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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1998  |  Volume : 9  |  Issue : 4  |  Page : 425-430
Incidence of Treated End-Stage Renal Disease in Asir Region, Southern Saudi Arabia

1 Department of Medicine, College of Medicine, King Saud University, Abha Branch, Abha, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine, King Saud University, Abha Branch, Abha, Saudi Arabia

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Incidence of treated end-stage renal disease (t-ESRD) in Saudi Arabia is not well documented and only few reports are available. This study was conducted to determine the incidence of t-ESRD in Asir region. The study period included January 1995 to December 1995. All new cases admitted for chronic dialysis treatment in all MOH­hospitals with a diagnosis of ESRD were included. There were 114 Saudi and 10 non-Saudi Patients. Among the 114 Saudi patients, there were 64 (56.1%) males and 50 (43.9%) females. Mean age 47.86 ± 19.86 years (range 9-90 years). The overall incidence of t­ESRD was 214.9 pmp. Age adjusted incidence for males and females were 243 pmp and 186 pmp, respectively. There were no differences between males and females (X 2 =2.019, p = <0.05). The majority of the patients (41.2%) did not have definitive diagnosis. Among the known causes, glomerulonephritis was diagnosed or suspected in 56.7%, diabetes was the cause of ESRD in 16.4% of the cases. This is the highest incidence of ESRD ever reported in Saudi Arabia. Geographical, environmental, genetical factors may have been contributing factors.

Keywords: Incidence, End-stage renal disease, Asir region, Saudi Arabia.

How to cite this article:
Al-Homrany M, Abolfotoh M. Incidence of Treated End-Stage Renal Disease in Asir Region, Southern Saudi Arabia. Saudi J Kidney Dis Transpl 1998;9:425-30

How to cite this URL:
Al-Homrany M, Abolfotoh M. Incidence of Treated End-Stage Renal Disease in Asir Region, Southern Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2021 Apr 15];9:425-30. Available from: https://www.sjkdt.org/text.asp?1998/9/4/425/39100

   Introduction Top

End-stage renal disease (ESRD) causes significant morbidity and mortality world­-wide and renal replacement therapies (dialysis or transplantation) are very expensive modes of treatment. In Saudi Arabia, the number of patients who reach ESRD, and require dialysis is increasing'. The true incidence of ESRD in Saudi Arabia is not known and few reports are available [2],[3],[4],[5],[6],[7] . Most of these reports are hospital-based studies, and some were conducted in the early eighties prior to the expansion of dialysis facilities throughout the country.

Asir region is located in the southwestern region of Saudi Arabia. There are 11 dialysis units in the region affiliated to the Ministry of Health hospitals to serve around 1/2 million Saudi population. [8] Any patient with symptoms requiring dialysis is expected to book to the nearest hospital. Asir Central Hospital is the tertiary hospital for the entire Asir region. We conducted this study in order to determine the incidence of treated end stage renal disease (t-ESRD) and to identify the possible etiological factors.

   Material and Methods Top

The study involves all Ministry of Health hospitals that have dialysis facilities (11 units) in Asir region. Only new cases with the diagnosis of ESRD requiring maintenance renal replacement therapy (hemo or peritoneal disease) between January 1st and December 31st, 1995 were included. Temporary visitors from other regions were not included. All target patients underwent full history, examination, and full investi­gations including complete blood count (CBC), Urea, creatinine, serum electrolytes, blood sugar, arterial blood gases, liver function test, urinalysis, chest X-ray, abdominal ultra sound, hepatitis screen, bilharzial titre, serum complement level (C3, C4), antinuclear anti-bodies (ANA), anti-DNA and some patients had voiding cystogram. All patients were referred to Asir Central Hospital (ACH) for creation of arteriovenous fistula (AVF) and were re-evaluated again for their diagnoses. Only three patients were treated with peritoneal dialysis. Cases who appeared for the; time without prior follow-up were labeled ESRD without definitive cause (unknown). The diagnoses in the rest of the cases w made based on the history, clinical examination and laboratory tests. These patients were known to have chronic renal failure and have been under follow-up for sometime before they reached dialysis (range between 9 months to seven years). Diagnosis glomerulonephritis was based on kidney biopsy proven diagnosis (20 cases: seven membranoproliferative, four focal segment two crescentic glomerulonephritis, and seven with features of chronic changes) or those cases which were followed, up for years with suspected diagnosis based on the presence proteinuria, and small kidneys and in the absence of any other risk factors. All cast were registered in both ACH and the referring hospitals.

