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| Year : 1997 | Volume
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| Issue : 2 | Page : 152-154 |
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| Renal Replacement Therapy in Egypt |
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Rashad Barsoum
Department of Nephrology, The Cairo Kidney Center, Cairo, Egypt
Click here for correspondence address and email
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How to cite this article:
Barsoum R. Renal Replacement Therapy in Egypt. Saudi J Kidney Dis Transpl 1997;8:152-4 |
 Introduction | |  |
Egypt is a large country with an area of one million square kilometers and is heavily populated (60 million inhabitants). It has many of the socio-economic problems as in any developing country, including low income per capita, and poor public health services.
In addition, debate has not settled yet in this country about benefiting from the cadaver organ donors, which would have major impact on the future renal replacement therapy. It is difficult to give an exact incidence of renal failure in Egypt, however, 200 new cases/million inhabitants/ year is a reasonable estimate, based on analysis of mortalities according to official statistical reports.
The causes of renal failure are similar to what is reported from other countries [1],[2],[3],[4],[5],[6],[7] , including chronic glomerulonephritis, hypertension, diabetes etc. Uniquely, the most common cause in this country is the urinary tract obstruction and glomerulonephritis related to schistosomiasis, especially for inhabitants in the suburban areas close to the banks of the river nile.
Also, partial sponsoring of hemodialysis in the private sector by the government, in addition to full sponsorship of the public sector, is another unique aspect of renal replacement therapy in Egypt.
| Dialysis Service in Egypt | | |
Hemodialysis started earlier than peritoneal dialysis in Egypt. The first hemodialysis was performed in Ain Shams University hospital in 1958, while the first intermittent peritoneal dialysis (IPD) was performed at the Cairo University Hospital in 1963. When continuous ambulatory peritoneal dialysis (CAPD) started to become popular, the doctors of Al-Salam Hospital in Cairo introduced this procedure in 1982, as a method for renal replacement therapy.
Currently, there are more than 300 active hemodialysis centers with more than 2000 hemodialysis machines, and more than 10,000 hemodialysis patients. Peritoneal dialysis has not expanded as expected in Egypt, so there are only three CAPD centers in the country with very few patients on CAPD and less than 100 patients on IPD. This may be due to the abundant and wide availability of hemodialysis in this country.
Hemodialysis patients in Egypt receive on the average 10 hours of dialysis time per patient per week and the arteriovenous fistula is the most common vascular access for treatment. However, less than 10% of them are on bicarbonate dialysate and approximately 10% are on erythropoietin therapy for their anemia.
Currently, there is a high percentage, (approximately 75%), of patients on hemodialysis who have positive anti-hepatitis C antibodies. On the other hand, the percentage of hemodialysis patients, who have hepatitis-B surface antigenemia is not more than 5%. These figures are comparable to those in the neighboring countries.
The patients on CAPD use the Y-shape connecting tubing. However, due to the very small number of patients treated by this method of therapy in this country, the figures of morbidity and mortality may not be meaningful.
The mortality of hemodialysis patients in Egypt is approximately 25-30% annually. Ischemic heart disease and infection are the leading causes of death among this population.
| Renal Transplantation in Egypt | | |
The first renal transplant was performed at Al-Mansoura University Hospital in 1976. It was a living related renal transplant. Currently, there are 12 renal transplant centers in this country. There have been more than 1500 renal transplants from living related donor since 1976 up till now. Only four renal transplants have been performed from executed criminals. This has created an overwhelming public debate and was abandoned.
In the early days, while the magnitude of the problem was still vague, living unrelated donors were accepted for humane reasons. However, this practice rapidly expanded until more than 3000 renal transplant of this type have been performed, a clear commercial trend. At present, living non-related renal transplantation has decreased tremendously, thanks to the ban imposed by the Egyptian Society of Nephrology and due to the increased awareness of the ethical and medical complications related to commercial transplantation.
Debate continues among the leaders of religion and medical community in Egypt about using the cadaver donors as a source for renal transplantation. A legislation may come up soon but may not be in favor of benefiting of cadaver donors.
Some of the Egyptians, who had renal failure while residing outside Egypt, got transplantation abroad. There are approximately 100 of such patients being followed up in this country.
Cyclosporine, azathioprine and prednisolone are used in Egypt in inducing and maintaining immunosuppression in the renal transplant patients in various combinations. There is a 10% mortality of renal transplant patients annually, and the most common cause of mortality in them is still infection.
| A Prospective | | |
The expanding population on dialysis therapy in Egypt will affect soon the quality of the renal replacement therapy rendered to them. At present, using the cadaver donors as a source for renal transplant and passing a legislation in favor of it, is a remaining hope to control the pool of the patients with end stage renal failure in Egypt.
| References | | |
| 1. | Akinsola W, Odesanmi WO, Ogunniyi JO, Ladipo GO. Diseases causing chronic renal failure in Nigerians a prospective study of 100 cases. Afr J Med Med Sci 1989;18(2): 131-7.  |
| 2. | Simon P, Ang KS, Cam G, Ramee MP. Epidemiology of chronic renal insufficiency treated by dialysis in a region in France. Changes in a 12- year period. Pressc Med 1988;17(42):2225-8. |
| 3. | Bang BK. Multicenter report on dialysis and transplantation in Korea, 1986. Korean Society of Nephrology. J Korean Med Sci 1988;3:135-41. |
| 4. | Osman EM, Abboud OI, Danielson BG. Chronic renal failure in Khartoum, Sudan. Ups J Med Sci 1987;92(1):65-73. |
| 5. | Stewart JH, McCredie M, Disney AP, Mathew TH. Trends in incidence of endstage renal failure in Australia, 1972-1991. Nephrol Diai Transplant 1994;9(10):1377-82. |
| 6. | El-Reshaid K, Johny KV, Sugathan TN, Hakim A, Georgous M, Nampoory MR. End-stage renal disease and renal replacement therapy in Kuwait, epidemiology profile over the past 4 1/2 years. Nephrol Dial Transplant 1994;9(5):532-8. |
| 7. | Woo KT. The Singapore Renal Registry: an overview. Singapore Med J 1993;34(2):157-63. |
Correspondence Address:
Rashad Barsoum
Chief of Nephrology, The Cairo Kidney Center, P.O. Box 91, Bab El Louk, Cairo
Egypt
PMID: 18417795
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