Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 3544 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
Table of Contents   
RENAL DATA FROM THE ARAB WORLD  
Year : 2017  |  Volume : 28  |  Issue : 2  |  Page : 349-354
Analysis of patients with end-stage renal disease on dialysis in Tabuk City, Saudi Arabia: A single-center, three-year retrospective study


1 Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
2 Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia; Department of Chemistry, Faculty of Science, Ibb University, Ibb, Yemen
3 Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
4 Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia; Department of Chemistry, Faculty of Science, Tanta University, Tanta, Egypt

Click here for correspondence address and email

Date of Web Publication23-Mar-2017
 

   Abstract 

This study was performed to analyze various demographic data such as age, gender, nationality, status of the patients, and the causes of end-stage renal disease (ESRD) of 349 patients who were undergoing hemodialysis (HD) during the period from January 2013 to December 2015 at the Dialysis Center of King Khalid Hospital in Tabuk City. One hundred and fifty-two patients (43.6%) were on HD in 2015. Age of the patients ranged from 9 to 93 years and the mean age was 51.3 ± 17.6 years. Majority of the patients, i.e., 140 (40.1%) were in the age group of 40–59 years, followed by the age group of 60–79 years by 27.8% (97 patients). Saudis constituted 84.2% (294) and non-Saudis accounted 15.8% (55) of the patients over the years studied. There were 198 males (56.7%) and 151 females (43.3%). The death rate in 2014 was 6.2%, whereas it increased in 2015 to 10.5%. The high escape rate (10.3%) of patients was in 2014. Diabetic nephropathy was the most common cause of ESRD, accounting for 30.4% of all cases, followed by unknown etiologies accounting for 25.2%. Nearly 22.6% of all ESRD cases had hypertension. Primary glomerular disease was seen in 8.9% and obstructive uropathy in 3.7%. Other causes constituted 7.4% of the cases. The data of ERSD patients in Tabuk City are comparable with that of other regions of the Kingdom of Saudi Arabia. We conclude that analysis studies of HD centers help to understand the problems and the needs of the patients, find the solutions, and create a connection between the consumers and health-care providers.

How to cite this article:
Almutairi FM, Al-Duais MA, Shalaby KA, Sakran MI. Analysis of patients with end-stage renal disease on dialysis in Tabuk City, Saudi Arabia: A single-center, three-year retrospective study. Saudi J Kidney Dis Transpl 2017;28:349-54

How to cite this URL:
Almutairi FM, Al-Duais MA, Shalaby KA, Sakran MI. Analysis of patients with end-stage renal disease on dialysis in Tabuk City, Saudi Arabia: A single-center, three-year retrospective study. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Jun 24];28:349-54. Available from: http://www.sjkdt.org/text.asp?2017/28/2/349/202769

   Introduction Top


Chronic kidney disease (CKD) is a condition associated with an increased risk of hospital admission, morbidity, and mortality due to cardiovascular disease.[1] CKD is characterized by an irreversible damage of kidney function that gradually progresses to end-stage renal disease (ESRD)[2] who will then require renal replacement therapy in the form of dialysis [hemodialysis (HD) or peritoneal dialysis] or a kidney transplant.[3] The incidence and prevalence of ESRD are increasing worldwide. In the USA, at the end of 2012, there were 449,342 patients undergoing treatment for ESRD.[4] Recently, ESRD has become an increasing public health problem for both high- and middle-income countries. Even in the developed countries, ESRD is a major cost driver for health-care systems.[5],[6] In 2012, in the USA, Medicare spending is seen approaching $90,000 per patient per year of care.[7]