   Statistical Analysis Top

Data was analyzed by the use of SPS; software program, chi-square test and z-test were used for comparing the categorical data, and ANOVA test was used for comparing the quantitative data. Both 5^i and 10% levels of significance were applied.

   Results Top

A total of 124 cases of t-ESRD were identified, with a mean age of 47.86 ± 19.85 years, range (9-99 years), 114 Saudis (91.9%) and 10 Non-Saudis (8.1%). Among the 114 Saudis, 64 (56.1%) were males and 50 (43.9%) females. The overall incidence of ESRD in Asir region was 214.9 per million population (PMP), with highest incidence reported in Billasmar (844.7 PMP) and lowest in Rejal Alma (65.6 PMP) [Table - 1]. [Table - 2] shows the distribution of the incidence by age and sex, the overall incidence in male and female patients were 243.8 PMP and 186.6 PMP, respectively, with no significant differences between sexes (X2 = 2.019, p > 0.05). The incidence of ESRD is increased with age with the highest incidence in-patients above 45 years old. However, there is no significant difference between the incidences in patients at age group of 45-64 years and those above 65 years (Z - 0.811, p > 0.05) [Table - 2]. The cause of ESRD was not known in 47 patients (41.2%) while glomerulonephritis was the commonest known cause (56.7%) [Table - 3]. We compared the distribution of ESRD by mean age and cause. We found that the patients with glomerulonephritis were the youngest, while those with diabetes, chronic pyelonephritis and obstructive uropathy were older.

   Discussion Top

Our results show high incidence of t­ESRD in Asir region higher than ever reported in Saudi Arabia. Recent report by Mitwalli et al showed that the incidence rates of ESRD in two different regions, Gizan and Al-Madinah, were 189.4 PMP and 65.2 PMP, respectively. [7] Data from other parts of the world showed that the incidence of t-ESRD is as follows: USA - 214 PMP, Japan - 190 PMP, France -85 PMP, Australia - 61 PMP, UK - 60 PMP, and New Zealand - 69 PMP. [9] There are several explanations for the high incidence in our population; a) The previous reports were conducted in the early eighties before the expansion of dialysis units and most of these studies were hospital-based and single center experiences. [2],[3],[5],[6] b) Regional variation in the incidence of ESRD is observed worldwide. [10],[11],[12],[13] Therefore, genetic and geographical factors may have contri­buted to the differences between our results and other investigators; c) Tropical diseases such as schistosomiasis, malaria and viral hepatitis are known to be associated with certain glomerular diseases. [13],[14],[15],[16] Asir region, Southern Saudi Arabia, is known to have high prevalence of such tropical diseases. [17],[18],[19],[20],[21] However, further studies are needed to confirm the true association of these diseases and the high incidence of ESRD we observed in the region.

Our results showed that the commonest known causes of ESRD in Asir region is glomerulonephritis (56.7%) whereas diabetes is responsible for 16.4% of the cases. Recent report by Mitwalli et al, found that obstructive uropathy is the leading causes of ESRD in Gizan region (24%) and diabetes is the commonest cause of ESRD (45.2%) in AI-Madinah area. [22] The majority of our patients (40%) presented late without prior diagnosis or follow-up. This might be due to the fact that most of the renal diseases present in a silent way and are only discovered during routine investigation of blood or urinalysis.

Such presentation could cause excess morbidity and may result in higher health care cost and harm to patient's. [23] Aware­ness of the public and health workers towards such health problem is the first and essential step to be taken. In addition, early detection of signs of renal disease and prompt treatment will reduce the number of patients reaching dialysis. These steps of detecting early manifestations of renal diseases should be implemented by the Primary Health Care Centers (PHCCs) which are accessible to the whole population in Saudi Arabia. A previous study conducted in the same region showed that 11-20% of the patients attending PHCCs had abnormal urinalysis [24] . Furthermore, we believe that there is a need to conduct large-scale study covering all regions of Saudi Arabia in order to identify the true incidence of ESRD and possible etiologic factors.

   Acknowledgment Top

We would like to thank all physicians working in the Dialysis Units in Asir region who participated in the study. Also, we appreciate the secretarial assistance of Mr. Rollie Go and Mr. Allan Agaton.

