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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 3  |  Page : 766-771

Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis


Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission24-Dec-2018
Date of Decision20-Jan-2019
Date of Acceptance26-Jan-2019
Date of Web Publication30-Sep-2020

Correspondence Address:
Rasha A. A. H. Issawi
Zagazig, El-Sharkia 44511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_395_18

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  Abstract 


Objectives
The objective of this work is to study the prevalence and etiology of end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD) in a central governmental Hospital of El-Sharkia governorate, Egypt.
Background
ESRD has become a public health concern worldwide as the total number of ESRD patients requiring renal replacement therapy has been growing dramatically. The main problem in developing countries is the lack and inaccuracy of data registry.
Patients and methods
This descriptive study had been done in the El-Sharkia governorate central governmental hospitals on adult patients' resident in the El-Sharkia governorate with ESRD on maintenance HD for more than or equal to 3 months. The study was done during the period from February 2017 to November 2017.
Results
The prevalence of ESRD patients on maintenance HD in the Sharkia governorate is 442 per million populations (pmp). The etiology of the studied ESRD patients: hypertension (30.1%), undetermined etiology (19.5%), diabetes mellitus (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), analgesic nephropathy (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), and gout (1.1%). Of the studied ESRD patients, 44.7% had positive antibodies for hepatitis C virus (+ve) and patients with hepatitis B virus surface antigen (+ve) were 2.2%.
Conclusion
The total prevalence of ESRD patients on maintenance HD in 2017 in Sharkia governorate, Egypt is 442 per million populations (0.0442%). The highest proportion of patients with ESRD was between 50 and 59 years (30.8%). Most of the ESRD patients were from the rural area (60.4%).

Keywords: chronic kidney disease, Egypt, end-stage renal disease, hemodialysis, prevalence


How to cite this article:
Ahmed HA, Zahran AM, Issawi RA. Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis. Menoufia Med J 2020;33:766-71

How to cite this URL:
Ahmed HA, Zahran AM, Issawi RA. Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis. Menoufia Med J [serial online] 2020 [cited 2020 Oct 29];33:766-71. Available from: http://www.mmj.eg.net/text.asp?2020/33/3/766/296684




  Introduction Top


End-stage renal disease (ESRD) has many causes that vary from one patient to another. The key risk factors for chronic kidney disease (CKD) are the increasing age of the population, diabetes mellitus (DM), hypertension (HTN), and medications, such as the use of analgesics regularly over long durations of time resulting in analgesic nephropathy and kidney damage. Polycystic kidney disease is an example of a hereditary cause of CKD [1]. Some studies suggest that tobacco use is positively associated with CKD [2]. Alcohol has been linked as a cause of kidney disorders in some clinical and experimental studies [3]. In many Arab countries, obstructive uropathy constitutes a major cause of ESRD (40%). The two most common underlying causes are renal calculi and schistosomiasis [4].

The main causes of ESRD in Egypt, other than diabetic nephropathy (DN), included HTN, chronic glomerulonephritis, unknown etiology, chronic pyelonephritis, schistosomal obstructive uropathy, and schistosomal nephropathy [5]. Currently, hemodialysis (HD) represents the main mode for the treatment of chronic kidney disease stage 5 (CKD-5). The health-care service in the HD facility extends to include infection control, patients' data recording, and other medical services [6]. Kidney disease is the ninth leading cause of death in the USA. Every year, kidney disease kills more people than breast or prostate cancer; in 2013, more than 47 000 Americans died from kidney disease [7].

Worldwide, the prevalence of ESRD differs greatly. In Europe, the prevalence has increased from 760 per million populations (pmp) in 2004 to 889 pmp in 2008 [8]. In 2013, there were 661 648 prevalent cases of ESRD in the USA. The ESRD prevalence reached 1981 pmp [9]. The prevalence in Taiwan was 2447 pmp, in Japan 2205 pmp, and in Philippines was 110 pmp [10]. In Egypt, the prevalence of ESRD in 2004 was 483 pmp [5].

The aim of this study is to study the prevalence and etiology of ESRD patients on maintenance HD in governmental HD units in Hospital of El-Sharkia governorate, Egypt.


