الفهرس 
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Abstract
The incidence and prevalence of renal replacement therapies (RRT) is increasing worldwide. As well as being a large and growing clinical problem, it consumes a considerable proportion of health care resources in both developed and developing countries. Ideally, every ESRD patient should have access to dialysis. The reality is that there is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. Efforts should be made to have the cost of peritoneal dialysis fluids reduced and to increase the availability of transplantation.
Also, Measurements of hospitalization in the dialysis population are important because it is an important indicator of patient morbidity and quality of life as well as the cost of treatment among dialysis patients
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.
This effort aimed to determine number and causes of hospital admissions per year among prevelant hemodialysis patients
The study was conducted during the period from January and December 2013.
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 12 months and details of HD prescription and full history of hospital admission in last 12 months.
The study population includes 825 patients on regular hemodialysis who are divided to two groups according to hospital admission in the last year were through our study we found the rate of hospital admission among the patients was about 49.21 % while 50.79 % had no history of admission through this period.
According to the demographic characteristics of the patients who were included in the study we found that the rate of hospital admission was common among male by ratio 62 .07% On the other hand , the age was range from 56.61 ± 9.27ys .
In this study, The cause of renal failure was statistically different between the two groups. 46% of individuals admitted to hospital were reported to have hypertensive cause of ESRD, while 28% show diabetic nephropathy and 7% report obstructive nephropathy.
Chronic pyelonephritis, polycystic kidney, analgesic nephropathy, Unknown cause of ESRD are also reported in our statistics, there ratio as a cause of renal failure among admitted population vary from 3-4 % for each.
And for duration of hemodialysis we found that the main duration among admitted group vary from 4.559 ±3.033
Regarding dialysis parameters through our statistics the length of the session vary from 3.978±0.147andfrequency per week is about 2.96 ± 0.17 . On the other hand the most common dialyzer surface area used was 130 – low flux with ratio 83 % Also, the most common dialysate used was bicarbonate with ratio 75.3%
And for vascular access, we found that most of patients admitted in the last year undergo hemodialysis through A-V Fistula by ratio 95 % while 3.7% have C-V catheter and 1.2% have permenant catheter.
There were no HIV positive cases. 48.7% of patients were HCV positive & 0.48% of patients were HBV positive.
The mean Hb hemoglobin level range from 9.8 ±1 g/dL, which was lower than the recommended level according to the NKF KDOQI anemia guidelines 2009 and USRDS 2010 Annual Report recommended that the target Hb level should be 11-12 g/dL and should not exceed 13 g/dL., urea 134 ± 40 , serum creatinine8 ± 5 ,serum calcium 8 ±1 and serum phosphorus 4.8± 1
The main reasons for hospitalization were vascular access complication (36.5 %),Uremic complication and volume overload (17 %),Cardio vascular complication (13.5 %) and Infection (7.7 %).
Through our study, vascular access complications are variable, they vary from thrombosis, infection, stenosis and aneurysm .The main number of admitted patients was due to A-V fistula thrombosis (25%).then infected A-V fistula (6.9%) and A-V fistula aneurysm (0.7%). All this data regarding vascular access complication is in agreement with the USRDS reported that HD access failure was the most frequent cause of hospitalization for patients with CKD stage 5.
As regard A-V fistula thrombosis, it is the main cause of hospital admission among our studied group 25%and 70% of vascular access related complications, we found that it is more common in age group 55±8 ys and more common in male(70%), more in patient under hemodialysis for about 5±3 ys. And for virology,it is more common in –ve HCV, Cause of ESRD is variable in relation to this complication, Hypertension(35%) is more common, then diabetic nephropathy (27%), polycystic Kidney(8.9%)
And as regard Infected A-V fistula , it represent 6.9% of causes of admission and 20 % of vascular access related complications, it is more common in age group 55±10ys ,more in male (57%).Also, more in patient under hemodialysis for about 4.5±2ys,Cause o ESRD is variable in relation to this complication, diabetic nephropathy (42%) is more common ,then Hypertension (28%).
In our study, cardiovascular complication represent 13.5% of total no. of hospital admission among patients on regular hemodiaysis, where coronary artery disease represent 11.5 % of total no. of admission, it is more common in age group 56± 8ys ,more in male (57%) Also, according to cause o ESRD, Hypertension (53%) is more common, then diabetic nephropathy (36%).
Cerebrovascular stroke represent 3.6% of causes of admission, it is more common in age group 64± 9ys , more in male (66%). Cause o ESRD is variable in relation to this complication, Hypertension (73%) is more common, then diabetic nephropathy (26%).
As regard infection, it represent 7.7 % of total hospital admission. Chest infection (6.9%) was the most common cause of admission regard infection ,it was more common in age group 58± 8ys ,more in male (57%) Also, and for cause of ESRD, diabetic nephropathy (50%) is more common.
In our study Kidney related/renal failure complications (17%) represent the second cause of hospital admission among studied group. For example, uremic encephalopathy (7.8%), pulmonary edema(5.9%), hypertensive encephalopathy(2.7%).