الفهرس 
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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 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 period from January 2012 to June 2012.
Our study sample consisted of 291 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Abo-Hamaad General Hospital, Abo-Sateey privte center, Menya-Elkameh Hospital, Elhelmeya Inestitute and Elsaedyeen Hospital. In all patient 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 23.7%, DM 9.6%, and in 34.7% 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 (72.9%), DM in (18.2%), ISHD in (9.7 %), CVS in (2,7%), PVD in (7.9%), CLD in (16.2%), COPD in (6.2%), and chronic arthropathy in (8.9%) of patients.
In our study we found that almost all patients 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 4.00 (± 3.46) years. The mean value of patients dry weight was 68.99 (± 17.49) Kg.
In our study population (68%) were not working, while (32%) were working.
Dependency status in the study population showed that (30.9%) of the patients were dependant, (69.1%) were not dependant, while (9.07%) of them were wheelchair bound.
As regard Sponsoring status in the study population (67%) of them were sponsored by Governorate, while (33%) of them were sponsored by Insurance.
In our study we found that 95.2% of patients were using AVF while 4.8 % were using venous catheter. this was in agreement with KDOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was 9.3 ±(1.79)gm/dl, we found that according to NKF- KDOQI guidelines recommendations out of 201 patients (88.51%) who have valid haemoglobin of our patients,203 patients were below the recommended level (86.56%), patient were above it (13.44%).
In our study the percentage of patients receiving regular erythropoietin was (100%).
Our study stated that mean PTH level was (522.90) ± (533.40)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 (75.40%) of them received vitamin B complex, as regard L-Carnitine (26.21%) of them received it, as regard vitamin D there were (88,10%) of our patients received it.
History of iron injection in the study population showed that (28.8%) received iron injection, while the other (71.2%) did not receive it.
We also found that the mean calcium level was (8.59) ± (2.14)mg/dl, According to KDIGO 2009 guidelines, out of 53 patients (10.69%) who have valid test, 23 patients (43.40%) were below the recommended level, 25 patients (47.17%) within the recommended level and 5 patients (9.43%) above the recommended level.
In our study we found that the mean phosphorus level was (5.93) ± (2.05) mg/dl. According to KDIGO 2009 guidelines, of only 39 patients (10.69%) who had done the investigation, 2 of our patients (7.55%) were below the recommended level, 16 patients (39.62%) within the recommended level and 19 patients (52.83%) were above the recommended level.
In our study 95.56 % of the patients were on phosphate binders therapy.
Out of 31 patients (9.27%), calcium phosphorus product level was above 55 in 11 patients (32.61%), while in 20 patients (67.39%) was below 55.
The percentage of HCV positive Pts is (48.5%), HBV positive Pts percentage is (2.2%), while (48.3%) of Pts are negative. all HBV positive Pts are totally isolated from HCV positive.
Our study showed that 226 of Pts (78.7%) were using dialyzer with surface area 1.3m, of synthetic material, sterilized by steam.All of them were low flux. While the other 8 patients (2.7%) were using one with surface area 1.4 m, of synthetic material, sterilized by steam.
As regard the criteria of dialysate used by the study population. Out of 291 patients, 167 of them (57.4%) were using dialysate with K concentration 2mmol/L, Ca concentration 1, 75 mmol/L, Na 137 mmol/L, Mg 0.75 mmol/L and bicarbonate based, While the other 124 patients (42.6%) using same dialysate but with Calcium concentration 1.50 m.mol/L, Na concentration 135 m.mol/L, Mg concentration0.5 m.mol/L and potassium concentration 2 m.mol/L.