الفهرس 
Hemodialysis PrescriptionOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
nd-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 led 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 February 2015.
Our study sample consisted of 300 clinically stable chronic patients on regular HD. Patients were collected from Kafr El Sheikh Governorate (sector ΙΙ) dialysis centers.
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 (Doctors, nurses and administration orders).
Results of this study demonstrated that there were many causes for ESRD in the study population, where HTN (47.3%),DM (17.7%), Unknown (12.7%), ADPKD(4.3%),Chronic GN(4.3%),and in (3.3%) the cause was obstructive uropathy, 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 (15.3%), DM in (13%), IHD in (5.3%), CLD in (5 %), CVS in (4.3%) of patients and COPD in (3.7%).
In our study we found that most of the patients 93 % receive 3 HD sessions /week,7 % receive 2 HD sessions /week and HD sessions duration were 11.67 % of sessions lasting 3 hours, 24.67 % of sessions lasting 3.5 hours and 63.67 % of sessions lasting 4 hours., this was with NFK-K/DOQI guidelines recommendations for HD adequacy.
The mean value of HD period is 5.3 (± 3.5) years.
The mean value of weight gain between sessions of the study population was 3 (± 1.2) Kg
In our study population (81%) was not working, while (19%) were working.
Dependency status in the study population showed that (19.7%) of the patients were dependent, (80.3%) were not dependent, while (6.3%) of them were wheelchair bound.
As regard sponsoring status in the study populations (92.7%) of patients were sponsored by Government while (7.3%) patients were sponsored by insurance.
In our study we found that 96.3% of patients were using AVF while 3 % were using venous catheter. This was in agreement with NFK-K/DOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was 9.32± 1.23 gm/dl, we found that according to NKF- KDOQI guidelines recommendations 78.6 % of our patients were below the recommended level, (3.7 %) were above it.
In our study the most frequent ESA used was Epoetin alfa by 69% of patients, Darbepoetin alfa by 15.7% of patients while 15.3% of patients (were not on ESA therapy at all.
History of iron injection in the study population showed that 52% received iron injection, while the other 48% did not receive it.
History of blood transfusion in the study population showed 16% of our patients received blood transfusion, while the other 84% did not receive it ().
History of vitamins use in the study population showed that 93% of patients received vitamin B complex, 34.3% received L-Carnitine and 7.7%of patients received folic acid .
In our study we found that the mean calcium level was (8.4 ± 1.14) mg/dl. According to KDIGO 2009 guidelines 31.7 % of our patients were below the recommended level, 2 % of our patients were above the recommended level, 25.3 % within the recommended level (8.4-10.2mg/dl) and while in 41% of our patients’ Calcium level were not routinely done.
In our study we found that the mean phosphorus level was (5.08 ± 1.32 mg/dl). According to KDIGO 2009 guidelines 7.3 % of our patients were below the recommended level, 32.7 % of our patients were above the recommended level, 19 % within the recommended level (3.5-5mg/dl) and while in 41% of our patients’ phosphorus level were not routinely done.
PTH was done for 52.3% of the patients in population study 27.4% of them achieved recommended PTH level (150-300 pg/dl) According to KDIGO 2009 guidelines.
In our study we found that the commonest complication during HD session in the study population is bone aches (15%), then itching (10%) and hypotension (10%), then muscle cramps (9%), the least common is fractures (5%).
Viral status in the study population showed that the 35% of patients were HCV positive, 4.3% of patients were HBV positive were, while 60.7% patients were negative (60.7%). All HCV and HBV positive patients were totally isolated from negative patients.
Our study showed that 19.7 % of our patients were using a dialyzer with surface area 1.3m2 ,45.7 % were using a dialyzer with surface area 1.4m2, 27.3% were using a dialyzer with surface area 1.6m2 and 7.3% were using a dialyzer with surface area 1.7m2.
All dialyzers used in the study population were low-flux type sterilized by steam.
As regard the criteria of dialysate used by the study population all of patients (100%) were using dialysate with K concentration 2mmol/L, Ca concentration 1.75 mmol/L, Na 140 mmol/L, Mg 0.50 mmol/L and bicarbonate buffer based.