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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2016  |  Volume : 27  |  Issue : 7  |  Page : 12-23
Demographics and key clinical characteristics of hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcomes and practice patterns study phase 5 (2012-2015)


1 Division of Nephrology, Jahra Hospital, Jahra, Kuwait
2 Dubai Medical College, Dubai, United Arab Emirates
3 King Saud University, Riyadh, Kingdom of Saudi Arabia
4 King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
5 Salmaniya Medical Complex, Manama, Bahrain
6 Hamad General Hospital, Doha, Qatar
7 Royal Hospital, Muscat, Oman
8 Adan Hospital, Adan, Kuwait
9 Arbor Research Collaborative for Health, Ann Arbor,MI, USA
10 List of Study Group in Acknowledgement

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Date of Web Publication1-Dec-2016
 

How to cite this article:
AlSahow A, AlRukhaimi M, Al Wakeel J, Al-Ghamdi SM, AlGhareeb S, AlAli F, Al Salmi I, AlHelal B, AlGhonaim M, Bieber BA, Pisoni RL, GD. Demographics and key clinical characteristics of hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcomes and practice patterns study phase 5 (2012-2015). Saudi J Kidney Dis Transpl 2016;27, Suppl S1:12-23

How to cite this URL:
AlSahow A, AlRukhaimi M, Al Wakeel J, Al-Ghamdi SM, AlGhareeb S, AlAli F, Al Salmi I, AlHelal B, AlGhonaim M, Bieber BA, Pisoni RL, GD. Demographics and key clinical characteristics of hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcomes and practice patterns study phase 5 (2012-2015). Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2017 Jul 27];27, Suppl S1:12-23. Available from: http://www.sjkdt.org/text.asp?2016/27/7/12/194885

   Introduction Top


The Gulf Cooperation Council (GCC) is made up of six Arab countries located on the Western shores of the Arabian Gulf. From 2012 to 2015, 928 chronic hemodialysis (HD) patients from 41 HD units from the six GCC countries participated in Phase 5 of the Dialysis Outcomes and Practice Patterns Study (DOPPS).

DOPPS, which began in 1996, is an international prospective cohort study of HD practices based on the collection of observational data from a random sample of patients from a representative and random sample of HD units. Thus far, there have been five study phases of DOPPS, with detailed data from >75,000 HD patients collected since 1996 and with the current participation of 21 countries.

In this study, we shed some light on the dialysis population in this part of the world, with description of the demographics, comorbidities, and socioeconomic characteristics of the GCC HD patients participating in DOPPS.


   The Gulf Cooperation Council Population Top


The GCC, which was established in 1981, is made up of six Arab countries located on the Western shores of the Arabian Gulf in the Middle East [Map 1]. These countries are Kuwait, Kingdom of Saudi Arabia (KSA), Bahrain, Qatar, United Arab Emirates (UAE), and Oman. The total area of the GCC countries is 2.41 million km 2 with a total population of more than 50 million in 2014. The total population of the GCC was 13.5 million in 1980 and that number jumped to 21 million in 1990. [1]



[Table 1] shows some basic information on the geography and economy of the GCC countries and [Table 2] shows some information on the demography and health status of the population in each of the GCC countries. [Table 1] also shows the percentage of males and the percentage of citizens in each of these countries. The GCC countries are the top six countries in the world with more male population than female population. [2] In addition, it is well known that the number of expatriates in the GCC countries is large, and in some of these countries, it exceeds the number of local citizens. Expatriates are on short-term residency permits that can be renewed indefinitely. A system whereby a foreign resident can become a citizen after staying in the country for a certain number of years does not exist in the GCC. Many expatriates, especially men, are in the GCC without families. Access of expatriates to dialysis services is limited across the GCC countries, since in some countries, public dialysis centers do not accept noncitizens, and in other countries, it is not provided free of charge for noncitizens. Consequently, many of these expatriates try to find an insurance company to accept them and cover the cost of dialysis or find a charity group that accepts them. Charity groups may not cover the full cost of the dialysis therapy. Many expatriates leave the GCC upon reaching end-stage kidney disease (ESKD) and return to their home country. Therefore, dialysis incidence and prevalence rates in each country for citizens are much higher than dialysis incidence and prevalence rates for the total population [Table 3].
Table 1: Basic geographic and economic data for the GCC countries.[1],[2],[3],[4]

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Table 2: Demography and health status of the population in each of the GCC countries.[1],[2],[4],[5],[6],[7]

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Table 3: Key clinical characteristics of the total dialysis population in each GCC country.

