| Abstract|| |
This is a prospective study of the outcome of patients with end-stage renal disease (ESRD) on regular hemodialysis admitted to a referral hospital in Madinah Al Munawarah, Saudi Arabia during a six-month period from January-June 2003. Ninety four patients out of 395 (23.7%) patients on regular hemodialysis were admitted 125 times of whom 27 (28.7%) patients were admitted twice; males accounted for 58.5% of the patients. The mean hospital stay period was 9.1 days per patient. The major cause of ESRD was diabetes mellitus (40%) followed by hypertension (13.6%). The main cause for admission was the vascular access related problems (33.6%) followed by infection (31.2%) and cardiovascular causes (18.4%). Most of the admissions were in the general ward but 17 % of the total stay in hospital was in the intensive care unit. Twelve out of the 94 (12.7%) study patients died during the study period; five patients died of cardiac failure, three of septicemia, one of severe gastrointestinal bleeding and one of Wegner's syndrome complicated by severe intra-pulmonary bleeding. Two patients had sudden death (most likely due to cardiac disease). In conclusion, our experience with morbidity and mortality of the hemodialysis patients admitted to hospital is comparable to other places in the world.
Keywords: ESRD, Morbidity, Mortality, Hemodialysis.
|How to cite this article:|
Mohamed AO. Morbidity and Mortality in ESRD Patients on Regular Hemodialysis: A Single Center Experience. Saudi J Kidney Dis Transpl 2005;16:336-41
|How to cite this URL:|
Mohamed AO. Morbidity and Mortality in ESRD Patients on Regular Hemodialysis: A Single Center Experience. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2020 Feb 19];16:336-41. Available from: http://www.sjkdt.org/text.asp?2005/16/3/336/32865
| Introduction|| |
The advances in renal replacement therapy have been remarkable taking end-stage renal disease (ESRD) from an invariably fatal disease in the first half of the last century  to a disease with mortality rate of about 20% - 25% per year.  This success is not complete in spite of the recent improvements in dialysis and dialysis prescription, treatment of anemia, hypertension and bone disease.
The population of ESRD is growing fast; mortality is still unacceptably high, frequent hospitalization is required; sleep disturbance is common, sexual function is unsatisfactory and return to work is infrequent.  Research about the causes of morbidity and mortality has helped improve the management of ESRD patients. Cardiovascular disease and infections are established as the main causes of mortality. ,
The outcome studies of ESRD in the kingdom of Saudi Arabia (KSA) are very few to the best of our knowledge , and are retrospective.
We attempt in our study to prospectively evaluate the reasons for and duration of hospitalization, co-morbidity and the causes of mortality in the regular hemodialysis patients.
| Material and Methods|| |
This study included chronic hemodialysis patients referred to King Fahad Hospital, Al-Madinah Al-Munawarah, Saudi Arabia, for regular dialysis. The total number of the patients was 395 at the start of the study that extended from January - June, 2003. We evaluated the reasons for all hospitalizations and mortality of any patient during the study period, in addition to the causes of ESRD, Co-morbid conditions.
| Results|| |
During the six months period of this study, there were 125 hospitalizations in 94 patients; 27 (28.7%) patients were admitted twice during this period and two patients were admitted three times. The hospitalized patients included 55 (58.5%) males and 39 (41.5%) females; 73 (77%) were Saudi nationals and 21 (23%) were non-Saudis. The mean age of the patients was 51.1 ± 27 years (range from13-85 years). The mean duration of hospitalization was 6.8 days per admission and 9.1 days per patient.
The major causes of ESRD in the study patients included diabetes mellitus in 50 (40%) admissions, unknown causes in 50 (40%), hypertension in 17 (13.6%) and glomerulonephritis in 8 (6%) [Figure - 1].
The major co-morbidities in the study patients are shown in [Figure - 2]. Diabetes Mellitus was the predominant cause of co-morbidity in 50 (40%) admissions, hypertension in 49 (39.2%), cardiovascular diseases in 41 (32.8%), hepatitis C in 23 (18.4%), and hepatitis B in 11 (8.8%). The combined co-morbidities for cardiovascular diseases are shown in [Table - 1].
The main reasons for hospitalization are shown in [Figure - 3]; the vascular access problems were the main reason in 33.6%, infections in 31.2%, cardiovascular disease in 18.4% and bleeding in 6.4%.
