الفهرس 
Chronic Kidney Disease and ManifestationsOnly 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 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 March & April 2014.
Our study sample consisted of 150 clinically stable chronic patients on regular thrice- weekly HD. Patients were collected from Red Sea hospitals.
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 Obstructive Uropathy (25.3%),HTN (16%), chronic (GN 12%), chronic Pyelonephritis (12%),DM (10.7%),and in (19.7%) the cause was unknown, this results disagrees with most of the studies where HTN & DM were the main causes of renal failure.
Different comorbidities in the study population were HTN in (56.7%), CLD in (17.3%), DM in (10.7%), ISHD in (10 %), CVS (2%) of patients.
In our study we found that most of the patients 98.7% 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 (± 3.4) years. The mean value of patients dry weight was 69.14 (± 15.2) Kg.
In our study population (65.3%) was not working, while (34.7%) were working.
Dependency status in the study population showed that (2.7%) of the patients were dependent, (97.3%) were not dependent, while (2.7%) of them were wheelchair bound.
As regard sponsoring status in the study population all 150 patients, were sponsored by Governorate (100%).
In our study we found that 87.3% of patients were using AVF while 12.7 % 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 9.23± 1.26 gm/dl, we found that according to NKF- KDOQI guidelines recommendations (97.2 %) of our patients were below the recommended level, (2.8 %) were above it.
In our study the all patients receiving regular erythropoietin (100%), the most frequent ESA used was Epoetin Alfa (100%).
In our study we found that the PTH not done for all patients, recommendations of KDIGO guidelines 2009 was to maintain its level 2-9 times the upper normal limit of the assay.
As regard vitamins use in the study population, all patients received vitamin B complex (100%), as regard L-Carnitine (6.7%) of them received it, as regard vitamin D all patients received it(100%).
History of iron injection in the study population showed that (95.3%) received iron injection, while the other (4.7%) did not receive it.
We also found that the mean calcium level was (8.6) ± (0.35)mg/dl, According to KDIGO 2009 guidelines 4.7 % of patients were below the recommended level, 6 % within the recommended level while in 89.3% of our patients calcium level were not routinely done.
The percentage of HCV positive Pts is (19.3%), HBV positive Pts percentage is (0.0%), while (80.7%) of Pts are negative. all HCV positive Pts are totally isolated from HCV negative Pts.
Our study showed that (49.3 %) of Pts were using a dialyzer with surface area 1.3m, of synthetic material, sterilized by steam, high flux, while (50.7%) were using one with surface area 1.6 m, of synthetic material, sterilized by steam, low flux.
As regard dialysate used in the study population (92%) were using dialysate with K concentration 2mmol/L, Ca concentration 1.75 mmol/L, Na 140 mmol/L, Mg 0.50 mmol/L and bicarbonate based, While the other 12 patients (8%) were using dialysate with K concentration 1.5mmol/L, Ca concentration 1.25 mmol/L, Na 138 mmol/L, Mg 0.75 mmol/L and acetate based.