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   Dialysis Services and Population in the Gulf Cooperation Council - 2014 Data Top


Bahrain

Bahrain is the smallest Arab country, but has one of the highest population densities in the world. The first HD was performed in 1971, with the first kidney transplantation performed in September 1995. There are 594 chronic dialysis patients served by six dialysis centers. HD is the predominant dialysis modality, with only 56 (9.4%) patients receiving PD. Three centers are private, serving only 3.4% of the total dialysis population, all are non-Bahrainis. The other three are for the Ministry of Health (two) and Ministry of Defense (one). One center is participating in DOPPS with 35 randomly selected patients.

The Kingdom of Saudi Arabia

The KSA is by far the largest and most populous country in the GCC. HD was initiated in the KSA in 1971, and the first kidney transplantation took place in 1979. Continuous ambulatory peritoneal dialysis (CAPD) program was started in 1980. In 2014, there were 187 dialysis centers in the KSA serving approximately 15,780 patients. Nearly 84% of the patients are Saudi citizens and 89.7% of the entire dialysis population are on HD. About 145 centers (77%) are public serving, 85% of the total dialysis population. Of the public centers, 122 (83%) belong to the Ministry of Health, serving 64% of the dialysis population. The remaining public centers belong to the army, national guard, police, and universities. Of the 42 private sector dialysis centers, seven are run by charity groups serving non-Saudi patients who represent 4.5% of the total dialysis population. About 20 centers are participating in DOPPS with 460 randomly selected patients. Beginning in 2015, the Ministry of Health has outsourced its dialysis services to the large dialysis organizations, DaVita and Diaverum.

Kuwait

HD was started in Kuwait in 1976 and CAPD was introduced in 1982. Kidney transplantation was started in Kuwait in 1979. Currently, there are nine dialysis centers in Kuwait serving 1650 patients; eight are public HD centers; seven of them belong to the Ministry of Health, two of which are satellite community units and the eighth is for the employees of the Ministry of Defense. Although there are more than 10 private hospitals, there is only one small private HD center serving <0.5% of the total dialysis population. Almost all patients treated in the private center are non-Kuwaitis, and the cost of dialysis therapy (not including medications) is paid by a charity group. Kuwaiti citizens comprise 74% of the total dialysis population in Kuwait with 89.5% of the total dialysis population receiving HD. Four of the nine dialysis units participated in DOPPS with 176 randomly selected patients. All belong to the Ministry of Health.

Oman

Oman is the second largest GCC country and like the KSA, the total number of citizens exceeds the total number of noncitizens. Dialysis services were started in Oman in the form of intermittent peritoneal dialysis (IPD) in 1980. HD was introduced later in 1983, and CAPD was introduced in 1992. There are 21 dialysis centers in Oman; 19 are public, altogether serving dialysis populations of 1500 patients, with 92% receiving HD. Non-Omanis represent only 2% of the dialysis population and are treated in the private sector. Four centers are participating in DOPPS with 106 randomly selected patients.

Qatar

HD was introduced in 1981, and the first transplantation took place in 1987. CAPD was introduced in 1997. There are five dialysis centers in Qatar serving 800 patients, all of which belong to the Ministry of Health. Seventy-five percent of the dialysis population is on HD and 53% of the dialysis population is Qatari citizens. Charity groups pay for the dialysis services for noncitizens. Two centers are participating in DOPPS with 91 randomly selected patients.

