Our study stated that median PTH level was560 ± pg/dl, recommendations of KDIGO guidelines 2009 was to maintain its level 2-9 times the upper normal limit of the assay.
As regard vitamins use in the study population 99.4% of them received vitamin B complex , as regard L-Carnitine(23.3%) of them received it , as regard vitamin D there were ( 47.4%) of our patients received it.
History of iron injection in the study population showed that (40.4%) received iron injection , while the other (59.6%) did not receive it .
We also found in our study that The mean value of S.Ca is 8.57 (± 1.1 ) mg /dl, while The mean value of phosphorus is 5.7 (±1.6 ) mg/dl, The mean value of Calcium Phoshorus product is50.13 (±14.9 ).
In our study 92.7% of the patients were on phosphate binders therapy.
The percentage of HCV positive Pts is (32%), HBV positive Pts percentage is (5%), while (63%) of Pts are negative. all HBV positive Pts are totally isolated from HCV positive.
Our study showed that Criteria of dialyzer used in the study population showed that 300 out of 359 patients (83.6 %) were using a dialyzer with surface area 1.3m, of synthetic(polysulfone) material, sterilized by ethylene, low flux(haidylena). While 58 patients(16.1%) were using one with surface area 1.7m, of synthetic material(polyamix), sterilized by steam, high reflux(Gambro).and only one patient was using one with surface area 1.6m ,of synthetic(polysulfone) material, sterilized by steam, high reflux (fersinus).
As regard dialysate used in the study population Out of 359 patients, 147 of them (40.9%) were using dialysate with K concentration 2mmol/L, Ca concentration 2 mmol/L, Na 134 mmol/L, Mg 0.75 mmol/L and acetate based, While 154 patients (42.9%) were using dialysate with K concentration 2mmol/L, Ca concentration 1.5 mmol/L, Na 135 mmol/L, Mg 0.375 mmol/L and bicarbonate based and the other 58 patients (16.2%) were using dialysate with K concentration 2mmol/L, Ca concentration 1.75 mmol/L, Na 138 mmol/L, Mg 0.50 mmol/L and bicarbonate based. bicarbonate based dialysate (59.1%) was more frequent than acetate(40.9%).