الفهرس 
Hemodialysis PrescriptionOnly 14 pages are availabe for public view
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Abstract
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 October & November 2014.
Our study sample consisted of 278 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Military & Police Hospitals in Cairo.
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).
In our study we found that 267 patients recieve 3 HD sessions/week each lasting 4 hours (96%), this was with KDOQI guidelines recommendations for HD adequacy.
This study showed that the commonest known cause of ESRD among the study population is hypertension (38.1%), followed by DM (17.3%) & unknown in (11.5%), which agrees with Data from several renal databases that identifies systemic hypertension & Diabetes mellitus as the most common causes for ESRD.
Different comorbidities in the study population were HTN (44.2%), DM (14.4%), Ischemic heart disease (32%), Peripheral vascular disease (6.8%) and chronic arthropathy (18%).
Work status in the study population showed that 194 of them were not working (69.8 %), while the other 84 patients were working (30.2%).
Dependancy status in the study population was showed that 71 of them were dependant (25.5%), 207 were not dependant (74.5 %) with a wheel chair bound 25 cases.
Sponsoring status in the study population showed that all the 278 patients were sponsored by Military (100%).
In our study we found that 86% of the study population use AVF with a frequency of access failure of 25.5%, 2.5% of them use AVG & 11.5% use venous catheter.
The AVF has the best long-term primary patency rate and requires the fewest interventions of any type of access.
As regard vitamins use in the study population 100% of our patients were receiving vitamin B complex, 81.7 % were receiving folic acid supplements and 52.5% were receiving vitamin D.
In our study we found that the mean hemoglobin was 10.52 g/dL which is rela¬tively low consi¬dering the recommended target ranges and surveys from other parts of the world.
In our study the percentage of patients receiving regular erythropoietin was 94.2% & the percentage of patients who received IV iron was 66.9% and a mean serum ferritin of 657.74.
In our study we found that the mean calcium level was 8.97 ± 0.2 mg/dl, 69.8% of the patients were within the recommended level of serum calcium (8.4-10.2mg/dl) according to KDIGO 2009 guidelines. And that the mean phosphorus level was 5.42 ± 0.2 mg/dl, 50.7% of the patients were within the recommended level (3.5-5.5mg/dl).
The commonest complication during HD session in the study population is itching (43.2%) and hypotension (31.7%) then bony aches (29.1%) & the mean interdialytic weight gain was 2.30.
In our study the percentage of patients who received blood transfusion was 37.4% which is a large percentage &Viral status in the study population showed that the percentage of HCV positive patients was (32%), HBV positive was (4.7%), while (63.3%) of patients were negative.
Dialysate calcium used in the study population showed that all the 278 patients were using dialysate calcium 1.75 (100%) based on Bicarbonate.
In our study methods for measurment of HD adequacy were not routinely done for most of the patients. The mean Kt/V in 155 patients was 1.29, the mean Urea reduction ratio in 190 patients was 64.44.
Anticoagulation type used in the study population showed that out of 278 patients, 260 of them were using HMWH (93.5%), while 18 of them were using Clexane (6.5%).