الفهرس 
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Abstract
The aim of the present study was: 1- To estimate the annual incidence of end-stage renal disease in Alexandria. 2- To estimate the annual number of patients who could benefit from long term dialysis in Alexandria. 3- To describe the characteristics of potential and actual uses of dialysis services in Alexandria. 4- To determine the number of renal dialysis units to provide optimum treatment for end-stage renal in Alexandria. required disease 5- To estimate the cost of long. term dialysis. Methodolgy : 1- Estimation of the annual incidence of ESRD among the health insured population in Alexandria, as a basis for estimation of the incidence of ESRD in Alexandria. Identifi cation of patients developing ESRD during the years 1980 through 1983 was done by using the hospital oombers of all patients suffering from primary of secondary renal diseases or from urermia of unknown cause. These were identified by using the disease index, medi cal and the records were retreived. The retreived records were screened, using blood 100 mg / the ml or more as urea level of The records of those with blood urea level of 100 mg/ml each patient suffered from ESRD screening index. or more were abstracted, were reviewed to determine whether or not, Criteria for diagnosing ESRD were sett by the supervisors. 11 Haemodialysis units in Alexandria, and characteristics of users of haemodialysis services: A survey was done 1984 to at the end of dialysis units available in characteristi cs of who used those during 1984. The characteristics studied determine the number of Alexandria and the haemodialysis services were sex and age only, because it was not possible to obtain other information. 111- Survival of patients studied £eritoneal dialysis:. was on haemodialysis and by follow of all up patients who started this therapy in Alexandria, during year 1980 through 1983. These the end of June 1985. the cases were followed up until IV Cost of Haemodialysis: The Medical Research Iostitute unit was chosen as the model unit. The items which used to determine the cost were: 1. Machine use. 2. Direct supplies as dialyzer-Bloodlines-Artificial kidney concentrate, syringes, cotton etc... 3. Man power. 4. Other cost: as water treatment cost and cost of machine maintenance. The Main Results of the present study were as follows: * ESRD among the health insured population in Alexandria: - The incidence of ESRD among males increased from a rate ~f 53.92 per million in 1980 to 110.07 per million in 1983. - Concerning females, it was 29.97 per million in 1980, and reached to 57.30 per million in 1983. * The greater proportion of males belonged to the age group 40-49 years, and 50-59 years (34.5 and 31.0 respectively). * The greater females belonged to the age 30.0 that chronic pyelonephritis and indicates chronic the years 1980 through 1983, it was found that one proportion of being compared to males (60.0 to 29.5 respectively). While the reverse 26.8 ESRD that were received 1980 through 1983, indi cates Survival of cases on peritoneal dialysis during the years of the group of 30-39 respectively) . years and 20-29 years (35.0 and the *’ Concerning the survival of cases on haemodialysis, during * ESRD by Distribution of cases of diagnosis, .glomerulonephritis the diagnoses leading were recorded respectively for 32.5 and 25.6 of cases. * Chronic pyelonephritis was common among females ’was found for chronic glomerulonephritis (15.0 to respectively). * Concerning the line of management followed for the cas es of health appeared insured population, it 17.7 26.6 maintained on haemodialysis, were maintained on peritoneal 55.2 dialysis, and medical treatment only. * . that: by the end first year, only 14.0 were alive, and none survived second year. year after begining the survival 62.0, while therapy was 49.0 were alive at the end of the second year, 41.0 at the end of the thirdyear, and 30.0 at the the end of fourth and fifth year. The dying proportion was greatest in the first year 38.0, followed by the fourth year 32.0. The number of new patients placed on maintenance haemodialysis in Alexandria: During the first year in which haemodialysis services were provided 25 on placed in Alexandria, patients were haemodialysis, and this figure increased to 53 in 1983. The number of haemodialysis units in Alexandria was 47 by the end of 1984, and reached to 68 of units by the end 1985. The private sector accounted for the lowest proportion of avai 1ab1e units, 7 hospital owing 10.3 of the total units by 1985. * The distribution of the patients receiving haemodialysis services in governmental age hospitals, by and sex, indicats that for both males and the females, those in age group of 40-49 years accounted for the highesj proportion of cases (28.9 and 29.6respectively). Those below 20 years of age accounted for only 1.3 males and 2.3 of females. of The cost of haemodialysis unit: It could be seen that the cost per haemodialysis session is 68.24 L.E., and the cost per case per year based on 2 sessions per week is 6824 L.E. * For estimating the incidence of ESRD among the population of Alexandria and forcasting this rate till the year 2000 , the figures of the insured population were ~ considered the basic starting point. Because the general population of Alexandria and the insured population are not indentical particularly regarding the age / sex composition there fore, some adjustment were found necessary. Thus, applying the incidence experience of ESRD of the insured population to the general population of Alexandria in 1984, and after making the necessary adjustments for age and sex, the incidence rate of ESRD among the Alexandria population was in the range 83.5 per million for age group of 20 years and over, and 1.3 per million for the age group of less than 20 years. The estimated overall rate of ESRD in Alexandria were found to be: 41 per million. By applying this estimated incidence rate of 41 per million population and the annual survival rate of 80 during the first five years, 85 during the next five years, and 90 of the five years there after, the number of cases of ESRD needing haemodialysis in Alexandria, by the year 2000, will be 708 cases. . The number of haemodialysis machines required by the year 2000, will be 138.8 machines assuming that one machine serves 6 patients and 208.3 machines assuming that one machine serves only 4 patients. Regarding the year 1985, there were 68 haemodialysis units in Alexandria, while according to this study, the Alexandria population need only 51.6 machines if the machine serves 6 patients and 77.5 machines if it serves 4 patients only.