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Saudi Journal of Kidney Diseases and Transplantation
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COUNTRY REPORT Table of Contents   
Year : 1998  |  Volume : 9  |  Issue : 1  |  Page : 36-39
Renal Replacement Therapy in Qatar


Hamad General Hospital, Doha, Qatar

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How to cite this article:
Rashid A, Abboud O, Taha M, El-Sayed M. Renal Replacement Therapy in Qatar. Saudi J Kidney Dis Transpl 1998;9:36-9

How to cite this URL:
Rashid A, Abboud O, Taha M, El-Sayed M. Renal Replacement Therapy in Qatar. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2019 Dec 10];9:36-9. Available from: http://www.sjkdt.org/text.asp?1998/9/1/36/39300

   Introduction Top


Chronic renal failure patients, reaching end­stage (ESRF) are not able to preserve homeostasis, and supportive treatment by dialysis or transplantation is needed to maintain life.

Qatar is a country with a population of 600,000 and an area of 11,200 square kilometers. On average, 73 new patients present every year with ESRF, giving an estimated incidence of 122 cases per million populations per year.

Hemodialysis (HD) was initiated in 1981 at Rumailah Hospital, shifted in 1987 to the Dialysis Unit established at Hamad General Hospital. Hemodialysis continued to be the most commonly used renal replacement therapy. Hemodialysis sessions increased from 4044 in the year 1985 to 23,142 in 1996. HD is offered free of cost for all eligible patients. The selection criteria were expanded to accommodate the increasing age and associated diseases in patients accepted for dialysis.

The first renal transplant in Qatar was performed in 1986, and despite the adequacy of transplantation facilities, the progress in the field of local organ transplantation remained very slow. We do not encourage live unrelated renal transplantation.


   Etiology of ESRF Top


The causes of ESRF listed in [Table - 1] are based on clinical evidence and histological diagnosis by renal biopsy, which became more feasible in the recent years. Chronic glomerulonephritis accounts for 33.7% of the cases, the proportion of diabetic nephropathy is increasing to form 26.1% of the total patients. We grouped reflux nephropathy, drug induced and obstructive nephropathy under chronic interstitial nephritis that constitutes 9.3% of the causes of ESRF.


   Dialysis Modalities Top


Hemodialysis started in 1981 by 4 dialysis machines, expanded to 42 machines at one dialysis center occupying a separate building on campus of Hamad General Hospital, Doha. Dialysis facilities include maintenance hemodialysis for regular chronic patients and acute dialysis, usually at the Intensive Care and Coronary Care Units. Continuous arteriovenous (CAVH), Veno-venous (CWH), hemofiltration, peritoneal cycler dialysis and continuous ambulatory peritoneal Dialysis (CAPD), in addition to plasmapharesis, are all available in service.

Currently, 187 patients receive regular maintenance hemodialysis, 85 female and 102 male patients. The mean age is increasing, 70 patients (37.4%) are older than 55 years.

The average time on hemodialysis is 11.4 hours per week. All patients are on bicarbonate bath supplied by our pharmacy in powder form and prepared locally at the dialysis unit. Hollow-fiber dialyzers made of cuprophane and polysulphone membranes are in use. Chemical monitoring, microbial monitoring and careful periodic disinfection are routine in our system. Only five patients are on CAPD with Y shape connecting system.

Full biochemical profile is requested for every patient once a month on regular basis and whenever needed. Hepatitis B and C antibodies are checked every three months, and HIV antibodies are checked every six months. A skeletal x-ray survey as well as serum parathormone (PTH) and aluminium levels are measured yearly for every patient, similar to the standard of care at neighbor countries [1],[2] . Most patients are prescribed calcium carbonate, pulse dosage of Vit. D 1-2 ug post dialysis 3 times/week [3] . Seventy percent of our patients are on recombinant human erythropoitein (rhuEPO) combined with intravenous iron sacharate, which decrease the need for blood transfusion to the minimum. We reported successful pregnancy in ladies on dialysis. The improved hemoglobin level and quality of therapy helped the better outcome of pregnancies in them [4] .

Periodic assessment and interview by dietitian to adjust the calorie protein intake, helps patient restoring adequate nutrition [5] .

Acute hemodialysis is performed using subclavian or femoral vein double-lumen catheters. The most commonly used long term vascular access is arterio-venous fistula (86.9%), Gortex grafts (7.6%) and internal jugular permanent catheter (5.3%). We found the use of local injections of tissue plasminogen activator (tPA) to be very useful for restoring the patency of blocked fistulas and catheters without complications. Access failure forms an obstacle to the continuity of treatment [6] . Over the last few years, 74 cases (39.5%) of the fistulas failed for reasons such as clotting, stenosis and distal ischemia. Fifty patients (67.5%) were older than 40 years, while 24 (32.4%) were of younger age group. A significant correlation with the duration on dialysis was noticed. There was no correlation between access failure and the presence of diabetes mellitus.

Due to increasing number of patients presently accepted on dialysis program, adverse effects of age and multi-organ involvement add to morbidity [7] . The causes of death in dialysis patients are listed in [Table - 3].


   Hepatitis in Dialysis Patients Top


Five patients (2%) are HBsAg positive and are dialyzed in a separate room. Seronegative patients receive a recombinant hepatitis vaccine 40 fig in three doses scheduled at 0, 1, and 6 months. All sero-negative dialysis staff are vaccinated using 20 µg standard vaccine.