The United Arab Emirates

The UAE is the third largest and second most populous country in the GCC. IPD was initiated in 1976, and CAPD begun in 1985. HD was established in 1977, with the first transplant (which was living related) occurring in 1985. There are 33 dialysis centers in the UAE: 22 are public and 11 in the private sector, altogether serving a dialysis population of 1750 patients, with 93.5% receiving HD. Of the total dialysis population, only 40% are citizens. Nine centers are participating in DOPPS with 283 randomly selected patients.


   Demographics and Characteristics of Gulf Cooperation Council hemodialysis Patients Participating in Dialysis Outcomes and Practice Patterns Study Phase 5 Top


Gender

GCC countries have more male population than female population, [2] therefore it is expected to conclude that the majority of GCC dialysis patients are men. This is the same across all GCC countries and for all DOPPS regions [Table 4] and [Table 5]. Male predominance in the HD population has been confirmed before [9] and reported recently in dialysis patients from more than 50 countries. [10]
Table 4: Key characteristics of patients participating in DOPPS Phase 5 (2012/2013) by DOPPS region.

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Table 5: Key characteristics of patients participating in DOPPS Phase 5 (2012/2013) by GCC countries.

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Age

GCC HD patients are younger with a mean age of 54.5 years, compared to a mean age of 63.4 for North America, 65.8 for Japan, and 66.7 for Europe [Table 4]. This is consistent with the general population which is also younger in the GCC population, with a median age of approximately 30 years [Table 2], compared with the median ages of 37, 42, and 46 for the USA, Europe, and Japan, respectively. In addition, more than 95% of the GCC population is younger than 60 years compared to 80% for the USA and Europe and 68% for Japan. [4],[11] Mean age of the GCC HD patients in DOPPS varies across the six countries ranging from 52 years in Oman to 58 years in Qatar. This is similar to national median age trends where Oman has the youngest and Qatar has the eldest population in the GCC. [4]

Diabetes

Diabetes is a major global threat affecting more than 380 million worldwide or 8.3% of the total world population. The highest prevalence is in the Middle East and North African region (MENA), which includes all Arab countries in addition to Iran and Pakistan with a comparative prevalence of 11% followed by the North America and Caribbean region (NAC) with a comparative prevalence of 9.6%. The highest national prevalence in the GCC is in Qatar and the lowest is in Oman. Kuwait, the KSA, and Qatar are among the top ten countries for comparative prevalence of diabetes in 2013, with Kuwait, Qatar, the UAE, and Bahrain among the top five countries regarding the prevalence of impaired glucose tolerance in 2013. However, the mean diabetes-related health expenditure per person with diabetes in the GCC countries is less than that of North America, Western Europe, and Japan. [5] DOPPS data indicate that diabetes is reported as the primary cause of ESKD for 41% of HD patients in the GCC compared to 43% in North America, 35% in Japan, and 25% in Europe [Table 4]. However, there is a wide variation among the GCC countries as it is the most common cause of ESKD in Kuwait (60%), followed by Qatar (50%), whereas hypertension is the most commonly reported cause of ESKD in Bahrain (48%) [Table 5]. Except for Bahrain, diabetes is the most common cause of ESKD in the GCC. However, the true incidence of hypertension-induced ESKD is debatable. This is because, first, the pathological changes seen in nephrosclerosis are not specific to hypertension and second, many cases are not biopsied but presumed to be due to hypertension. [12],[13],[14]

Body mass index

Kuwait, the KSA, Bahrain, and the UAE are among the obese countries of the world with the Kuwait's general population having the highest average BMI in the world (29.5 kg/m 2 compared to a national average BMI of 28.8 kg/m 2 in the USA. Qatar is not too far behind with a national average BMI of 26.8 kg/m 2 , but Oman has escaped the trend with a national average BMI of 24.9 kg/m 2 . [4],[6] Consistent with what is seen in the general population, it is also not surprising to see HD patients from Kuwait in DOPPS to have the highest BMI and HD patients from Oman in DOPPS to have the lowest BMI among the GCC patients [Table 5].

