الفهرس 
Hemodialysis prescriptionOnly 14 pages are availabe for public view
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Abstract
nd-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 assessment of the current status of dialysis patient in Egypt using a questionnaire. This project is modulated by Nephrology department, Ain Shams University.
Our study sample consisted of 300 clinically stable ESRD patients on regular HD. Patients were collected from 7 dialysis centres from Giza Governerate sector (D) which include (El Monib, El Maleka, Abou El Nomrs, Kafr Tohrms, Faysal &Saft districts).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.
Most of patients (90%) were receiving 3 HD sessions per week, but still there were 10% receiving 2 sessions per week.
The mean age of our dialysis patients was 51.88 ± 12.59 years, ranging from 18 – 85 years, 53.3% of them were males and were under dialysis for a mean period of years 3.23± 3.04 years.
Results of this study demonstrated that there were many causes for ESRD in the study population, where HTN represents 45%, DM represents 18% and in 13% of patients, the cause was unknown. These results agree with those of most studies where HTN and DM were the main causes of renal failure.
Different comorbidities in the study population were HTN present in 58.7% of patients, DM in 16 %, cardio vascular disease is in 9% of patients, ischemic heart disease in 3.7 %, chronic arthropathy in 4 %, chronic liver disease in 2% of patients and peripheral vascular disease in 1 % of patients
Although most of patients were receiving 4 hours dialysis session (62%) , but the rest were receiving dialysis session for 2-3 hours.
In our study population, (81 %) were not working, while (19 %) were working.
Dependency status in the study population showed that (22) % of patients were dependent, of them 6% were wheelchair bound while 78% of patients were independent.
Sponsoring status in the study population revealed that (86 %) of them were sponsored by ministry of health, while (14%) of them were sponsored by health insurance.
Type of vascular access used in the study population showed that (5%) of patients were using a venous catheter, (2.7%) were using AVG, while (92.3%) were using AVF. This was in agreement with K/DOQI guidelines for venous access placement.
In our study the mean hemoglobin level of our patients was 10.04 gm/dl and this level was less than the lower cutoff level recommended by K/DOQI guidlines which suggest to maintain hemoglobin level in CKD patients between 11-12 gm/dl.
In our study the percentage of patients receiving regular erythropoietin was 77.7%. The ESA used is Epoetin alfa in 99.1% while.9% used(Darbepoetin alfa).
Unfortunately, most our patients did not undergone regular Hb and iron profile testing in most of the patients. This may explain the lower target Hb and frequent need for blood transfusion and might explain the poor response to ESA which is used in all of our patients. Our Hb levels do not agree with K/DOQI anemia guidelines that recommend that during the initiation of erythropoietin treatment, iron status be tested every month in patients not receiving ongoing iron repletion
As regard vitamins use in the study population, (95.7%) of them received vitamin B complex, as regard L-Carnitine, (89.6%) of them received it, as regard vitamin D, (50.7%) of patients received it, as regard iron injection, there were (73.2%) of our patients received it.
None of the HD centers included in the study were performing tests of HD adequacy whether the simple urea reduction rate or the more complex Kt/V. This may lead to under recognition of efficiency of‘ dialysis and poor general quality of life of our patients.
In our study the mean calcium level was 8.028.028.028.02 mg/dl, which is lower than the recommended level proposed by KDIGO 2009 guidelines, mean Ca X PO4 product level was 37.71 which is lower than therecommended level proposed by KDIGO 2009 guidelines, the mean phosphorus level was 5.15.15.12 mg/dl which is similar to recommended target of KDIGO 2009 guidelines.
In our study all (23%) of the patients were on phosphate binders and (50.7%) were on active vitamin D.
The percentage of HCV positive patients is (30.3%), The percentage of HBV positive patients is (3.3%) all of them were isolated.
The most common complications during HD were hypotension in (26.5%) of patients followed by muscle cramps in (20.7%) of patients.
Our study showed that (68.3%)of patients were using a dialyzer with surface area 1.3m2, synthesized from Polysulphone, sterilized by steam, (12.3%)of patients were using a dialyzer with surface area 1.6m2 synthesized from Polysulphone, sterilized by steam, While 19.3 percent were using one with a surface area 1.4 m2, synthesized from helixone material, sterilized by steam. All dialyzers are of low flux type.
All patients used high molecular weight heparin as the standard anticoagulant.
As regard dialysate used in the study population, all patients used dialysate with K concentration 2mmol/L and Na concentration 138 mmol/L. 39.3 percent of them used acetate based dialysate with Ca concentration 1.25 mmol/L and Mg concentration 0.75 mmol/L, While the other 60.7 percent used bicarbonate based dialysate with Calcium concentrraion 1.75mmol/L and Mg concentration 0.5 mmol/L.