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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2006  |  Volume : 17  |  Issue : 1  |  Page : 66-69
Causes of Chronic Renal Failure in Hemodialysis Unit: A single center experience in Yemen

Department of Medicine, College of Medicine, University of Hadhramout for Science and Technology, Mukalla, Yemen

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This cross-sectional study was carried out to determine the possible causes of chronic renal failure (CRF) in Ibn Sina Teaching Hospital (ISTH) in Hadramout, Yemen. Fifty-one CRF patients (29 men and 22 women) on regular hemodialysis were included in the study. Glomerulonephritis (25.4%) was the commonest cause of CRF, followed by obstructive nephropathy (13.7%), hypertension (11.8%), pyelonephrits (11.8%), diabetic nephropathy (7.8%), arthritis, malaria, vasculitis and postpartum hemorrhage (5.9% each) and the least common one was Alport's syndrome (3.9%). There were more men than women (57% and 43%, respectively). The mean age range of the patients was 42 years. More patients were the from coast of Mukalla than from the valley and desert (59% and 41%) respectively

Keywords: Chronic, renal, failure, Hemodialysis.

How to cite this article:
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

How to cite this URL:
Badheeb AM. Causes of Chronic Renal Failure in Hemodialysis Unit: A single center experience in Yemen. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Jan 27];17:66-9. Available from: https://www.sjkdt.org/text.asp?2006/17/1/66/32449

   Introduction Top

There is large population on dialysis world wide.[1] The social and economic consequences of chronic renal failure (CRF) are conside­rable.[2],[3] The last decade has witnessed a marked increase in the incidence of end stage renal disease (ESRD) across the world. [4],[5]

Further, there are important differences in the incidence of end-stage renal disease (ESRD) according to age, gender and race. The incidence of ESRD is higher in males and tends to increase with age reaching around 1000 PMP/Year in patients over 65 years.[4] In the US, the incidence of ESRD is higher in African Americans and native Americans.[6]

In Yemen, a study of ESRD in Sana'a area (population 1,200,000) showed an incidence of 385 PMP/Year.[7] If the results were extra­polated to the whole population, one would expect almost 7000 new patients every year. Furthermore, in Hodaida, a city on the Red Sea, the incidence is probably higher due to the high prevalence of schistoso­miasis and renal stones. Aden, the commer­cial capital, with a population of half million, has about 200 new patients per year.[8]

Those patients who develop CRF may be asymptomatic in the early stage and symp­tommatic in the late stage of the disease.[1],[9],[10]

This study aims at the evaluation of the prevalence, causes, and the demographic and rehabilitative data of the CRF patients in Hadhramaut area, Yemen.

   Methods Top

This is a cross-sectional hospital based study of 51 patients with CRF. They received regular hemodialysis in Ibn Sina Teaching Hospital (ISTH) in Hadhramout, Yemen during the period from 1st December 2001­-30 th April 2002.

The patients were interviewed according to a questionnaire prepared for this purpose. The questionnaire was developed to include the relevant information such as: gender, age, presenting symptoms, past history…etc. Further information was obtained from patient's files. About the socio-economic condition we classified our patients according to their income, low, moderate and high. In calculating the prevalence of renal failure, the census adopted was of 1994.

   Results Top

The prevalence of renal failure in 1997 was 282.7 per million populations (pmp), then it increased to 495.8 pmp in 1999 and 2000 but in 2001 it decreased to 281.3 pmp, [Table - 1].

The presenting symptoms of CRF were commonly those of late stage of the disease such as 84.3% fatigue, 82.4% vomiting and 80.4% (anorexia and nausea).

Of the 51 CRF patients, 29 (57%) were men and 22(43%) were women. The age group distribution of the dialysis patients is shown in [Figure - 1]. The mean age was 42 years.

Glomerulonephritis (25.4%) was the commo­nest cause of CRF, followed by obstructive nephropathy (13.7%), hypertension (11.8%), pyelonephrits (11.8%), diabetic nephropathy (7.8%), arthritis, malaria, vasculitis and post­partum hemorrhage (5.9% each) and the least common one was Alport's syndrome (3.9%), [Table - 2].

The most common comorbidity was hypertension (HTN) in 39.2% followed by urinary stone in 27.5%, malaria in 9.8%, diabetes (DM) in 3.9%, prostatic disease in 3.9%, bilharzias in 2% and others in 9.8%. There were 3.9% of the patients without comorbidities. Of the study patients, 11.8% had hepatitis B, 2% had hepatitis C and nil cases of AIDS.

