الفهرس 
HEMODIALYSIS PRESCREPTIONOnly 14 pages are availabe for public view
 |  | from | 14 |  |  |
| | | from | 14 | | |
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 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 April & May 2013.
Our study sample consisted of 331 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from EL Gharbiah governorate sector D (EL Santa, Kotour, Samanoud).
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 41.1%, DM 21.1% and in 16.3% 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 (62.2%), DM in (21.8%), CLD in (13.6 %), chronic arthropathy in (11.8%), CVS in (2.7%), PVD in (2.7%), ISHD in (5.7%) of patients and COPD in (1.8%).
In our study we found that most of the patients 98.5% recieve 3 HD sessions /week and most of them (87.6%) lasting 4 hours/session, this was with KDOQI guidelines recommendations for HD adequacy.
The median value of HD period is 6.6 (± 4.7) years. The mean value of patients dry weight was 71.08 (± 15.94) Kg.
In our study population (84.6%) were not working, while (15.4%) were working.
Dependency status in the study population showed that (13.3%) of the patients were dependant, (86.7%) were not dependant, while (1.5%) of them were wheelchair bound.
As regard Sponsoring status in the study population (62.2%) of them were sponsored by Government, (37.2%) of them were sponsored by insurance and (0.6%) were sponsored by military.
In our study we found that 89.1% of patients were using AVF, 1.5 % were using AVG while 9.4 % 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 9.59 ± (1.9)gm/dl.
In our study the percentage of patients receiving regular erythropoietin was (87.9%), the most frequent ESA used was Epoetin alfa (85.5%), Epoetin beta (2.4%), while (12.1%) of patients were not on ESA therapy.
IN our study, Ca, phosphorus and PTH levels were not done at regular basis for the study population and this is against KDOQI guidelines which recommend that dialysis patients should do calcium and phosphorus level every month and PTH level every 3 months.
As regard vitamins use in the study population (48.3%) of them received vitamin B complex, as regard L-Carnitine (38.1%) of them received it, as regard vitamin D there were (94.3%) of our patients received it.
History of iron injection in the study population showed that (53.8%) received iron injection, while the other (46.2%) did not receive it.
In our study all patients were on phosphate binders therapy. Viral status in the study population showed that the percentage of HCV positive patients was (59.8%), while there were no HBV positive or HIV positive patients.
As regard HCV isolation, 90.4% of them were isolated and 9.6% of them were not isolated.
As regard the type of dialyzer used by the study population, 54.4% were using one with surface area 1.3m, 26.9% of them were using one with surface area 1.6m, 16.6% of them were using one with surface area 1.4m and 2.1% patients were using one with surface area 1m, 57.7% were sterilized by ethylene oxide and 42.3% were sterilized by steam, all of them was low flux and of synthetic material (polysulfone).
Criteria of dialysate used by the study population showed that, 47.7% were using acetate based dialysate with Sodium concentration 134 mmol/L and calcium concentration 1.5 mmol/L, 52.2% were using bicarbonate based dialysate with Calcium concentration 1.75 mmol/L, 43.8% were using dialysate with Sodium concentration 105 mmol/L, while 8.4% were using dialysate with Sodium concentration 103 mmol/L. All patients were using dialysate with potassium concentration 2 mmol/L and Magnesium concentration 0.5 mmol/L.
As regard dialysate used in the study population (64.3%) were using dialysate with K concentration 2mmol/L, Ca concentration 1.50 mmol/L, Na 105 mmol/L, Mg 0.50 mmol/L and bicarbonate based, while (35.7%) were using same dialysate but with Calcium concentrraion 1.75mmol/L, Na 103 mmol/L.