الفهرس 
HEMODIALYSIS PRESCRIPTION
Types of dialyzers and its choiceOnly 14 pages are availabe for public view
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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 assessment 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
June 2013.
Our study sample consisted of 319 clinically stable
chronic patients on regular thrice- weekly HD. Patients
were collected from Mubarak university hospital, Infectious disease hospital, Medical complex hospital, Al labara
hospital, American hospital , El-Farouk hemodialysis center,
and Delta international 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 .
Results of this study demonstrated that there were many
causes for ESRD in the study population .HTN was
responsible for 21.6% of these cases , DM was responsible
for 15% of these cases ,and in 38.2% the cause was
unknown.
Different comorbidities in the study population were
HTN in (70.8%), DM in (18.2%), ISHD in (13.5 %), and
CLD in (1.6%) of patients.
In our study we found that most of the patients( 99.7%)
were receiving 3 HD sessions/week .(85.89%) of them
lasting for 4 hours .
The mean value of patients dry weight was 76.4 (±
17.33) Kg.In our study population (78.4%) were not working ,
while (21.6%) were working .
Physical dependency status in the study population
showed that (16.9%) of the patients were dependant,
(83.1%) were not dependant , while (4%) of them were
wheelchair bound .
As regard Sponsoring status in the study population
(42.63%) of them were sponsored by Governorate , (50.16%)
of them were sponsored by insurance, (6.9%) were sponsored
by company, while (0.31%) were a private cases .
In our study we found that( 94.04 %) of patients were
using AVF , (1.57 %) were using AVG while (4.39%) were
using venous catheter .
In our study the mean hemoglobin level of our
patients was 5.57(±1.73)gm/dl, we found that according to
NKF- KDOQI guidelines recommendations(86.21%) of our
patients were below the recommended level, (13.79 %) were
above it.
In our study the percentage of patients receiving regular
erythropoietin was (83.39%) , the most frequent ESA used
was Epoetin alfa (81.5%), Recormon (0.63%),while(16.61%) of patients were not on ESA therapy.
As regard vitamins use in the study population
(66.46%) of them received vitamin B complex , as regard LCarnitine(87.8%) of them were receiving it , as regard
vitamin D there were ( 60.82%) of our patients were
receiving it.
History of iron injection in the study population
showed that (46.70%) were receiving iron injection, while
the other (53.30%) did not receive it.
We also found that the mean calcium level was
(8.8) ± (0.7)mg/dl , According to KDIGO 2009 guidelines
(1.6 %) of patients were below the recommended level , (
71.5 %) within the recommended level and (1.3 %) above the
recommended level and (25.7%) have no available results.
In our study we found that the mean phosphorus level
was (5.2) ± (1.5)mg/dl. According to KDIGO 2009
guidelines (55.2 %) of our patients were below the
recommended level, and (18.8 %) above the recommended
level and (26%) have no available results.
In our study ( 83.70 %) of the patients were on
phosphate binders therapy mainly calcium salts, the other (
16.30%) were not receiving.Calcium phosphorus product level was above 55 in
(3.45%) ,while in (96.55%)was below 55.
The percentage of HCV positive Patients was (53.6%),
HBV positive Patients percentage is (4.1%), while (46.4%)
of Patients were negative. all HBV positive Patients are not
isolated from HCV positive.HCV positive patients were
isolated from HCV negative patients.
Our study showed that out of 319 patients (52.35 %)
were using a dialyzer with surface area 1.3m, (36.99%) were
using one with surface area 1.6 m, ,(1.25%) of them were
using one with surface area 1.8m,(0.31%) of them were using
one with surface area 1.5,(9.09%) of them were using one
with surface area 1.1m, All of these filters were synthetic
material ,low flux sterilized by ethylene oxide.
As regard dialysate used in the study population that
212 (66.46%) patients were using dialysate with K
concentration 2mmol/L, Ca concentration 1,50 mmol/L ,Na
140 mmol/L, Mg 0.50 mmol/L and bicarbonate based. while
the other 107 ( 33.54%) were using dialysate with K
concentration 1.5 mmol/l, Ca concentration 3 mmol/l ,Naconcentration 135 mmol/l, and Mg concentration 1.5 mmol/l
and acetate based.
K/DOQI guidelines recommendations for HD patients
treated 3 times per week with minimal residual renal function
(less than 2 mL/min per 1.73 m2) stated that minimally
adequate dose should be a Kt/V of 1.2 (or a URR of 65 %)
and target recommended dose should be a Kt/V of 1.4 (or a
URR of 70 %) .(NKF K/DOQI guidelines, 2006
2006 K/DOQI guidelines recommended that the
delivered dose of HD should be measured at regular
intervals not less than monthly. Less frequent
measurements may compromise the timeliness with which
deficiencies in the delivered dose of HD are detected and
hence may delay implementation of corrective action.
(K/DOQI guidelines, 2006)
Unfortunately, in our study, methods for measurement
of HD adequacy were only done in 2 units ,not done for all
patients because of financial limitation.