Thirty (59%) patients were from the coastal area while 21 (41%) were from valley and desert. Most of the patients were from the middle class (62.2%), while 35.1% of the patients were from the low class and 2.7% were from the high class. Most of the patients were illiterate (63%) while 35% had primary education and 2% had secondary education. Only five cases (9.8%) of CRF patients had a family history of renal failure.

The history of medication intake included non-steroidal anti-inflammatory drugs (NSAIDs) in 17.6% of the patients, anti-hypertensives in15.7% and anti-DM in 2%, while most of the patients (43.1%) had negative drug history. Among the study patients, smoking was seen in 5.9% followed by tobacco and Qat chewing in 3.9%, and alcohol consumption (2%).

The renal ultrasound findings included renal atrophy (29%), hydronephrosis (25.5%), chronic nephritis (21.6%), renal hypertrophy 19.3% and renal stones 9.8%. However, 45% of the ultrasound examinations showed normal kidneys.

   Discussion Top

The present study evaluates the demo­graphics of the dialysis population in a single center in Yemen. The mean age of the patients was 42 years; this finding is different from the studies reported from other countries.[11] There was a preponderance of males, which is close to the findings of other studies. [12] One third of our study patients were poor and many lived away from the dialysis center.

The pattern of renal disease causes in our study was similar to that reported from Europe, especially the GN percentage.[13],[14] However, our study showed that few patients had DM. in comparison with other developed countries that reported 25- 35% prevalence of DM in the dialysis population. [2],[11]

Hypertension is also one of the important risk factors in CRF. In our study, 11.8% of the patients were suffering from hypertensive nephropathy, whereas 8.33% of hyper­tensive nephropathy was reported in Saudi Arabia, 10% in India, and Australia and 9% in New Zealand.[15]

In our study 13.7% of the patients were found to have obstructive nephropathy; this percentage is high compared with the 3% in reports from other countries.[15]

   References Top

1.Jacop. Terminal chronic kidney failure: treatment by dialysis. Conformational and controversies after 35 year experience. Press med 1995 June;10:24; 972-4. ???  Back to cited text no. 1    
2.Davidson, principle and practice of medicine, chronic renal failure, 18 th edition ,Churchill living stone 1999 ; 432-7.  Back to cited text no. 2    
3.Walls J. Chronic renal failure -causes and conservation management, Med Int 9:144-8.  Back to cited text no. 3    
4.Incidence and prevalence of ESRD. United States Renal Data System. Am J kidney Dis 1998; 32 (suppl 1):S38-49.  Back to cited text no. 4    
5.Valderrabano F, Berthoux FC, Jones EH, Mehls. Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. Nephrol Dial Transpl 1996;11 (suppl 1):2-21.  Back to cited text no. 5    
6.Smith SR, Svetkey LP, Dennis VW. Racial differences in the incidence and progression of renal diseases. Kidney Int 1991; 40:815-22.  Back to cited text no. 6  [PUBMED]  
7.Sheibane AK. Abstract, EDTA procee­dings 1996;:117.  Back to cited text no. 7    
8.Sheiban A, AlGarba. Yemen nephro­logy - Revisited. Saudi J of kidney dis and transplant, 1999;10:183-6.  Back to cited text no. 8    
9.Kumar P, Clark M. Clinical medicine, chronic renal failure, Fourth edition, W.B Saunders,1999;.572-573.  Back to cited text no. 9    
10.Drucke TB. Well bone disease still remains one of the most serous compli­cation in dialysis patient? Nephrol dial transplant 1996;2-5.  Back to cited text no. 10    
11.Steinman TI. Kidney protection: how to prevent or delay chronic renal failure. Geniatrics1996;51:28-35.  Back to cited text no. 11    
12.Khalid Amin. Etiological prevalence of CRF, the professional medical journal, Vol.07. No.04, OCT, NOV, DEC, 2000. ???  Back to cited text no. 12    
13.Wing AJ.Causes of end stage of renal failure in Oxford text book of clinical nephrology, ed. Cameron JS, Davison AM, Grunffffield JP, DNS.1992.  Back to cited text no. 13    
14.Mallick Np.what do we learn from the European Registry; What will be the underlying problem in the year 2000? Nephrol Dial Transplant 1995;10:2-6.  Back to cited text no. 14  [PUBMED]  
15.Williams DG. The common causes of chronic renal failure. Med Int 1991; 86:3563-8.  Back to cited text no. 15    

Correspondence Address:
Ahmed M Badheeb
Department of Medicine, College of Medicine, University of Hadhramout for Science and Technology, Mukalla
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PMID: 17297542

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  [Table - 1], [Table - 2]


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