The mortality among dialysis patients is 6.1 – 7.8 times higher than that for individuals in the general age-matched population.[4] In Saudi Arabia, the incidence and prevalence of ESRD have increased in the last three decades probably due to factors such as an increase in life expectancy, rapid changes in lifestyle, urbanization, and high population growth.[8] At the end of 2014, there were a total of 15,782 dialysis patients treated in 187 dialysis centers in the Kingdom of Saudi Arabia, 14,366 of them are treated by HD, and the remaining 1,416 by peritoneal dialysis.[9] The prevalence of end-stage renal failure treated by dialysis was 513 cases per million population (PMP).[9] Tabuk Region is located along the Northwest coast of Saudi Arabia with an area of 146,072 km2 and a population of 791,595 (2010 census). Tabuk City is the capital city of this region, and it is the biggest city in the northern part of the Kingdom. The population of Tabuk City is 534,893 (2010 census). There is a paucity of the statistical data concerning the ESRD patients in Tabuk City; therefore, the collection of accurate epidemiological data has great importance for health-care planning.[10] This study was conducted to analyze the data of ESRD patients in one dialysis center in Tabuk City over the last three years with regard to the disease, age, sex, and nationality, in addition to assessment of the diagnosed and presumed causes of ESRD in these patients.


   Subjects and Methods Top


This study was carried out in Tabuk City which has three dialysis centers with varying capacities. One of the largest of them is the one in King Khalid Hospital which plays a major role in health-care management in the city. In this monocentric retrospective study, we analyzed the clinical data for all cases of ESRD - who were undergoing HD during the period from January 2013 to December 2015 at the Dialysis Center in King Khalid Hospital in Tabuk. This study was approved by the Research Ethics Committee of Tabuk University. During data collection, care was taken to avoid reduplication of cases. The medical records were the major source of information on the patients. We retrieved the demographic data such as sex, age, nationality, status of the patient, and the cause of ESRD.


   Statistical Analysis Top


Continuous variables were reported as means ± standard deviation, and all analyses were conducted using the Social Package of Statistical Sciences Statistics for Windows, Version 22.0, (IBM Corp., Armonk, NY, USA,) and Microsoft Office Excel 2010. Tables and figures were used to describe categorical variables.


   Results Top


The total number of HD patients included in this study was 349 during the study period. Of them, 152 patients (43.6%) were in 2015. Age of the patients ranged from 9 to 93 years. The mean age of the patients was 51.3 ± 17.6 years. The majority of the patients (40.11%) were in the age group of 40–59 years, followed by the age group of 60–79 years by 27.79%. The distribution of the study patients according to nationality and gender is summarized in [Table 1]. Saudis constituted 84.2% (294) and non-Saudis accounted 15.8% (55) of the patients over the years studied. Males contributed 56.7% of the studied patients and females contributed 43.3% of the patients [Table 1]. The status of patients at the time of the study is summarized in [Table 2]. The death rate was calculated according to a formula published elsewhere.[11] The death rate in 2014 was 6.2% (6 patients), whereas it was increased in 2015 to 10.5% (16 patients). The highest escape percent of patients was in 2014 by 10.3% (10 patients). Diabetic nephropathy (DN) was the most common cause of ESRD in our study patients (30.4%), while hypertension was accounted 22.6% of the cases [Table 3]. Nearly 25.2% of ESRD cases among our study patients were with unknown etiology of kidney disease. Primary glomerular disease was seen in 8.9% and obstructive uropathy in 3.7%. Other causes constituted in 7.4% of the cases [Table 3].
Table 1: Distribution of the study hemodialysis patients according to nationality and gender.

Click here to view
Table 2: The status of the study patients.

Click here to view
Table 3: Causes of ESRD among the study patients.

Click here to view



   Discussion Top


Tabuk City is the capital city of Tabuk region, and it is the biggest city in the northern part of the Kingdom. At the end of 2014, the prevalence of dialysis patients in northern region was 686 PMP, whereas the incidence of dialysis patients was 187 PMP.[9] On the other hand, it was reported that the prevalence of treated ESRD in Tabuk region was 460 PMP.[12]

Our results showed that the majority of the patients (57.6%) were males. This male predominance was similar to some other local,[9] regional,[13],[14] and international studies.[15],[16],[17] In contrast, a female predominance was reported among ESRD patients in many Asian and European countries[18] including Saudi Arabia.[11] Thus, differences in a gender prevalence of ESRD are demonstrated in most reports. The researchers on geographic variations in ESRD occurrence and acquisition of kidney transplants have investigated continental patterns.[19]