Hypertension

Hypertension is prevalent in the GCC as obesity, physical inactivity, unhealthy dietary habits, and smoking dominate the lifestyle. [15] The WHO 2008 estimated prevalence for hypertension is 37.1% for Bahrain, 29.1% for Kuwait, 34.5% for Oman, 33.8% for Qatar, 33.1% for the KSA, and 27.5% for the UAE. [7] It is surprising to see such a high prevalence in Oman despite a lower national BMI average and a lower rate of smoking. The rate of hypertension-induced ESKD is the highest in the GCC compared with other DOPPS regions [Table 4]. The rate of hypertension-induced ESKD varies widely among the GCC countries ranging from 48% in Bahrain to 6% in Qatar [Table 5]. This could be due to biopsy policies and/or definition criteria (see diabetes section above). The low number of hypertension-induced ESKD in Qatar and Japan did not translate into a lower number of hypertensive HD patients [Table 4] and [Table 5]. The percentage of hypertensive HD patients in the GCC DOPPS is lowest in Oman, possibly influenced by lower BMI average, younger median age, and lower rates of smoking, and highest in Qatar, possibly influenced by older median age, and in Kuwait, possibly influenced by higher BMI average.

Cancer

Cancer prevalence in the GCC is relatively low. The highest prevalence of 112/100,000 is in Bahrain and lowest of 82/100,000 is in Oman. [16] Therefore, it is not surprising to see the percentage of GCC HD patients in DOPPS with cancer to be lower than that in other regions [Table 4]. In addition, among GCC HD patients, it is not surprising to see the highest prevalence is in Bahraini HD patients [Table 5].

Blood-borne viruses (hepatitis B virus/hepatitis C virus/human immunodeficiency virus) in the Gulf Cooperation Council population and the Gulf Cooperation Council dialysis population

Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are major health problem worldwide being major causes for cirrhosis, end-stage liver disease, and hepatocellular carcinoma. [17],[18] HBV prevalence in the GCC is estimated to be low intermediate (2-4%)as shown in [Table 6]. [17] Vaccination and maternal screening have helped control HBV infection in the GCC countries. [19] [Table 4] also shows the prevalence of HCV in the general population of the GCC countries and in the dialysis population of the GCC countries. The prevalence of HCV in the MENA region is estimated to be 3.6%. [20] However, this is an overestimation for the true prevalence in the GCC, since the MENA region includes Egypt, which has the highest HCV prevalence in the world. [21] In addition, data is based on HCV seroprevalence among specific groups (e.g., blood donors, medical students), and not representative of the community. [22] In the GCC, HCV is mostly of genotype 4, with HCV prevalence estimated to be low (1-1.9%). [22],[23] In Kuwait, the prevalence of anti-HCV among Kuwaiti and non-Kuwaiti Arabs first-time blood donors was 0.8% and 5.4%, respectively. [23] Qatar has a very low prevalence rate of HCV at 0.04%. [24] In Oman, the prevalence was 1% in nondialysis, nontransplant chronic kidney disease patients, 0% in 134 medical students, and 0.9% in blood donors. [25] The estimated prevalence in the KSA based on the number of reported positive HCV cases is 1.1-1.7%. [26] In the UAE, the prevalence of HCV was 0 in 261 healthy Emirati medical students and 0.1% in almost 60,000 blood donors. [27],[28] The prevalence of HCV infection among 7700 healthy blood donors in Bahrain was 0.3%. [29] The new direct-acting antiviral drugs provide a simplified and shortened oral treatment course with increased tolerability and efficacy. [18] This regimen has been tested successfully in HD patients which is an exciting news. [30] The estimated number of people acquiring human immunodeficiency virus (HIV) in the MENA rose by 26%, from 18,000 to 22,000, and the estimated number of AIDS-related deaths more than trebled, from 3,600 to 12,000 between 2000 and 2014. [31] However, the GCC countries have a low HIV prevalence [Table 6]. [32]
Table 6: Prevalence of blood-borne viruses in the general population of the GCC, in the general dialysis population of the GCC, and in the GCC HD patients participating in DOPPS Phase 5.

