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 JULY & August 2013.
Our study sample consisted of 321 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from hemodialysis units at Kafr El Zayat and Basyon areas (El Garbia Governorate). 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 H D prescription (Doctors, nurses, administration orders).
Results of this study demonstrated that there were many causes for ESRD in the study population, where HTN 39.9%, DM 12.8%, and in 19.6% 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 (57.3%), DM in (15.0%), ISHD in (19.9 %), CLD in (5.9%) of patients.
In our study we found that all the patients 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 3.74 (± 3.63) years. The mean value of patients dry weight was 71.63 (± 15.86) Kg.
In our study population (90.3%) were not working, while (9.7%) were working.
Dependency status in the study population showed that (35.2%) of the patients were dependant, (64.8%) were not dependant, while (8.4%) of them were wheelchair bound.
As regard Sponsoring status in the study population (61.4%) of them were sponsored by Governorate (34.4%) of them were sponsored by Health Insurance, while (1.2%) of them were sponsored by company.
In our study we found that 88.2% of patients were using AVF, 0.9 % were using AVG while 10.9 % were using venous cathter. This was in agreement with KDOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was 8.39± (1.71)gm/dl, we found that according to NKF- KDOQI guidelines recommendations (92.2 %) of our patients were below the recommended level, (1.9 %) were above it.
In our study the percentage of patients receiving regular erythropoietin was (77.9%), while (22.1%) of patients were not on ESA therapy.
All studied populations did not do Ca, PO4 and PTH routinely.This does not agree with K/DOQI guidelines 2003 which recommend to do PTH every 3 months and serum Ca and phosphorus every month for dialysis patients (K/DOQI, 2003).
As regard vitamins use in the study population (66.0%) of them received vitamin B complex, as regard L-Carnitine (53.0%) of them received it, as regard vitamin D there were (82.9%) of our patients received it.
History of iron injection in the study population showed that (64.8%) received iron injection, while the other (35.2%) did not receive it.
In our study 87.9 % of the patients were on phosphate binders therapy.
The percentage of HCV positive Pts is (61.7%), HCV negative Pts percentage is (38.3%). all HCV positive Pts are totally isolated from HCV negative.
Our study showed that(62.6 %) were using dialyzer with surface area 1.3m (7.5%) were using one with surface area 1.4m (29.0%) were using one with surface area 1.6m (0.3%) were using one with surface area 1.7m. all of synthetic material, sterilized by ethylene, low flux.
As regard dialysate used in the study population (57.9%) were using bicarbonate based dialysate with K concentration 2mmol/L, Ca concentration 1, 75 mmol/L, Na 137 mmol/L, Mg 0.50 mmol/L. While (42.1%) were using acetate based dialysate with K concentration 1.5mmol/L, Calcium concentration 1.25mmol/L, Mg 0.75mmol/L, (32.4%) of them were using Na concentration 138 mmol/L,1(9.7%) of them were using Na concentration 134 mmol/L.