الفهرس 
HemodialysisOnly 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.
This effort aimed to study current status of clinical practice of hemodialysis in Egypt using questionnaire. Eight hemodialysis units in Cairo participated in this study. These units included 400 patients on regular hemodialysis.
The study was conducted during the period from August to October, 2012.
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.
In this study, we found that the common causes of the chronic renal failure which leads to dialysis was hypertension represented by 112 cases (28%) and diabetes mellitus 66 cases (16.5%).
The mean age of our patients was 53 ± 14.1 years, 221 patients (55.25%) were males & 179 patients (44.75%) were females.
360 patients (90%) of studied population weren’t working while only 40 patients were working (10%).
The mean of dialysis period was 4.4 years
398 patients (99.5%) of our studied population underwent dialysis 3 times/week.
In studied group 330 patients (82.5%) spent 4 hours per session, 67 patients (16.75%) spent 3.5hours per session, while 2 patients (0.5%) spent 2hours per session.
As regard sponsoring status in the study population (59.25%) of them were sponsored by governorate while (34.25%) of them were sponsored by health insurance, (3.5%) sponsored by company, (1%) sponsored by army and (2%) of them were private cases.
AVF was the preferred vascular access. 381 patients (95, 25%) had been dialyzed from A.V. F. Failure of access was in 108 cases (27%) of study population. The mean no. of failed access was 1.73±1.48.
There were not cases of HBV or HIV positive. 43% of patients were HCV positive in the studied group.
The mean HB level was 10.13 gm/dl which below the target level (11-12g/dl) according to NKF-DOQI guideline (2007).
5 out of 8 HD units in our study did not measure iron status routinely.
57.7% of patients had s.ferrtin>500 and 42.3% had s.ferrtin<500.
54.2% of patients had TSAT <30 % and 45.8% had TSAT>30 %.
In the current study 79.5% of patients used ESAs.54.5% of them used iron injection.
According to KDIGO, (2009), (58.3%) of patients had s.Ca within the target level (8.4-10.2 mg/dl) and (41.7%) had s.Ca below the target.
According to KDIGO (2009), (60%) of patients had s.P within the target level (3.5-5.5mg/dl), (35%) had s.P above the target and (4.4%) had s.P below the target
In the present study, mean s.PTH was 970.8 pg/ml.•According to KDIGO guidelines 2009 iPTH levels should be maintained in the range of approximately two to nine times the upper normal limit for the assay
In the studied group: 374 patients (93.5%) used phosphate binder (calcium only). 314 patients (78.5%) used Vitamin D supplement.
In the studied group we searched for the common complication of dialysis and we found that bony aches represented by 204 cases (51%) cramps 139 cases (34.8%) Hypotension 115 cases (28.8%) Itching 87cases (21.8%) and Fractures 5 cases (1.3%).
In the studied group dry weight of patients ranged 36-130 kg (mean 74.83 kg).Average weight gain was 0-5kg.
Out of 8 HD units, only two unit s measure urea reduction ratio as a tool for adequacy of dialysis routinely every three months. Urea reduction ratio ranged 28-95% (mean 61.33%).
In the current study Bicarbonate dialysate was used as the buffer in 71.25 % of patients.41.5% of patients were using dialysate Ca 1.25 mmol/l. 82% of patients were using dialysate K 2 mmol/l.
Synthetic and low flux dialysers were used for all study population.