  Patients and Methods Top


This descriptive study was conducted in Sharkia governorate in Egypt on patients with ESRD on maintenance HD in 21 HD units in central governmental hospitals. Adult patients had been selected from the dialysis units in the different cities and centers of Sharkia governorate central governmental hospitals. The study was done during the period from February 2017 to November 2017. According to Sharkia Health Directorate the total population of Sharkia governorate is about 7 163 824 (year 2017); out of them 2186 adult patients had ESRD on maintenance HD in central governmental HD units, 180 ESRD adult patients in insurance authority hospitals, 102 ESRD adult patients in university hospital, 85 ESRD adult patients in educational authority hospital, and 614 ESRD adult patients on maintenance HD in private HD units.

Selected patients' criteria: adult ESRD patients on maintenance HD for more than or equal to 3 months. Exclusion criteria: patients with acute renal failure, stages 1–4 CKD patients on conservative treatment, ESRD patients on maintenance HD in nongovernorate centers and patients who are not residents in the El-Sharkia governorate. All selected patients were subjected to a predesigned questionnaire that included the following data: personal and sociodemographic data, medical history, HD history, investigations [hemoglobin, antibodies for hepatitis C virus (HCV Ab), hepatitis B virus surface antigen, random blood glucose]; further investigation for diabetic patients (glycated hemoglobin), serum albumin, serum urea, serum creatinine, and pelviabdominal ultrasonography. Informed consent from patients was taken as well as permission from the ethics committee of Sharkia Health Directorate. The diagnosis of the etiology of ESRD was made according to each disease documented criteria.

The collected data were computerized and statistically analyzed using the Statistical Package for the Social Sciences (SPSS) program, version 18.0. (SPSS Incorporated, Chicago, Illinois, USA). Quantitative (numerical) variable data were statistically described as mean ± SD and qualitative (categorical) variables were statistically described as percentage.


  Results Top


The total population of Sharkia Governorate (year 2017) is 7 163 824. Of the patients 0.0442% (3167 patients) had ESRD on maintenance HD. The prevalence of ESRD patients on maintenance HD in Sharkia governorate is 442 pmp [Figure 1].
Figure 1: Prevalence of ESRD patients on maintenance HD in Sharkia governorate (year 2017). ESRD, end-stage renal disease; HD, hemodialysis.

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Two thousand one hundred and eighty-six of Sharkia governorate populations have ESRD on maintenance HD in Sharkia governorate central governmental hospitals, 180 ESRD patients in insurance authority hospitals, 102 ESRD patients in university hospital, 85 ESRD patients in educational authority hospital, and 614 ESRD patients on maintenance HD in private HD units [Figure 2].
Figure 2: Distribution of ESRD patients (3167) on maintenance HD between different types of hospitals in Sharkia governorate (year 2017). ESRD, end-stage renal disease; HD, hemodialysis.

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The highest percentage of the studied ESRD patients (n = 2186) on maintenance HD in Sharkia governorate central governmental hospitals is found in Alhusienia (10.2%), followed by Hehia (8.6%), Abu Kabir (8.4%), Deyarb Negm (7.9%), and Belbeis (6.3%). On the other hand, Alsaleheyah, Zagazig Alhomyat (Fever hospital), Alsofya, and Tal Rak demonstrated the lowest percent (1.9, 1.9, 1.8, and 1.8%) [Figure 3].
Figure 3: Distribution of studied ESRD patients (n = 2186) in Sharkia governorate central governmental hospitals (year 2017). ESRD, end-stage renal disease.

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The sociodemographic characteristics of the studied ESRD patients are tabulated in [Table 1]; the mean age is 52.69 ± 11.71, most of the studied ESRD patients in Sharkia governorate central governmental hospitals are above 50 years old. The highest proportion of them is in the age group between 50 and 59 years (30.8%). Most of the ESRD patients were from rural areas (60.4%). The male sex represents the highest percentage (54.8%); 88.6% of the studied ESRD patients are married; 37.1% are uneducated; 47.5% are unemployed, 68.3% have low income, 75.8% are independent, and 72.5% are nonsmokers.
Table 1: Sociodemographic data of the studied end-stage renal disease patients (n=2186) in Sharkia governorate central governmental hospitals (year 2017)