The detailed reasons for admissions related to vascular accesses are shown in [Table - 2]; the majority were related to creation of vascular access (71.4%), followed up by closure of complicated arteriovenous fistulas (14.3%) and infected native arterio-venous fistulas (7.1%).
The causes of infection in the hospitalized patients are shown in [Table - 3]; infected dialysis catheters accounted for 28.2% of the total infections.
The cardiovascular reasons for hospitalization are shown in [Table - 4]; heart failure was the reason in 30.4%, coronary syndrome in 17.4%, cerebrovascular accident in 17.4% and cardiac arrest in 13.0%.
Six of the eight patients admitted with bleeding, suffered from gastrointestinal bleeding and two from frank hematuria.
Most of the admissions were in the general wards; 66 (52%) admissions to the medical wards and 42 (33%) to the surgical wards, while 17 admissions were to the intensive care units (ten in the medical intensive care unit and seven in the coronary care unit). One hundred forty five of the total 851 days (17%) of patients hospital stay were spent in the intensive care units [Figure - 4].
Twelve patients (12.8%) died during the study period, 9 men and 3 women with mean age of 53.0 + 23.2 years; seven were Saudis and five were non-Saudis. The major cause of ESRD in this group was diabetes mellitus in eight (66.6%) patients, hypertension in two (16.6%) and, Wegner's granulomatosis in one. The major co-morbidities were diabetes and hypertension. Hypertension was present in all the diabetics. Ischemic heart disease was present in four patients who were also hypertensive and diabetic. One patient had ischemic vascular disease involving his lower limbs.
Five patients died of cardiac failure, three of infection complicated by septicemia, two of sudden death, one of severe gastrointestinal bleeding and the one with severe intra-pulmonary bleeding due to Wegner's granulomatosis.
| Discussion|| |
We report in our study those issues related to morbidity and mortality in a prospective manner compared to other published data from this country, which to the best of our knowledge was mostly retrospective.
The average age of admitted patients was 51.1 + 27 years, not much different from that reported by Al-Wakeel et al  of 53.7 years for average age of ESRD but is slightly higher than the average age of the newly recruited patients to our unit in the year 2001, which was 47.9 years. 
The mean period of hospitalization in our study was 9.1 days / patient / year that was lower than the 11.6 days / patient /year as reported by Al-Wakeel et al,  or the 11.3 days / patient / year as reported by United States Renal Data System(USRDS).  This lower figure may be related to the reason for admission. In our study, the main reason was creation of vascular access and its related problems that usually needs fewer days than the other studies in which cardiovascular disease was the main reason for admission. 5],
The major cause of ESRD in our study was diabetes mellitus similar to the cause of ESRD reported before from our unit,  which is higher than reported elsewhere in the KSA. ,,, and similar to that from the USRDS.  This has an impact on the morbidity and mortality due to cardiovascular disease.
Hospitalizations due to cardiovascular disease in our study (32.8%) was lower than that (46%) reported by Al-Wakeel et al. 
In our study, hospitalizations due to infections were mainly related to infected PermCaths, which could be reduced by policies to deal with such infections and removal of these catheters when they are deemed unnecessary. Tuberculosis was responsible for 12.8% of all infections and 4% of all hospitalizations which reflects the increased prevalence of tuberculosis in this population in the KSA.  The prevalence of other infections are similar to those reported elsewhere. 
We reported the details of the cardiovascular diseases in our study. Such reasons for hospit alization were not detailed in previous reports from this country. ,
Bleeding, which accounted for 6.4% of all admissions, was reported in all previous studies. The vulnerability of ESRD patients to bleeding is well documented due to platelet dysfunction, use of heparin and higher prevalence of gastrointestinal ulcers.
Twelve of the patients in our study died (12.8%) with a mean age of 53.0 compared with a mean age of all admissions of 51.1 years (the number is small for any statistical comparison). The majority consisted of diabetic patients and the major cause of death was heart failure similar to other reports. ,,
In conclusion, our experience with morbidity and mortality of the hemodialysis patients admitted to hospital is comparable to other places in the world.
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Abdulrahman Osman Mohamed
King Fahad Hospital, P.O. Box 1928, Madinah Al-Munawarah
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]