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 Table of Contents  
REVIEW ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 267-271

Epidemiological study of patients on regular haemodialysis at the Kafer El-Shakh Governorate, Egypt


1 Department of Internal Medicine, Faculty of Medicine, Menufiya University, Al-Minufya, Egypt
2 Desouq Hospital, Kafer El-Shakh, Egypt

Date of Submission06-Jul-2014
Date of Acceptance20-Sep-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Mohammed M Ebazaway
Desouq Hospital, Kafer El-Shakh 33511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163858

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  Abstract 

Aim of this work
To study the epidemiology of haemodialysis among patients in the Kafer El-Shakh Governorate.
Background
End-stage renal disease (ESRD) has become a worldwide health concern. In developed countries, there is electronic data registry, which allows easy statistical analysis and determination of the size of the problem for future plans. In developing countries, there is no data registry and only scarce data were available about the epidemiology of dialysed patients.
Patients and methods
A questionnaire was conducted in haemodialysis units in the Kafer El-Shakh Governorate during the year 2012, focusing on the demographic data, vascular access, the hepatitis C status and causes of ESRD.
Results
The mean age was 51.34 + 13.5 years, and 60.7% of the patients were male. The mean duration of dialysis was 34 + 1. The main known causes of ESRD were hypertension (34%) and diabetic nephropathy (14%), whereas unknown causes represented 25.3% of the cases. The prevalence of hepatitis C was 39.7%. Out of 735 patients, 654 (89%) had no history of vascular access failure.
Conclusion
In the Kafer El-Shakh Governorate, there was a low prevalence rate of haemodialysis compared with the whole of Egypt. Haemodialysis represents the only mode of treatment of ESRD patients. Hypertension and diabetes constituted the major known causes. A unified system of electronic data registry should be started in each governorate to constitute the National Egyptian Data Registry.

Keywords: Egypt, end-stage renal disease, epidemiology of haemodialysis, etiology of end-stage renal disease, Kafer El-Shakh Governorate


How to cite this article:
Ahmed HA, Yassine YS, Tawafe AR, Ebazaway MM. Epidemiological study of patients on regular haemodialysis at the Kafer El-Shakh Governorate, Egypt . Menoufia Med J 2015;28:267-71

How to cite this URL:
Ahmed HA, Yassine YS, Tawafe AR, Ebazaway MM. Epidemiological study of patients on regular haemodialysis at the Kafer El-Shakh Governorate, Egypt . Menoufia Med J [serial online] 2015 [cited 2020 Feb 20];28:267-71. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/267/163858


  Introduction Top


End-stage renal disease (ESRD) has become a public health concern worldwide, and the total number of ESRD patients requiring renal replacement therapy has been growing drastically [1] . Chronic kidney disease (CKD) is at least three to four times more frequent in Africa than in developed countries [2] . Patient registry and statistical evaluation of patients with ESRD is useful to clarify the characteristics of ESRD patients and dialysis therapy, to assess complications or results on the basis of scientific evidence, to improve the quality of dialysis therapy and to provide socioeconomic health administration information for a future health plan [3] .

According to the United States Renal Data System annual report 2011 (USRDS), the prevalence of ESRD varies worldwide; it is high in Taiwan [2447 patients per million populations (pmp)], Japan (2205 pmp) and USA (1811 pmp) and low in Philippines (110 pmp), Bangladesh (140 pmp) and Russia (173 pmp) [4] . In developing countries such as Egypt, there is an increase in the prevalence and the incidence of ESRD, exerting a considerable burden on the health system.

The prevalence of ESRD in Egypt increased from 225 pmp in 1996 to 483 pmp in 2004 [5] . The main cause of ESRD in Egypt is hypertension, followed by diabetes, and still unknown causes represent about 15% of the cases [5] . The main problems in developing countries are the lack and the inaccuracy of the data registry. Also, there are no available epidemiological reports for different parts of the country.

In the Kafer El-Shakh Governorate, there are no peritoneal dialysis or transplant programmes and haemodialysis represents the main mode of treatment for ESRD. In the Kafer El-Shakh Governorate, there are no reports depicting the epidemiological characteristics of ESRD patients. Kafer El-Shakh is considered as 'a rural region' lying in the delta area of Egypt.


  Patients and methods Top


The protocol for this study followed the ethical standards and was approved by the ethical committee of our institution, and all participants gave informed consent to participate in this study.

This study was a cross-sectional survey of all ESRD patients undergoing haemodialysis in the Kafer El-Shakh Governorate, Egypt. Data of haemodialysed patients were collected simultaneously from all working HD centers by direct patient interviews. All patients were offered regular haemodialysis three times per week, each session 4 h. The diagnosis of hypertension as a cause of ESRD was made when there was long-standing hypertension before the development of ESRD with no evidence suggestive of other diagnoses. The diagnosis of diabetic nephropathy (DN) was made when there was long-standing diabetes with proteinuria and associated diabetic retinopathy. Primary glomerulonephritis (GN) was a biopsy-proven diagnosis. Immune/collagen secondary GN was diagnosed when there was a history or laboratory data suggestive of immune/collagen disease with kidney affection or biopsy-proven kidney involvement of immune/collagen disease. Hepatitis C virus positivity was defined by a history or laboratory data suggestive of hepatitis C virus infection or as tested by a third-generation enzyme immunoassay.

Statistical evaluation

We used the statistical package of social science (SPSS, version 16, Chicago, USA) and Excel to perform the analysis. Quantitative data were expressed as mean ± SD, whereas categorical data were expressed as numbers and percentages.