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Infection control is one of the key areas of focus in caring for HD patients who are routinely being cannulated at least thrice weekly and are at a great risk of acquiring any of the blood-borne viruses. All HBV-positive patients are dialyzed in separate rooms with dedicated staff in accordance with guidelines from the Centers for Disease Control and Prevention (CDC) and other international authorities. [33] For HCV-positive patients, infection control policies are variable as some centers isolate them completely similar to HBV-positive patients while other centers follow CDC and other authorities' guidelines and dialyze HCVpositive patients with the general population but with dedicated machines and staff. HIVpositive patients are isolated either in dedicated rooms or in the rooms dedicated for HBV-positive patients when the room is empty although international guidelines do not request this. [33] However, the total number of HIV-positive patients on dialysis in the GCC is only 20.


   Living Status and Socioeconomic Characteristics of GCC HD Patients Participating in DOPPS Phase 5 Top


Percentage of married HD patients, percentage of HD patients living with family or friends, and percentage of HD patients who are homemakers are similar in the GCC with that in Japan but much higher than in Europe and North America [Table 7]. This could be because both societies are still attached to older traditional values. However, higher rates of marriage and social support and younger age for the GCC patients were found not to be significantly related to better physical and mental scores compared to other regions [Table 4], [Table 7], and [Table 9]. The overall education level for the GCC HD patients was less than that of North American and Japanese HD patients but greater than that of European patients. Lower educational attainment is associated with an increased risk of adverse health outcomes in individuals with CKD but not with progression to ESKD. [34] Education level did not influence employment rates in the GCC, probably because patients are younger. Higher rates of unemployment in working-age dialysis patients compared with that of the general population have been noticed before. [35] Percentage of married patients was reported to be lowest in Oman and Bahrain, which are the least wealthy countries in the GCC. However, despite being the least wealthy country in the GCC, Bahrain has the highest rate of retirement, highest rate of homemaker status, and a modest prevalence of employment compared with other GCC countries [Table 8].
Table 7: Socioeconomic characteristics of patients participating in DOPPS Phase 5 (2102/2013) by DOPPS region.

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Table 8: Socioeconomic characteristics of GCC HD patients participating in DOPPS Phase 5 (2012/2013) by GCC country.

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Table 9: Patient-reported quality of life in DOPPS Phase 5 (2012/2013) by DOPPS Phase 5 regions.

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   Gulf Cooperation Council Patients Participating in Dialysis Outcomes and Practice Patterns Study Phase 5 Reported Quality of Life Compared to other Dialysis Outcomes and Practice Patterns Study Phase 5 Regions Top


Cognitive impairment, depression, malnutrition, and functional decline are nonrenal determinants of quality of life and mortality. There is also a significant independent effect of depressive symptoms on the survival of dialysis patients. [36],[37]


   Gulf Cooperation Council Patients Participating in Dialysis Outcomes and Practice Patterns Study Phase 5 Reported Quality of Life as per Gulf Cooperation Council Countries Top


The physical component summary and mental component summary scores for the six GCC countries are comparable; however, the Center for Epidemiological Studies-Depression score is lower, and the presence of depressive symptoms is lower in Qatar and Kuwait and highest in Oman and the KSA. This is despite the fact that the number of patients living with families is very high in all countries and the level of education is comparable in all countries, despite the fact that patients in Qatar are older. Being employed has been shown to be associated with lower odds of depressive symptoms in a prior international DOPPS study. [38] However, in the GCC patients, lower rates of employment in Qatar and Kuwait were associated with lower percentage of patients with a high score of depressive symptoms [Table 10].
Table 10: Patient-reported quality of life of GCC patients participating in DOPPS Phase 5 (2012/2013) by GCC countries.