The mean age of the patients in our study was 51.3 ± 17.6 years. This finding shows that our patients were younger than those encountered in Northern Cyprus[20] but older than encountered in Yemen.[21] It was reported that in the KSA in the early 1980s, the mean age of ESRD patients was 37.9 years, then in the 1990s, it was 51.3 years.[22] The majority of our patients (40.1%) were in the age group of 50–59 years, followed by the age group of 60 years and older (32.1%). This result is in accordance with the latest data from Saudi Center for Organ Transplantation (SCOT 2015), which reported that 45.3% of people receiving dialysis treatment were in the age group of 26–55 years.[9] In Palestine, 45.1% of ESRD patients were in the age group of 45–64 years.[14] This concurs with international reports where the changes in age to older age groups are associated with increased prevalence and incidence of CKD.[18]

The death rate in 2015 was higher compared to 2014 probably due to the higher number of new ESRD patients getting initiated on hemodialysis during 2015, and as a result, the death rate also would increase because a higher loss of life occurs within the first few months of initiating dialysis.[4] The prevalence of CKD among people over 65 years of age is associated with more comorbid conditions such as hypertension, cardiovascular disease, and diabetes mellitus, which increases the pressure on health-care services and impacts on the quality of life of patients.[23] In the USA, Medicare spending for patients with CKD aged 65 and older exceeded $50 billion in 2013, representing 20% of all Medicare spending in this age group.[24] Our results showed that DN was the most common cause of ESRD among our study patients. It affected 30.4% of all cases. This finding is in agreement with other studies. DN is the leading cause of ESRD, accounting for approximately 50% of cases in the developed world.[25] It was estimated that patients having DN in the USA were 6.9 million during 2005–2008.[26] DN is also a common cause of ESRD in many Arabic countries such as Libya,[27] Kuwait, Egypt, and Lebanon.[28] In Saudi Arabia, at the end of 2014, DN affected 41.7% of all ESRD cases.[9] On the other hand, DM was one of the least encountered causes of ESRD in some countries such as Egypt[29] and Yemen.[13] DN is an important public health and clinical challenge. Recently, the epidemiology and the concept of DN have changed, taking into account that histological renal lesions may vary from the nodular or diffuse glomerulosclerosis to tubulointerstitial and/or vascular lesions.[30] DN is associated with an increased risk of death from cardiovascular disease.[31],[32] Hypertension was responsible for 22.6% of all cases in our ESRD patients, compared with 35.5% in the whole country.[9] Hypertension is highly prevalent in Saudi Arabia. It was reported that hypertension affected more than 25% of the adult population.[33] This high prevalence may be related to the change in diet and lifestyles of the Saudis.[34] In the USA, hypertension and diabetes are the two leading causes for increasing number of individuals with ESRD.[4] Hypertension is also a major cause of ESRD in other regional countries such as Egypt,[29] Iran,[35] and Turkey.[36] Hypertension causes glomerular damage by affecting blood vessels and arteries which reduce blood flow to the kidneys.[37]

Our results show that 25.2% of patients were with unknown causes of ESRD. This is similar to the data from other countries. In Turkish-

Cypriots, 29.8% of the patients with ESRD had unknown etiology of their ESRD,[20] whereas, in Yemen, there were more than 57% of patients with unknown cause of ESRD.[13] Moreover, the unknown etiology of ESRD was 16.1% in the UK,[38] 10.5% in the Netherlands,[38] and 3.9% in the USA.[4] This highlights the need for earlier detection of these cases and possibility that there may be other uncharacterized conditions causing ESRD.[2]

Our study has some limitations, mainly related to the nature of the study. The data represented here were based on the number of patients in one single HD unit and probably do not represent the actual number of patients in the city. Therefore, the incidence of ESRD reported in our study may be an underestimate of the true incidence of ESRD. Moreover, our data were based on the recorded information of the patients. Early diagnosis may play a role in slowing the progression of kidney disease. We feel that our results can provide a foundation for future researchers to undertake further studies.