   References Top

1.Shahcen FAM. Organ transplantation in theKingdom of Saudi Arabia: new strategies.Saudi J Kidney Dis Transplant 1994;5(l):3-5.  Back to cited text no. 1    
2.Nielson GW, Nielson B. On the prevalenceof kidney disease in Southern Saudi Arabia (Abstract). Kidney Int 1984;26(4):487.  Back to cited text no. 2    
3.Veberbrants E, Said R, Hussein M. Four-year experience with end-stage renal disease in Saudi Arabia. Kidney Int 1985; 27(1):173.  Back to cited text no. 3    
4.Ibrahim MA, Kordy MN. End-stage renaldisease (ESRD) in Saudi Arabia. Asia Pac J Public Health 1992-93;6(3); 140-5.  Back to cited text no. 4    
5.Lokkeguard H, Chander WP 5 Hafez M,Malik GH, Nielson B 5 Paul TT. One yearexperience with treatment of terminal renalfailure at King Fahd Hospital, Gizan. SaudiMedJ1986;7(6):553-60.  Back to cited text no. 5    
6.Hussein M, Mooij J, Roujouleh H, Bakir N.End-stage renal disease in Saudi Arabia: a single centre study. Saudi Kidney Dis Transplant Bull 1991;2(2):79-84.  Back to cited text no. 6    
7.Mitwalli AH, Al-Swailem AR, Aziz KMS,et al. The incidence of end-stage renaldisease in two regions of Kingdom of SaudiArabia. Saudi J Kidney Dis Transplant1995;6{3):280-5.  Back to cited text no. 7    
8.Directorate of Health in Asir region. AnnualReport 1995.  Back to cited text no. 8    
9.International comparison of ESRD therapy.Am J Kidney Dis 1997;30(2)Suppl 1:S187-S194.  Back to cited text no. 9    
10.McClellan W, Brogan D. The epidemiologyof end-stage renal disease in Georgia. J MedAssocGal990;79(3): 153-6.  Back to cited text no. 10    
11.Eastcrling RE. Racial factors in theincidence and causation of end-stage renaldisease (ESRD). Trans Am Soc Artif InternOrgans 1977;23:28-33.  Back to cited text no. 11    
12.Rosansky SJ, Huntsberger TL, Jackson K,Eggers P. Comparative incidence rates ofend-stage renal disease treatment by state.AmJNephrol 1990;10(3):198-204.  Back to cited text no. 12    
13.Byrne C, Nedelman J, Luke RG. Race,socioeconomic status and the developmentof end-stage renal disease. Am J Kidney DisI994;23{l):16-22.  Back to cited text no. 13    
14.Sitprija V. Nephropathy in falciparummalaria. Kidney Tnt 1988;34;867-77.  Back to cited text no. 14    
15.Andrade ZA, Rocha H. Schistosomalglomerulopathy. Kidney Int 1997;16;23-9.  Back to cited text no. 15    
16.Johnson RJ, Gretch DR, Yamabe H, et al.Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med 1993;328:465-70.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]
17.Johnson RJ, Couser WG. Hepatitis Binfection and renal disease: clinical, immu-nopathogenetic and therapeutic considerations. Kidney Int 1990;37:663-76.  Back to cited text no. 17  [PUBMED]  
18.Alseghayer S. Malaria controls in theKingdom of Saudi Arabia. Saudi Epidemiol Bull 1996;3(1):4.  Back to cited text no. 18    
19.Al-Knawy B, El-Mekki A, Hamdi J, Thiga R,Sheikha A. Prevalence of antibody to hepatitis C virus in Saudi blood donor. Can J Gastroenterol 1995;9(3):141-43.  Back to cited text no. 19    
20.Fayed MA. Scliistosomiasis in Asir districtin southern region of Saudi Arabia. J Egypt Soc Parasitol 1985;15:289-92.  Back to cited text no. 20  [PUBMED]  
21.Al-Madani AA. Problems in the control ofschistosomiasis in Asir province, Saudi Arabia. J Community Health 1991;16(3):143-9.  Back to cited text no. 21    
22.Mitwalli AH, Al-Swailem AR, Aziz KMS,et al. Etiology of end-stage renal disease in two regions of Saudi Arabia. Saudi J Kidney Dis Transplant 1997;8(1): 16-20.  Back to cited text no. 22    
23.Ifudu O5 Dawood M, Homel P, Friedman EA.Excess morbidity in patients starting uremiatherapy without prior care by a ncphrologist.Am J Kidney Dis 1996;28(6):841-5.  Back to cited text no. 23    
24.Al-Homrany M, Mirdad S, Al-Harbi N, Mahfouz A, Al-Amari 0, Abdulla S. Utility of urinalysis in patients attending primary health care centers. Saudi J Kidney Dis Transplant 1997;8(4): 419-22.  Back to cited text no. 24    

Correspondence Address:
Mohammed Al-Homrany
Associate Professor of Medicine, King Saud University, Abha Branch, P.O. Box 641, Abha
Saudi Arabia
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PMID: 18408312

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