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   Conclusion Top


This is the first study that provides general information on the dialysis population of the GCC. It shows a relatively young population plagued with diabetes, hypertension, and obesity. The prevalence of dialysis in this region is high with diabetes being responsible for more than half of the cases. HD is the preferred modality for the vast majority of patients. It shows disparity between the percentage of expatriates in the general population, which is large, and the percentage of expatriates in the dialysis population, which is much smaller. It also shows a low prevalence of blood-borne viruses (HBV, HCV, and HIV). Cancer rates in this region are low. Patients' reported quality of life in the GCC is comparable to other DOPPS regions.


   Acknowledgments Top


The authors wish to thank the devoted efforts of GCC-DOPPS Phase 5 study group members for their numerous contributions to this study including Country Investigators (Dr. Sameer Al-Arrayed, Dr. Sumaya Al Ghareeb, Dr. Bassam Al Helal, Dr. Naser Alkandari, Dr. Ali Al Sahow, Dr. Anas AlYousef, Dr. Mohammad AlAzmi, Dr. Yaqob Ahmed Almaimani, Dr. Issa Al salmi, Dr. Nabil Salmeen Mohsin, Dr. Fadwa Al Ali, Dr. Mohamed El-Sayed Abdel Fatah, Dr. Ashraf Fawzy, Dr. Abdulla Hamad, Dr. Saeed M. G. Al-Ghamdi, Dr. Mohammed Al Ghonaim, Dr. Jamal Al Wakeel, Dr. Fayez Hejaili, Dr. Ayman Karkar, Dr. Faissal Shaheen, Dr. Samra Abouchacra, Dr. Ali Abdulkarim Al Obaidli, Dr. Mohamed Hassan, Dr. Mona Nasir AlRukhaimi, Dr. Abdul Kareem Saleh, Dr. Sylvia Ramirez, Dr. Bruce M. Robinson, and Dr. Ronald L. Pisoni), Clinical Research Associates and Project Coordinators/Managers (Dr. Amgad El-Baz El-Agroudy, Dr. Balaji Dandi, Ms. Cherry Flores, Mrs. Ph. Fatma Al Raisi, Ms. Ibtisam Al-Hasni, Dr. Ashraf Fawzy, Dr. Haroun Zakaria Ahmed, and Mr. Dan Santiago from the Saudi Center for Organ Transplantation, Mr. Muhammad Awwad, Ms. Roberta Al Housani-Blakely, Christina Pustulka, Anne Vandermade, Melissa Fava, Anna Hogan, Michelle Maxim, and Justin M. Albert), Biostatisticians (Brian A. Bieber), and Study Site Medical Directors and Study Coordinators: Dr. Hamid Ali Alyousif, Ms. Sohair Abdulroof Albably, Dr. Ahmed Eid Alkady, Dr. Samir Al Muielo, MD, Dr. Fakreldein Elamien Ali, Dr. Ayman El Monger, Dr. Sameh Mohammed Al-sammad, Dr. Baraa Rajab, Dr. Atif Hanan, Tarek Abdelfattah Ahmed Ali, Dr. Ayman Karkar, Dr. Mohammed Abdelrahman, Dr. Mohammed Hussein, Dr. Wael Abdlah, Dr. Faisal Mushtaq, Dr. Salah Eldin El Sheik Beshir, Dr. Medhat Abdelmonem Shalaby, Dr. Mustafa Khaleel Al Obeid, Dr. Mohamad El Hadary, Dr. Alaa Al Shamy; Dr. Aboud Mamari, Dr. Mohammed Raily, Dr. Mustafa Ahmed; Ramzi Abou-Ayache, Dr. Hormoz Dastoor, Dr. Mohamed Hassan, Dr. Bassam Bernieh, Dr. Hareth Muthanna Mohammed Saaed, Dr. Mustafa Kamel, Prof. Abdel Basset Hassan, MD, PhD, FASN, Dr. Hassan Khammas, Dr. Balaji Dandi, Dr. Sumaya Al-Ghareeb, Dr. Fadwa Al Ali, Dr. Anas Alyousef, Dr. Nasser AlKandari, Dr. Ali Alsahow, Dr. Bassam AlHelal, Dr. Ahmed Mandour, Dr. Yaqob Ahmed Almaimani, Dr. Amer Ahmed Alaamri, Dr. Ibrahim Sayed Ibrahim, Dr. El Badri Abdelgadir, Dr. Mohammed Al-Sayed Seleem, Dr. Ali Hassan Hakami; Dr. Samir Beshay, Dr. Nayer Morsy, Mr. Menwer Al-Ofi, Ms. Sohair Abdulroof Albably, Dr. Huda Mohammed Saeed Ahmed, Ola Al-Marhoon; Dr. Samir Al Muielo, Ms. Joynalyn Barrios, Ms. Fatima Cruza; Ligaya Battad, Mr. Abdullah A. K. Al Harbi, Dr. Sameh Mohammed Al-sammad, Ms. Manal Ahmed Hamdan, Jennifer Samson, Mr. Ahmed Mousa Khawaji, Ms. Eman Al-Hejji, Ms. Rosalinda Lamis, Ms. Lagrimas Codotco, Dr. Wael Abdlah, Mrs. Priyanka Prasad, RN, Mr. Bander Faisal Justinia, Mr. Faisal Al Enazy, Sarah Brazil, Dr. Naemah Abdullah, Dr. Alaa Al Shamy, Dr. Aboud Mamari, Mely Gari Piling, Dr. Fakhriya Al Alwai, Rusmina Binti Sudin, Dr. Chandra Mauli Jha, MD; Katheryn Jamilano, Basima Khaddah, Hilal Al Rasbi, MuhyEddin Hashem Hasan, Sr. Ekram Awadh Salem, Walid Gouiaa, Mini Issac, Jiby Mammen, Mary Ellen Monday, Mrs. Afrah Al Jamri, Mr. Yasser Khalil Abbas, Mrs. Rania Abd El-Aziz, Rania Abd El-Aziz, Cherry Flores, Mini Kumari Ramakrishnan, Shanty Mannaraprayil, Maria Charisse Bernardo, Bassam AlHelal, Evangeline Valdez, Rosily Joseph, Mrs. Ghaniya AlShukaili, Adel Mohamed Bayoumy, Hamid Alshahri, Amira Balkhair, Amina Said Al Shezawi, Sultan Saif Ali Alroshdi, Dr. Shaninaz Faisal Bashir, Dr. Ahmed Mousa Dawood, Keirin Porras, Dr. Anthonimuthu Victor, and Mr. Sultan Al-Toqi.