   Acknowledgment Top


The authors extend their appreciation to the Deanship of Scientific Research at Tabuk University for funding the work through the research group Project No. S-0157-1436.

Conflict of interest:

None declared.

 
   References Top

1.
Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant 2012;27 Suppl 3: iii73-80.  Back to cited text no. 1
    
2.
Kopple JD. National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2001;37 1 Suppl 2:S66-70.  Back to cited text no. 2
    
3.
Mathur AK, Ashby VB, Sands RL, Wolfe RA. Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation. Am J Transplant 2010;10(4 Pt 2):1069-80.  Back to cited text no. 3
    
4.
U.S. Renal Data System (USRDS). Annual Data Report: Atlas of Chronic Kidney Disease and end-stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016. Available from: http://www.usrds.org/adr.aspx.  Back to cited text no. 4
    
5.
ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2008. Amsterdam, The Netherlands: Academic Medical Center, Department of Medical Informatics; 2010.  Back to cited text no. 5
    
6.
Woo KT, Choong HL, Wong KS, Tan HB, Chan CM. The contribution of chronic kidney disease to the global burden of major non-communicable diseases. Kidney Int 2012;81: 1044-5.  Back to cited text no. 6
    
7.
Saran R, Li Y, Robinson B, et al. US Renal Data System 2015 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 2016;673 Suppl 1:Svii, S1-305.  Back to cited text no. 7
    
8.
Al-Sayyari AA, Shaheen FA. End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene. Saudi Med J 2011;32: 339-46.  Back to cited text no. 8
    
9.
SCOT Data. Dialysis in the Kingdom of Saudi Arabia. Saudi J Kidney Dis Transpl 2015;26:839-48.  Back to cited text no. 9
    
10.
Byrne C, Ford D, Gilg J, Ansell D, Feehally J.UK Renal Registry 12th Annual Report (December 2009): Chapter 3: UK ESRD incident rates in 2008: National and centre-specific analyses. Nephron Clin Pract 2010; 115 Suppl 1:c9-39.  Back to cited text no. 10
    
11.
Subramanian PT, Jamal A, Shah MY. Hemodialysis utilization in a single in-center dialysis unit, in the Kingdom of Saudi Arabia. Saudi J Kidney Dis Transpl 2001;12:64-74.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
El Minshawy O, Ghabrah T, El Bassuoni E. End-stage renal disease in Tabuk Area, Saudi Arabia: An epidemiological study. Saudi J Kidney Dis Transpl 2014;25:192-5.  Back to cited text no. 12
    
13.
Al-Rohani M. Causes of chronic renal failure at one center in Yemen. Saudi J Kidney Dis Transpl 2003;14:80-3.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Khader MI, Snouber S, Alkhatib A, Nazzal Z, Dudin A. Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine. Saudi J Kidney Dis Transpl 2013; 24:832-7.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
UK Renal Registry. The Eighteenth Annual Report; 2015. Available from: https://www.renalreg.org/reports/2015-eighteenth-annual-report/.  Back to cited text no. 15
    
16.
Australia and New Zealand Dialysis and Transplant Registry [ANZDTA]. The 39th Annual ANZDATA Report 2016. http:// www.anzdata.org.au/v1/report_2016.html  Back to cited text no. 16
    
17.
Chandrashekar A, Ramakrishnan S, Rangarajan D. Survival analysis of patients on maintenance hemodialysis. Indian J Nephrol 2014;24:206-13.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: Systematic review. BMC Public Health 2008;8:117.  Back to cited text no. 18
    
19.
Ashby VB, Kalbfleisch JD, Wolfe RA, Lin MJ, Port FK, Leichtman AB. Geographic variability in access to primary kidney transplantation in the United States, 1996-2005. Am J Transplant 2007;7(5 Pt 2):1412-23.  Back to cited text no. 19
    
20.
Connor TM, Oygar DD, Gale DP, et al. Incidence of end-stage renal disease in the Turkish-Cypriot population of Northern Cyprus: A population based study. PLoS One 2013;8: e54394.  Back to cited text no. 20
    