Hepatitis C antibody, tested by a second generation recombinant immuno-sorbant assay (RIBA), was positive in 44.6% of our patients. A significant correlation was found with duration on dialysis; 54.3% months in the sero­positive compared to 22.2 months in the sero­negative group. Histological study of liver biopsy in eight patients with hepatitis C revealed chronic hepatitis. Such patients, in addition to those with positive PCR, receive Interferon before they undergo renal transplantation [8] .

There is a considerable practical difficulty to isolate the anti-HCV positive cases because of their large number. Proper sterilization, better aseptic technique and universal precautions have reduced the incidence of seroconversion.


   Renal Transplantation Top


A total of 27 renal transplant operations were performed at Hamad General Hospital. 22 live related and five cadavers; live unrelated renal transplants are not permitted. Our transplant program was initiated early in 1986 It, however, progressed very slowly over the years because of lack of suitable donors and shortage of cadaver grafts. Fifteen out of the 27 transplant are stable with normal function grafts, four have chronic rejections, three died and five returned to dialysis. The Ministry of Health fully finances the live related transplantation performed for Qatari patients in Europe and USA.

At present, 120 patients (mean age 40.5 years) are on active regular follow-up at our out-patient transplant clinic, 72 males and 48 females. Fifty patients received live related, 17 cadaver and 53 live unrelated grafts. Eighty two percent of the transplant patients receive triple immunosuppressive therapy. Azathioprine was discontinued in some patients because of the abnormal rise in liver enzymes, and was replaced by mycophenolate mofitel in four patients. Review of medical records showed that myocardial infarction was the most common cause of death, followed by septicemia, liver failure and cerebrovascular accidents.


   Comments Top


Chronic renal failure is a continuous process that begins when some nephrons are lost and ends by ESRF when the remnant nephron population can no longer sustain life. The incidence of ESRF in Qatar is relatively high, similar to other countries in the region.

Although the specific cause of ESRF has little influence on the indication and management of maintenance dialysis, perhaps a better control of the original disease helps delaying the progress of renal failure. Diabetes mellitus, a common disorder in the Gulf area represent an important example. Diabetic patients need careful follow-up and better care [9] . Furthermore, family counseling may reduce the hereditary renal disorders.

Our dialysis program is relatively satisfactory. Accepting elderly patients with multiple organ disease aggravates the consequences of uremia resulting in extra morbidity and mortality. We found that starting dialysis early before the appearance of uremic complications achieves a better quality of life and socio-professional rehabilitation. We also found that using bicarbonate bath provides a more physiologic correction of acidosis and avoids complications of acetate. In addition, use of r­huEPO dramatically improved quality of life.

To avoid A-V fistula failures, we found that initial assessment by doppler and angiography study was beneficial prior to the initial surgical procedure.

At present, there are two new satellite dialysis units under construction at the North and South parts of the country, to accommodate patients living in their vicinity. We plan, as well, to support more CAPD as a modality of home dialysis.

Reactivation of our transplant program is essential. This should include encouraging the physicians in-charge of intensive care areas to report cadaver cases to the brain death committee. As well, more efforts and proper information are needed to overcome the socio­-economic reasons of low donation.

 
   References Top

1.Yassin IE, Shakuntala V, Zahir BM, etal. Treatment of end-stage renal failure in Abu Dhabi, United Arab Emirates. Saudi J Kidney Dis Transplant 1994 ;5 (3): 3 84-95.  Back to cited text no. 1    
2.El-Reshaid K, Johny KV, Sugathan TO, Hakim A, Georgous M, Nampoory MR. End-stage renal disease and renal replacement therapyin Kuwait-epider­niological profile over the past 4 1/2 years. Nephrol Dial Transplant1994;9:532-8.  Back to cited text no. 2    
3.Malluche HH, Faugere MC. Renal bone disease 1990: an unmet challenge for the Nephrologist. Kidney Int 1990;38:193­-211.  Back to cited text no. 3    
4.Patel M, Saleh AR, Awad R, et al. Successfulpregnancy in a patient on long term hemodialysis. Arm Saudi Med 1990;10(3):328-29.  Back to cited text no. 4    
5.Slomowitz LA, Monteon FJ, Crosvenor M,Laidlaw SA, Kopple JD. Effect of energyintake on nutritional status in maintenance hemodialysis patients. Kidney Int 1989;35:704-11.  Back to cited text no. 5    
6.Palder SB, Kirkman RL, Whittemore AD, Hakim RM, Lazarus JM, Tilney NL. Vascularaccess for hemodialysis. Patency rates and results of revision. Ann Surg 1985;202:235-9.  Back to cited text no. 6    
7.Awad R, Saleh AR. Hemodialysis in the elderly. Saudi J Kidney Dis Transplant 1992;3.  Back to cited text no. 7    
8.Abboud O, Rashid A, Al-kaabi S. Hepatitis C Virus infection in hemodialysis patients in Qatar. Saudi J Kidney Dis Transplant 1995;6(2):151-3.  Back to cited text no. 8    
9.Hawthorne VM. Consensus statement: International workshop on preventing the kidney disease of diabetes mellitus. Am JKidney Dis 1989;8(l):l-6.  Back to cited text no. 9    

Top
Correspondence Address:
Omar Abboud
Hamad General Hospital, P.O. Box 3050, Doha
Qatar
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PMID: 18408281

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    Introduction
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    Dialysis Modalities
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