الفهرس 
HemodialysisOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Summary and Conclusion
Nowadays hemodialysis (HD) is considered the main mode for treatment of chronic kidney disease stage 5 (CKD5), previously called End stage renal disease (ESRD) or chronic renal failure which is one of the top morbidities affecting Egyptian’s health.
In Egypt; the problem with hemodialysis is the absence of practice guidelines. Currently, efforts are made by the Egyptian Ministry of Health (MOH) to develop and establish guidelines regarding this process aiming at improving of the quality of health care services provided to this group of patients.
This study is part of the project carried out by the nephrology department Ainshams University that aimed at assessing the current status of dialysis patients in Egypt.
Our study was carried out from January 2013 till August 2013. It included 406 patients on hemodialysis from 6 different centers in Suez governorate.
All the 406 patients were subjected to questionnaire containing full history including dialysis history & clinical examination with stress on etiology of renal disease and associated complications and full review of all medical records over the last 6 months with stress on average hemoglobin level, other investigations that were done specifically complete blood picture, iron study, blood transfusion, use of hematinics (iron & folic acid) and use of ESAs and their brands.
The average age of our study cases was 52.7% ± 13.9 years. 242 (59.9%) were males and 162 (40.1%) were females.
107 (26.5%) patients were employed compared to 297 (73.5%) unemployed. 237 (58.7%) were independent while 167 (41.2%) were dependant and 31 (7.7%) were wheelchair bound.
The average dialysis period for our patients was 4.5 years where the majority (90.3%) undertook dialysis 3 times per week. Regarding the time per session, 83.4% spent 4 hours per session and 10.6% spent 3.5 hours per session.
163 (40.3%) of our study cases were sponsored by insurance, 153 (37.9) by government, 80 (19.8%) by companies and 8 (2%) were private cases.
As for the vascular access; 371 (91.8%) used AVF while 25 (6.2%) used AVG and 8 (2%) used Catheter. The percent of patients with failure of vascular access was 27% with average number of access failure to be 1.8± 1.3 times.
121 (30%) of the patients were HCV positive where as 7 (1.7%) were HBV positive and there were no HIV cases.
In our study, there were many causes of ESRD; where hypertension leading the causes with 31.2%, followed by both Diabetes mellitus and obstructive uropathy with 8.7% and 31.9% were unknown etiologies.
Regarding the co morbidities; 238 (58.9%) suffered from HTN, 136 (33.7%) suffered from arthropathy, 128 (31.7%) CLD, 100 (24.3%) ISHD, 69 (17.1%) PVD, 66 (16.3%) DM, 35 (8.7%) COPD and 10 (2.5%) patients suffered from CVD.
As for the hemoglobin levels, the average hemoglobin level was 9.2mg/dl, where the majority of our cases (82.5%) lied below 10.5mg/dl. The DOPPS recommended the levels to be not lower than 11 mg/dl or there will be greater risk of hospitalization.
Serum iron, ferrtin and TSAT were not routinely measured and this does not agree with KDIGO guidelines. Among the 59 cases who have these measures regularly done (14.6%); the mean serum iron was 98.08, the mean serum ferritin was 1524.78ng/ml and mean TSAT was 38.83.
Regarding the ESA usage, 345 cases (85.4%) used ESA. 54.5% of the patients used the generic ESA and 30.9% used the originator ESA.
In our study, 24.8% of patients received iron injection and 76.5% received blood transfusion. 81.9% (331) used vitamin B complex, 40.3% (163) used folic acid and 52% (210) used L-Carnitine.
The mean calcium was 8.75mg/dl. 368 patients (91.1%) have routine calcium lab, 33.2% of which fall below recommended category, 60.6% in the recommended category (from 8.4 to 10.2) and 6.2% above recommended category.
The mean phosphorus level in our study was 4.99mg/dl. 367 patients (90.8%) have routine phosphorus check, 3.5% of which fall in the <3.5mg/dl category (below recommended), 73.2% from 3.5 to 5.5 (recommended) and 23.2% with > 5.5mg/dl (above recommended).
The mean PTH was 438.24. PTH levels in our study were as follows: 31 patients (7.7%) were below 150Pg/dl, 12 cases (3.3%) were between 150-300Pg/dl, 13 (3.2%) between 300-600, 6 (1.5%) between 600-900 and 12 (3%) above 900Pg/dl.
193 of cases (47.8%) received regular vitamin D supplement where the most frequent dosage taken was 3ug/week (23.3%) and 1.75ug/week (16.8%).
76.2% of the patients used phosphate binders where 75% used calcium based PO4 binder and 1.2% used calcium and sevelamer. Regarding the Cinacalcet usage, 3% of our cases used it.
The dialysis complications were bony aches 42.8%, itching 36.6%, hypotension 31.7%, cramps 26% and finally fractures 1%.
Only 69 patients (17%) have Kt/V and URR routinely done. The mean Kt/v was 1.16 and the mean URR in our study was 61.9996.
The mean dry weight of our HD patients was 73.7988 kg and the average weight gained was 2.33kg.
Regarding the dialyzer type, 96.8% used low flux filter and 3.2% used high flux. 86.1% (348) used dialyzer with 1.3 surface area, 10.6% (43) used 1.6 and 3.2% (13) used 1.7. Regarding sterilization, 64.9% of dialyzers were sterilized using steam and 35.1% using ethylene oxide.
401 cases (99.3%) used bicarbonate buffer and dialysate with 2mmol/l potassium concentration, 1.75mmol/l calcium and 0.5mmol/l magnesium.
As for the sodium, 80.9% used 135mmol/l sodium concentration, 15.8% used 138mmol/l and 3.2% used 140mmol/l.
All our study cases took high molecular weight heparin HMWH, where 3.7% took 2500 units, 83.2% took 5000 unit and13.1% took 7500 unit, with mean dosage of 5235.1485 unit.