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The main known cause of ESRD in the studied ESRD patients (n = 2186) in Sharkia governorate central governmental hospitals (year 2017) is HTN (30.1%), followed by DM (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), analgesic nephropathy (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), gout (1.1%), and 19.5% of the patients were with ESRD on maintenance HD with unknown etiology [Table 2] and [Figure 4].
Table 2: Etiology of end-stage renal disease in the studied end-stage renal disease patients (n=2186) in Sharkia governorate central governmental hospitals (year 2017)

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Figure 4: Etiology of ESRD in the studied ESRD patients (n = 2186) in Sharkia governorate central governmental hospitals (year 2017). ESRD, end-stage renal disease.

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Of the studied ESRD patients, 83.8% take 4 h in the HD session; 99% of the studied ESRD patients have three HD sessions per week; and 94% of the studied ESRD patients have arteriovenous fistula. The most used dialyzer surface area for the studied patients is 1.3 m 2 (41.72%) [Table 3]; 978 (44.7%) of the studied ESRD patients were HCV Ab + ve and 47 patients with hepatitis B virus surface antigen + ve (2.2%).
Table 3: Dialysis history of the studied end-stage renal disease patients (n=2186) in Sharkia governorate central governmental hospitals (year 2017)

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  Discussion Top


Köttgen [11] reported that several countries have observation programmers to monitor kidney failure treated by dialysis and transplantation. Incidence and prevalence vary because of the differences in the underlying disease rates and availability of government-sponsored treatment. Eckardt [12] reported that the incidence of ESRD requiring renal replacement therapy is steadily increasing and poses a massive burden on health-care budget even in developed countries.

In this study, the prevalence of ESRD patients on regular HD in Sharkia governmental HD units is 442 pmp (0.0442%).

The prevalence of ESRD in Egypt varies from one governorate to another. El Minshawy [13] reported that in the El-Minia governorate the prevalence was 308 pmp. Hassan et al. [14] reported that in Sohag governorate the prevalence was 316 pmp. Boshra et al. [15] reported that in Assiut governorate it was 366 pmp; El-Zorkany [16] reported that in Menoufia governorate the prevalence was 483 pmp; and Hamouda [17] reported that in Beheira the prevalence of ESRD patients on regular HD in the governmental HD units was 390 pmp.

Saran et al. [18] reported that the prevalence of ESRD differs greatly worldwide. The highest prevalence was found in Taiwan with 3317 pmp, followed by 2529 pmp in Japan and the lowest prevalence was 119–211 pmp in Bangladesh. In the USA, the prevalence was 2138 pmp. Pippias et al. [19] reported that the prevalence in Europe was 889 pmp.

These higher values in ESRD prevalence in some countries could result from not only an increasing number of incident cases, but also longer survival between ESRD patients because the prevalence shows both the incidence and course of the illness. Low prevalence values could result from lack of registration and documentation programs for ESRD patients and also due to the short life expectancy for these patients.

In our study, the mean age of the studied patients is 52.69 ± 11.71 years. Hamouda [17] reported that in Beheira the mean age was 52.53 ± 16.46 years. El-Zorkany [16] reported that in Menoufia the mean age was 53.18 ± 13.26 years.

Collins et al. [9] reported that the mean age in USA was 59.2 years. Pippias et al. [19] reported that the mean age in Europe was 60.3 years.

In our study, the percentage of patients with ESRD has increased with age, particularly after 50 years of age, the highest proportion of patients with ESRD is in the age group of 50–59 years (30.8%), followed by the age group of 60–69 years (24.7%). El-Zorkany [16] reported that in Menoufia governorate, the highest proportion of patients (36.6%) was aged between 50 and 60 years. Saran et al. [18] reported that in USA the highest percentage of patients with ESRD was in the age group of 45–64 years (44%), followed by the age group of 65–74 years (23.8%).

The decline in percentage in patients with ESRD above 69 years of age could be due to the high mortality rate among these oldest ESRD patients.

