الفهرس 
Hemodialysis prescriptionOnly 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 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 January and February 2014
Our study sample consisted of 365 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Bani swaif governmental hospitals(Beba ,El fashn, Sumusta and Ehnasia)
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, administration orders).
Results of this study demonstrated that there were many causes for ESRD in the study population ,where HTN 27.67% , DM 17.53% ,and in 20% the cause was unknown, this results agrees with most of the studies where HTN & DM were the main causes of renal failure .
Different co-morbidities in the study population were HTN in (41.09%), DM in (19.45%), IHD in (8.76 %), CLD in (1.64%) of patients.
In our study we found that most of the patients 98.91% 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 2.7 (± 1.3) years. The mean value of patients dry weight was 77.25 (± 12.32) Kg.
In our study population (89.58%) were not working , while (10.42%) were working .and according to dependency status in the study population showed that (3.8%) of the patients were dependant, (91.7%) were not dependant , while (4.38%) of them were wheelchair bound .
As regard Sponsoring status in the study population (70.67%) of them were sponsored by Governorate , while (28.75%) of them were covered by Health insurance and only (0.58%) by Army .
In our study we found that 95.6% of patients were using AVF , 3.8 % were using venous catheter while 0.28 % were using permanent cathter and 0.28% were using AV graft. this was in agreement with KDOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was 9.89±(1.72)gm/dl , we found that according to NKF- KDOQI guidelines recommendations (69 %) of our patients were below the recommended level, (13 %) were above it. as regard blood transfusion the study population showed that 87.12% received blood transfusion.
History of iron injection in the study population showed that (54.52%) received iron injection , while the other (45.48%) did not receive it.
In our study the percentage of patients receiving regular erythropoietin was (67.7%) , and it was Epoetin alfa only.
As regard vitamins use in the study population (76.2%) of them received vitamin B complex , as regard L-Carnitine (14 %) of them received it , as regard vitamin D there were ( 71.5%) of our patients received it.
We also found that the mean calcium level was (8.6) ± (0.83)mg/dl , According to KDIGO 2009 guidelines 36.9% of patients were below the recommended level , 59.5 % within the recommended level and 3.6 % above the recommended level.
In our study we found that the mean phosphorus level was (4.72) ± (1.18)mg/dl. According to KDIGO 2009 guidelines, 16.3% of our patients were below the recommended level, 59.3% within the recommended level and 24.4 %above the recommended level. In our study 86.57 % of the patients were on phosphate binders therapy. calcium phosphorus product level was above 55 in (12%) ,while in (88%) was below 55.
The commonest complication during HD session in the study population is hypotension (26.8%), cramp (20.8%), Itching (8.8%) bone aches (2.5%), and the least common is fractures (0.3%).
The percentage of HCV positive Pts is (55.6%), while (44.4%) of Pts are negative. HBV positive patients and HIV patients are not allowed to have dialysis in these centers .
As regard dialyzers used in the study population showed that out of 365 patients, 196 of them (53.7%) were using a dialyzer with surface area 1.4 m, sterilized by steam, 65 patients (17.8%) used dialyzer with surface area 1.6 m, sterilized by ethylene oxide, 64 patients (17.5%) used dialyzer with surface area 1.0 m, sterilized by ethylene oxide, while only 40 patients (11%) used dialyzer with surface area 1.3 m, sterilized by ethylene oxide. All dialyzers were synthetic and low flux.
As regard dialysate used in the study population showed that out of 365 patients, 364 of them (99.7%) were using dialysate with K concentration 1.25mmol/L, Ca concentration 2.5mmol/L, Na 138mmol/L, Mg 1.25mmol/L and acetate based, while only one patient using bicarbonate based dialysate with K concentration 2mmol/L, Ca concentration 1.5mmol/L, Na 105mmol/L and Mg 0.5 mmol/L.
As regard haemodialysis adequacy. Although Kt/V and URR are not routinely used. Urea reduction ratio in the study population showed that 126 patients have URR ≥ 65%, 72 patients have URR <65%, URR not available for 167 patients.