  Results Top


According to the last preliminary results of the 2012 census, the total population of the Kafer El-Shakh Governorate was 2.9 million people [6] . Accordingly, the haemodialysis prevalence rate was 282.6 pmp. Unfortunately, we do not have annual data, and so we could not calculate the incidence rate.

[Table 1] shows the mean age of the patients. The mean age of the patients was 51.3 ± 13.5years. [Table 2] shows that male patients comprise 60.7%, whereas female patients comprise 39.3% of the participants. [Table 3] shows that the mean duration of dialysis was 4.35 ± 4.43 years.
Table 1 Age of the ESRD patients

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Table 2 Sex distribution among the different studied groups

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Table 3 The duration of dialysis in years

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[Figure 1] shows the distribution of the studied sample regarding the location. The highest percentage was at Bailla center (16.7%) and the lowest percentage was at Fawa center (5.3%). [Figure 2] shows that 25.3% of the surveyed patients had no identified cause for their renal impairment. Hypertension was the most commonly reported cause of ESRD (34.0%), followed by DN (14%). GN was the reported cause in a relatively small proportion of patients (8.2%). [Figure 3] shows the prevalence of hepatitis C (39.7%). [Figure 4] shows that out of 735 patients, 654 had no history of vascular access failure (89%), whereas 81 of them had a history of access failure (11%).
Figure 1: Distribution of the studied sampler with regard to the location .

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Figure 2: Causes of kidney failure

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Figure 3: The hepatitis C status

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Figure 4: Data on access failure in the studied patients

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  Discussion Top


The incidence of ESRD requiring renal replacement therapy is steadily increasing and poses a tremendous burden on healthcare budgets even in developed countries [7] . Unfortunately, we do not have previous reports in the Kafer El-Shakh Governorate to compare with the current prevalence.

In the whole of Egypt, there are no recent data about the prevalence; however, the last statistics were from 2004, with a prevalence of 483 pmp [5] . In the EL-Minia Governorate, one of the Upper Egypt governorates, the prevalence was 308 pmp [8] .

The prevalence worldwide differs significantly. According to the, the highest prevalence was found in Taiwan (2447 pmp) and the lowest prevalence was in Philippines (110 pmp). In the USA, the prevalence was 1811 pmp [4] . In Europe, the prevalence increased from 760 pmp in 2004 to 889 pmp in 2008 [9] .

In our study, the mean age was 51 years. Adel Afifi et al. [5] reported that the mean age in Egypt increased from 45.6 years in 1996 to 49.8 years in 2008. The increasing mean age of ESRD patients reflects the improvement in healthcare; however, we are still much behind developed countries, as the mean age in the USA was 61.1 years [4] and the median age in the UK was 65.9 years [10] .

In the current study, the main known cause of ESRD was hypertension (34%), followed by diabetes (14%). The global diabetes burden is predicted to increase to 366 million by 2030, and would present itself as a major health challenge; it has been predicted that the greatest relative increases in diabetes in the next 25 years will occur in the Middle Eastern Crescent, Sub-Saharan Africa and India [11] . In Egypt, the prevalence of DN as a cause of ESRD has increased from 8.9% in 1997 to 13.5% in 2008, still being the second most common cause, as hypertension is the main cause with 36.6% prevalence [5] .

In Egyptian governorates, hypertension and DN were the most frequent causes of ESRD. In Cairo, the main cause of ESRD was hypertension (29.7%), followed by DN (12.5%); in Canal governorates, hypertension was the main cause of ESRD (27.3%), followed by DN (10.7%); and in the Minia governorate, hypertension (20%) was followed by DN (8%) [8] as the main causes of ESRD.

In this study, unknown causes constitute 25.3% of all causes of ESRD. It was estimated to be 27% in the Minia governorate and 18.1% in the Cairo governorate [8] , and in the whole of Egypt, it was estimated to be 15.2% [5] .

In this study, the prevalence of hepatitis C was 39.7%. The prevalence of hepatitis C in dialysis patients showed wide variations worldwide. It was estimated to be 52.1% in Egypt [5] .

The high prevalence of hepatitis C in the Kafer El-Shakh Governorate may be attributed to the high prevalence of hepatitis C in the general population, the high rate of blood transfusion in dialysis units to treat anemia, instead of iron therapy and erythropoietin, which are costly, and a lack of standard methods for infection control in dialysis units.

The sponsoring status in the study population showed that 587 patients (80.13%) were sponsored by the Governorate (80.13%), whereas 146 were sponsored by Insurance (19.87%).

In our study, we found that only 9% of the cases used a central venous catheter during the time of dialysis due to complications that occur at the arteriovenous fistula or in new patient without mature arteriovenous fistula when starting dialysis; this reflects a lack of awareness of the treating physician and the primary healthcare physician about the proper time for referral to the nephrologists, and may be a lack of awareness of some nephrologists about the proper time for preparing the patient for renal replacement therapy.


  Conclusion and recommendations Top


In the Kafer El-Shakh Governorate, we reported a high prevalence of ESRD patients treated with haemodialysis. Hypertension and DN were the main causes of ESRD and unknown causes represent 25.3%. There is no data registry of dialysis patients.

A significant proportion of patients discovered their kidney problem late and were also not well prepared for renal replacement therapy. We also have a high prevalence of hepatitis C. We recommend the following:

  1. Unified local electronic data registry for each governorate to constitute the National registry.
  2. Increased public awareness about CKD and also increased awareness among primary healthcare physicians about the early detection and prevention of CKD and the proper time for referring patients to nephrologists.
  3. Restrict the application of infection control measures in dialysis units.
  4. Start a peritoneal dialysis programme together with both living and deceased kidney transplant programmes.[26]

  Acknowledgements Top


Conflicts of interest

There are no conflicts of interests.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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