In the present study, the main known cause of ESRD is HTN (30.1%), followed by DN (17.6%). This result is similar to that reported a number of governorates in Egypt. El-Zorkany [16] reported that in Menoufia the main known cause of ESRD was HTN (33.4%), followed by DN (9.2%). Hamouda [17] reported that in Beheira the main known cause of ESRD was HTN (27.8%), followed by DN (20.1%). El Minshawy [13] reported that in Cairo the main cause of ESRD was HTN with 29.7%, followed by DN 12.5%; in Canal governorates HTN was the main cause of ESRD (27.3%) followed by DN (10.7%) and in El-Minia governorate the main cause was also HTN (20%), followed by DN (8%).

Consistent with the result of the current study, Naicker [20] reported that HTN is a leading cause of CKD in sub-Saharan Africa, ranging from 25% in Senegal to 29.8% in Nigeria, 45.6% in South Africa, and 48.7% in Ghana, especially within the black patients.

The findings of the current study are also consistent with results from other Arab countries. Banaga et al. [21] reported that in Khartoum State, Sudan the most common cause of ESRD was HTN (34.6%), followed by chronic glomerulonephritis (17.6%), DM (12.8%), obstructive uropathy (9.6%), autosomal dominant polycystic kidney disease (4.7%), chronic pyelonephritis (4.6%), analgesic nephropathy (3.5%), and 10.7% were with unknown cause. Moukeh et al. [22] reported that in Aleppo, Syria HTN represented the main cause of ESRD (21.5%), followed by chronic glomerulonephritis (20.5%) and DN as a cause of ESRD was found to be 19.5% and counts the third cause.

In contrast to the current result, Hassanien et al. [23] reported that in the Gulf Cooperation Council countries it has been found that the leading cause of ESKD was DN (17%), followed by glomerulonephritis (13%) and HTN (8%). Yao et al. [24] reported that the incidence of DM in China was 17.2% and counts the second cause of ESRD after chronic glomerulonephritis. Kramer et al. [25] reported that the most common identifiable cause of ESKD in European countries was glomerulonephritis (20.4%), followed by diabetes (15.6%), etiology uncertain (14.6%), and HTN (10.7%). Saran et al. [18] reported that in USA diabetes was reported as the main cause of ESRD with 38.2%, followed with HTN (25.5%).

In this study, undetermined etiology constitutes19.5% of all causes of ESRD. Hamouda [17] reported that in Beheira undetermined etiology was estimated to be 24.2% of all causes of ESRD. El Minshawy [13] reported that in El-Minia governorate undetermined etiology was 27% and 18.1% in Cairo governorate. In earlier registry by Afifi [5] in Egypt the undetermined etiology was estimated to be 15.2%. Malekmakan et al. [26] reported that in Iran uncertain etiology of ESRD was 14.4%; Shigidi et al. [27] reported that in Qatar it was 14%, and Saran et al. [18] reported that in USA uncertain causes represent 16.8%.

In this study, a remarkable percentage of patients discovered their kidney deterioration just when they must endure on HD without benefit of prior nephrology care. This reflects the lack of awareness in patients about the proper time of request a medical counsel and also lack of awareness among the physicians of primary health care about early detection of CKD in its early stages especially for patients at high risk of deterioration in renal function.

In this study, the prevalence of HCV in the studied patients was found to be 44.7%. Hamouda [17] reported that in Beheira governorate, the prevalence of HCV in the ESRD patients was found to be 38.1% and El-Zorkany [16] reported that in Menoufia the prevalence of HCV in the ESRD patients was found to be 36.8%. The prevalence of HCV in dialysis patients showed wide variations worldwide. Afifi [5] reported that in Egypt it was 52.1%, Moukeh et al. [22] reported that in Aleppo, Syria it was 54.4%, Nakai et al. [28] reported that in Japan it was 9.83%, and Sesso et al. [29] reported that it was 5.8% in Brazil.

The high prevalence of HCV in our study may be attributed to the high prevalence of HCV in the general population of the governorate.


  Conclusion Top


The prevalence of ESRD patients on maintenance HD in El-Sharkia governorate, Egypt is 442 pmp (0.0442%) in 2017. The highest proportion of patients with ESRD was in the age group of between 50 and 59 years (30.8%). Most of the ESRD patients were from rural areas (60.4%).

The main etiologies of ESRD are HTN (30.1%), followed by undetermined etiology (19.5%), DM (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), drugs (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), and gout (1.1%).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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



 

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