| Abstract|| |
In this report we present the current status of dialysis and transplantation in Yemen. The reported incidence of end stage renal disease (ESRD) in one region of Yemen was estimated as 385 per million population (PMP) per year. The total population of Yemen is also estimated as 16,000,000. Peritoneal dialysis was started in 1980, while hemodialysis was started in 1981. At present there are around 36 hemodialysis machines distributed in the large cities of Yemen. Intermittent peritoneal dialysis is commonly used; however, continuous ambulatory peritoneal dialysis has been out of practice since 1992. Renal transplantation has not yet been started in Yemen; however, at present there are 327 transplant patients being followed up in it. The majority of patients had their grafts from living non related donors abroad. In our experience, such transplantations were associated with high morbidity and mortality, in addition to acquisition of serious, potentially lethal extra-renal medical problems. We believe that there is a wide shortage of renal services in Yemen. Establishing a National Kidney Foundation to organize these services may be helpful.
Keywords: Yemen, Hemodialysis, Peritoneal dialysis, Transplantation.
|How to cite this article:|
Sheiban AK, Yehia A, Mohamed YA, Hajar A R. Renal Replacement Therapy in Yemen. Saudi J Kidney Dis Transpl 1996;7:313-4
| Introduction|| |
Yemen is located in the south western corner of Arabian Peninsula and has an area of 555,000 sq km. The population of Yemen, according to latest census in early 1995, is approximately 16,000,000. The capital of Yemen is Sana'a. Chronic renal failure has become one of the major health problems in Yemen  . The estimated annual incidence of ESRD in Sana'a region is 385 per million population  . The highest incidence occurred among patients between 20-50 years of age, with male: female ratio 2:1. This high incidence rate was attributed to certain environmental, socio-economic factors, endemicity of bilharziasis and other tropical diseases in Yemen. Obstructive uropathy with renal failure is still among the commonest causes of renal failure in Yemen  .
| History of Renal Replacement in Yemen|| |
1. Peritoneal Dialysis (PD)
Dialysis started in Yemen in 1980 by using peritoneal dialysis in a small center at Al Thawra Hospital. In 1990, eight PD cyclers were available at that center, in addition to 76 beds in the nephrology department.
a) Intermittent Peritoneal Dialysis (IPD):
IPD is commonly used in Yemen. Approximately 750 patients were treated with intermittent peritoneal dialysis in 1991. Those patients included nearly all new uraemic cases, who had on the average 3-4 dialysis sessions, children with severe diarrhea complicated with acute renal failure, and hemodialysis (HD) patients with failed vascular access or cardiac instability  .
b) Continuous Ambulatory Peritoneal
Only 16 patients were treated with CAPD between 1990-1991, however, this method of renal replacement therapy failed due to untoward side effects such as peritonitis, septicaemia, and inadequate follow up. It was abandoned in 1992.
2. Hemodialysis (HD)
Hemodialysis as a mode of renal replacement therapy was started in Yemen with two machines in Al Thawra Hospital in 1981. The center was expanded to eight hemodialysis machines in 1985. At present, there are 12 hemodialysis machines available at that center.
In 1987, six hemodialysis machines were installed at the Military Hospital in Sana'a. In 1992, another hemodialysis center with eight machines was established in Hodeida.
In 1993, a hemodialysis center with eight machines was established in Taiz, and another center with the same capacity was established in Aden. A new center is planned to start in Mukalla late in 1996.
Until now, renal transplantation has not been started in Yemen. Living unrelated kidney transplantation performed abroad is still the main source of transplantation for patients with ESRD in Yemen. At present, there are 327 transplant recipients actively followed up in this country. Most of the operations (86%) were performed in India, while 12% were performed in Iraq. Nevertheless, 2% of renal transplants using living related donors were performed in Saudi Arabia, Jordan and United Kingdom. Only one case received a cadeveric kidney in Germany  .
Follow-up of transplant patients is subsidised by the government including immunosuppressive therapy. The increased morbidity and mortality of the patients who had commercial renal transplants, was mostly related to inadequate standard medical workup prior to renal transplantation, especially those related to selection of donors and recipients. This has added tremendous economic burden on health care providers in Yemen.
| Conclusion and Recommendations|| |
Due to the high incidence of CRF and ESRD in Yemen and its impact on the economy of our country, we believe that efforts should be organized to have a "National Kidney Foundation". which may be responsible for the following:
Proper study of the size of obstructive uropathy and other correctable environmental factors in order to take the proper preventive measures.
Organizing proper health education in order to prevent the progression of renal diseases to ESRD.
Starting Renal Transplant Program after establishing the legality of transplantation from both living related and cadaveric kidney donors.
| References|| |
|1.||Mohammed YA, El-Sorori AW. Pattern of adult medical admissions at Al Thawra teaching hospital. Annual statistic report for 1993 department of vital and health statistic, 1994. Sana'a Yemen. |
|2.||Ministry of Health. Al-Thawra teaching hospital. Annual statistic report for 1933 department of vital and health statistic 1994. Sana'a Yemen. |
|3.||Sheiban AK. Chronic renal failure in Yemen Arab Republic. Med J Cairo Univ 1988;56:3. |
|4.||Sheiban AK, Thesis on chronic renal failure and hypertension in Yemen, Sana'a and Khartoum University 1994. |
|5.||Sheiban AK, Abu-Baker A, Abdullah HA. Kaposi Sarcoma among Yemeni renal transplant patients. Presented to the first Yemeni international medical congress 1991. Sana'a Yemen. |
Al Thawra Modern General Hospital, Sana'a