21.
Badheeb AM. Causes of Chronic Renal Failure in Hemodialysis Unit: A single center experience in Yemen. Saudi J Kidney Dis Transpl 2006;17:66-9.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Jondeby MS, De-Los Santos GG, Al-Ghamdi AM, et al. Caring for hemodialysis patients in Saudi Arabia. Past, present and future. Saudi Med J 2001;22:199-204.  Back to cited text no. 22
    
23.
Muneer A, Al Nusairat I, Kabir MZ. Clinical profiles of chronic renal failure patients at referral to nephrologist. Saudi J Kidney Dis Transpl 2004;15:468-72.  Back to cited text no. 23
[PUBMED]  [Full text]  
24.
Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 2015;66(1 Suppl 1): Svii, S1-305.  Back to cited text no. 24
    
25.
Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: A report from an ADA Consensus Conference. Am J Kidney Dis 2014;64:510-33.  Back to cited text no. 25
    
26.
de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA 2011;305:2532-9.  Back to cited text no. 26
    
27.
Goleg FA, Kong NC, Sahathevan R. Dialysis-treated end-stage kidney disease in Libya: Epidemiology and risk factors. Int Urol Nephrol 2014;46:1581-7.  Back to cited text no. 27
    
28.
Shaheen FA, Al-Khader AA. Epidemiology and causes of end stage renal disease (ESRD). Saudi J Kidney Dis Transpl 2005;16:277-81.  Back to cited text no. 28
[PUBMED]  [Full text]  
29.
El-Minshawy O, Kamel EG. Diabetics on hemodialysis in El-Minia Governorate, Upper Egypt: Five-year study. Int Urol Nephrol 2011; 43:507-12.  Back to cited text no. 29
    
30.
Martínez-Castelao A, Navarro-González JF, Górriz JL, de Alvaro F. The concept and the epidemiology of diabetic nephropathy have changed in recent years. J Clin Med 2015;4: 1207-16.  Back to cited text no. 30
    
31.
Pálsson R, Patel UD. Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis 2014;21:273-80.  Back to cited text no. 31
    
32.
Mora-Fernández C, Domínguez-Pimentel V, de Fuentes MM, Górriz JL, Martínez-Castelao A, Navarro-González JF. Diabetic kidney disease: From physiology to therapeutics. J Physiol 2014;592:3997-4012.  Back to cited text no. 32
    
33.
Saeed AA, Al-Hamdan NA, Bahnassy AA, Abdalla AM, Abbas MA, Abuzaid LZ. Prevalence, awareness, treatment, and control of hypertension among Saudi adult population: A national survey. Int J Hypertens 2011;2011: 174135.  Back to cited text no. 33
    
34.
Almutary H, Bonner A, Douglas C. Chronic kidney disease in Saudi Arabia: A nursing perspective. Middle East J Nurs 2013;7:17-26.  Back to cited text no. 34
    
35.
Nemati E, Ghanbarpour F, Taheri S, Einollahi B. Prevalence of hypertension among Iranian hemodialysis patients and associated risk factors: A nationwide multicenter study. Pak J Biol Sci 2008;11:910-4.  Back to cited text no. 35
    
36.
Turkish Society of Nephrology (2008). Registry of the Nephrology, Dialysis and Transplantation in Turkey. Annual Report Books. Istanbul.  Back to cited text no. 36
    
37.
Bidani AK, Griffin KA. Pathophysiology of hypertensive renal damage: Implications for therapy. Hypertension 2004;44:595-601.  Back to cited text no. 37
    
38.
ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2012. Amsterdam, The Netherlands: Academic Medical Centre, Department of Medical Informatics; 2014.  Back to cited text no. 38
    

Top
Correspondence Address:
Mohammed A Al-Duais
Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia

Login to access the Email id


DOI: 10.4103/1319-2442.202769

PMID: 28352019

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
   Introduction
   Subjects and Methods
   Statistical Analysis
   Results
   Discussion
   Acknowledgment
    References
    Article Tables
 

 Article Access Statistics
    Viewed1703    
    Printed7    
    Emailed0    
    PDF Downloaded239    
    Comments [Add]    

Recommend this journal