| Abstract|| |
Two hundred and thirteen patients who were already on hemodialysis (HD) at other locations visited Al-Madina Al-Munawarah, Saudi Arabia, during the year 1996. These patients were accepted for temporary HD at the King Fahad hospital during their stay in the city. Only 29 (13.6%) patients had detailed medical reports with them. Forty-one (19.2%) patients had full serology reports with them. Those coming from within Saudi Arabia were comparable to those from other countries. Hemodialysis per se should not deter patients from leading as normal a life as possible, including visiting places for leisure or religious purposes. Full cooperation and communication between HD units would give appropriate and timesaving services to those patients at place of visit and would limit possible problems.
Keywords: Hemodialysis, Visitors, Co-operation, Nephrologists.
|How to cite this article:|
Mohamed AO, Sirwal IA, Bernieh B, Ahmed M. Patients on Hemodialysis Visiting Madina Munawarah: Communication Between Nephrologists. Saudi J Kidney Dis Transpl 2000;11:31-4
|How to cite this URL:|
Mohamed AO, Sirwal IA, Bernieh B, Ahmed M. Patients on Hemodialysis Visiting Madina Munawarah: Communication Between Nephrologists. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2013 May 24];11:31-4. Available from: http://www.sjkdt.org/text.asp?2000/11/1/31/36689
| Introduction|| |
The number of patients on renal replacement therapy, particularly hemodialysis (HD), is increasing in the Kingdom of Saudi Arabia (KSA) as well as in other countries. , Their awareness of the health care facilities given to them in the Holy Places further encourages many patients to travel for Omra and for visiting the prophet Mohammed's mosque at the Holy City of Al-Madina Al-Munawarah in Saudi Arabia.
We had already highlighted some of the problems faced by our unit in handling such visitors during Hajj season, , and we had suggested some recommendations. Our recommendations included the importance of communication between the nephrolgosits in charge of these visitors and the dialysis unit at the visited holy city.
In the present study, we prospectively evaluated these visitors with regard to the level of communication between nephrologists inside and outside KSA and our unit.
| Materials and Methods|| |
We conducted the study between January 1 st to December 31 st of 1996. Data of the study were collected via a pre-set form, which was filled for any patient who was already on HD at another dialysis center and referred for therapy during his/her visit to Al-Madina Al-Munawarah. The form included the following: the patient's identification data, whether prior communication by any means was attempted between the referring center and our unit before the arrival of the patient, and whether the patient carried a medical report with relevant information regarding the hemodialysis prescription and problems related to dialysis.
We paid particular attention to the presence or absence of the hepatitis serology and HIV status in the patient's report. Patients diagnosed for the first time and dialyzed during the visit were excluded from the study.
| Results|| |
Two hundred and thirteen patients who were already on hemodialysis (HD) at their place of living visited the Holy City of Al-Madina Al-Munawarah, Saudi Arabia during the year 1996. These patients were accepted for HD at the King Fahad hospital during their stay in the city. There were 143 (67.1%) males and 70 (32.9%) females. The study patients' age-range was between 16 to 86 years (mean 47 ± 13.2). Of them, 133 (62.4%) were from countries bordering KSA; and 83 (62%) of these were from Egypt. Furthermore, 22 (10.3%) patients were referred from inside KSA.
The referring centers pre-communicated with ours before the arrival of the patient in only four (1.9%) patients; two of them by the treating nephrologist. A report, which mentioned the medical and surgical problems were available on only ten (4.7%) of the referred patients Medical report including details of the patients physical examination was available on only three (1.4%) patients.
Fifty-nine (27.7%) patients were carrying dialysis prescription that included the type of machine, hours of dialysis, loading and maintenance dose of heparin, dry weight and interdialysis weight gain, the blood flow rate, filtration rate and whether the patient received erythropoietin.
At the time of their arrival, hepatitis B, C, and HIV status was available on 41 (19.2%) of the referred patients. Hepatitis B and C serological test results without HIV were available on 16 (7.5%) patients and hepatitis B alone on 13 (6.1%) patients.
There were no pre-communication on any of the 22 patients who were referred to our center from within the KSA. Ten (45.5%) of these patients carried full serological reports on hepatitis B, C, and HIV status, four (18.2%) on hepatitis B and C without HIV status, one (4.5%) on only hepatitis B, while seven (31.8%) patients did not carry any serological report. Dialysis prescription was available on 10 (45.5%) patients from inside KSA [Table - 1].