   Source of Support Top


The DOPPS Phase 5 study in the GCC has been supported by Amgen without restrictions on publications. The DOPPS program is supported by Amgen, Kyowa Hakko Kirin, AbbVie Inc., Sanofi Renal, Baxter Healthcare, and Vifor Fresenius Medical Care Renal Pharma, Ltd. Additional support for specific projects and countries is also provided by Amgen, BHC Medical, Janssen, Takeda, and Kidney Foundation of Canada (for logistics support) in Canada; Hexal, Deutsche Gesellschaft fur Nephrologie (DGfN), Shire, and WiNe Institute in Germany; and the Japanese Society for Peritoneal Dialysis Outcomes and Practice Patterns Study in Japan. Funding for the DOPPS program is provided without restrictions on publications.

Conflicts of interest: None declared.

 
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Correspondence Address:
Ali AlSahow
Division of Nephrology, Jahra Hospital, P. O. Box 2675, Jahra Central, 01028, Jahra
Kuwait
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DOI: 10.4103/1319-2442.194885

PMID: 27991475

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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   Introduction
    The Gulf Coopera...
    Dialysis Service...
    Demographics and...
    Living Status an...
    Gulf Cooperation...
    Gulf Cooperation...
   Conclusion
   Acknowledgments
   Source of Support
    References
    Article Tables
 

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