The visitors were dialyzed for a total of 1578.5 hours, which was equal to about 2% of the dialysis time in our center that year. Thirty-six (16.9%) patients had severe hyperkalemia (K > 6.5 mmol/L) at the time of presentation and needed urgent dialysis on arrival. Twenty-five (11.7%) patients had vascular access problems and needed temporary access for dialysis. Nine (4.2%) patients had hemoglobin level of less than 70 g/l and needed blood transfusion.
Fourteen (6.6%) patients were admitted to the hospital for different medical reasons including cardio-respiratory arrest, severe uncontrolled hypertension or severe diabetes. Three (1.4%) patients died in hospital [Table - 2].
| Discussion|| |
The two hundred and thirteen visitors do not represent all the visitors to our unit during the year 1996. They were only those who had been on established chronic hemodialysis. Other visitors were diagnosed for the first time in our unit, on peritoneal dialysis or had renal transplants. We noted that the male to female ratio was two to one and the reasons of this preponderance are not clear. A high percentage of patients were from neighboring countries.
Although there was a small number of patients referred for dialysis from inside KSA, pre-communication, which would save time for these patients and allow a more organized service, was absent in those from within the Kingdom. At this era, when communication facilities are easily available (phone, fax, letter etc), this failure could only be explained by the lack of awareness of the referring physicians of its importance for the patient and the receiving dialysis center.
Full medical report including dialysis information was available on a small percentage of patients. This information, which all Nephrologists would agree on is vital for optimal therapy, was missing in the majority of patients. A traveling dialysis patient should be instructed to contact his doctor for a full medical report and dialysis information, as this would help to assure better management at the receiving center.
Hepatitis C represents one of the major problems in the dialysis population inside and outside the KSA. ,, Service to visitors without available result of serology test of hepatitis C is either delayed until the status is known or are dialyzed on a machine, which is later disinfected depending on the patient's condition. The hepatitis serology status of visiting patients is crucial for limiting transmission of this infection from areas of high prevalence to areas of low prevalence. Only 19.2% of the study patients and 45.5% of those from inside KSA carried full serology report.
At our unit 2% of dialysis time was expended on the visiting patients. However, considerable time was spent on getting history, physical examination, investigations and performing procedures. Thus, the real time spent on these visitors, especially those without medical, dialysis and hepatitisserology information, was much more than 2%. Much help could be done to our unit by prior communication and provision of necessary data. We believe that this is also true regarding units in Makkah and other areas receiving many visitors.
Finally, the incidence of hospitalization for different reasons and mortality was not significantly different from that seen in our regular HD patients.
We conclude that since hemodialysis alone is not a deterrent for a patient to lead as normal a life as possible, including visiting places for leisure or religious purposes, prior medical communication is essential. Full medical reports and dialysis prescriptions should be available for the receiving dialysis center, if appropriate and time saving service is to be offered to the travelling patients.
| References|| |
|1.||Mitwalli AH, Al-Swailem AR, Aziz KMS, et al. The incidence of end-stage renal disease in two regions of Kingdom of Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6(3):280-5. |
|2.||Barsoum R. Renal replacement therapy in Egypt. Saudi J Kidney Dis Transplant 1997;8(2):152-4. |
|3.||Mohamed AO, Abbas EA, Altabakh AA, Abdelgadir AI. Renal problems of pilgrims attending Hajj. Saudi Kidney Dis and Transplant Bull 1991;2(1):12-16. |
|4.||Bernieh B, Sirwal IA, Mohamed AO, et al. Nephrological problems in Hajj. Saudi J Kidney Dis Transplant 1996;7(2):S590-4. |
|5.||Bernieh B, Allam M, Halepota A, et al. Prevalence of hepatitis C virus antibodies in hemodialysis patients in Madina AlMunawarah. Saudi J Kidney Dis Transplant 1995;6(2):132-5. |
|6.||Said RA, Hamzeh YY, Mehyar NS, Rababah MS. Hepatitis C virus infection in hemodialysis patients in Jordan. Saudi J Kidney Dis Transplant 1995;6(2):140-3. |
Abdelrahman O Mohamed
Department of Nephrology, King Fahad Hospital, Madina Munawarah
[Table - 1], [Table - 2]