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RENAL DATA FROM THE ARAB WORLD |
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| Year : 2009 | Volume
: 20
| Issue : 1 | Page : 140-146 |
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| Epidemiology of hemodialysis patients in Aleppo city |
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Ghamez Moukeh1, Rabi Yacoub1, Fadi Fahdi1, Samer Rastam2, Sami Albitar1
1 Department of Nephrology, Aleppo University, Aleppo, Syria
2 Department of Biostatistics, Aleppo University, Aleppo, Syria
Click here for correspondence address and email
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 Abstract | | |
To determine the characteristics of the hemodialysis (HD) patients in Aleppo city, we surveyed the hospitals representing the main dialysis centers in the city including private and community facilities during 2006. Personal patients' interviews and hospitals records were the source of data. The total number of patients in 2006 undergoing HD was 550 patients; 280 (50.9%) were males, and the age ranged from 5-82 years with mean and median age 44.7 and 45 years, respectively. The incidence (IR) and prevalence rate (PR) for hemodialysis were 60 pmp and 226 pmp, respectively. The major primary renal diseases in the end-stage renal disease (ESRD) patients included hypertension (HTN), glomerulonephritis (GN), and diabetes mellitus (DM), 21.1%, 20.5 %, and 19.45, respectively. The percent of Anti-HCV, HBV hepatitis and HBV vaccine were 54.4%, 7.8%, and 52.9%, respectively. This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population. Keywords: Aleppo city, Epidemiology, ESRD, HBV, HCV, HD
How to cite this article:
Moukeh G, Yacoub R, Fahdi F, Rastam S, Albitar S. Epidemiology of hemodialysis patients in Aleppo city. Saudi J Kidney Dis Transpl 2009;20:140-6 |
How to cite this URL:
Moukeh G, Yacoub R, Fahdi F, Rastam S, Albitar S. Epidemiology of hemodialysis patients in Aleppo city. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 27];20:140-6. Available from: https://www.sjkdt.org/text.asp?2009/20/1/140/44725 |
| Introduction | |  |
The management chronic renal failure, especially hemodialysis (HD), is considered one of the most arising medical problems for clinicians and workers in the medical field in our country and the world due to increased median age of the population and increased number of chronic diseases such as hypertension (HTN) and diabetes mellitus (DM) (12% of the population in Syria, and 24% of them are in the province of Aleppo). [1]
The total number of the population in Syria in 2006 was about 19.17 million (excluding the Iraqi refugees). [2] The estimated population of Aleppo city was 2.431 million, [2] and the male counts were 1.264 million. [2] The accurate statistics of renal replacement therapy (RRT) and especially HD were not found in Syria, especially in Aleppo city. However, in Turkey, the prevalence rate (PR) equal 281 pmp and incidence rate (IR) was 52 pmp in 2002. [3]
Accordingly, we attempt in this study to assess the HD services in Aleppo city, as a sample of the Syrian population, in order to improve the medical care.
| Patients and Methods | | |
This is a cross-sectional study under the auspices of Aleppo University. We surveyed 5 dialysis centers in Aleppo city from January 1 to December 31, 2006. The centers belonged to public (Aleppo University Hospital: AUH, Educational Kidney Hospital, and Ibn Rushed hospital) and private sectors (we named them Z, and S), we considered that because there was a participation in treating those patients between private and public centers. We excluded the patients with acute renal failure, and those who failed their kidney graft. The total number of patients was 550, and the total number of Aleppo city inhabitants was about 2.5 million. The dialysis centers, machines, and count of the weekly sessions are shown in [Table 1].
Data collection
Personal interviews with the patients in the centers using a questionnaire, which was filled up by medical staff, and we checked the laboratory records for patients. The collected data included gender, age, socioeconomic status, educational status, and co-morbidity.
We also studied the causes of end-stage renal disease (ESRD), the hepatitis status (HBV, and HCV), administration of HBV vaccines, HD starting age, vascular access, dialysate used in HD, HD frequency (weekly) at starting and present, albumin status, adjunctive therapy (iron, calcium, erythropoietin: EPO), and dialysis adequacy (Kt/V, percent reduction urea: PRU).
| Statistical analysis | | |
We used the statistical program "SPSS®" for windows to analyze the data we got from the questionnaire for getting the percentages and statistical data (mean, median, Standard Deviation: SD), IR and PR are given as number per million population (p.m.p), besides the tables and appropriate charts. We used Backwald logistic regression for the risk of hepatitis, HBs-Ag and Anti-HCV, by calculating the odd ratio, confidence interval (CI 95%), and Pvalues for possible risk factors.
| Results | | |
Overall incidence and prevalence rate of HD in ESRD patients
The total numbers of patients undergoing HD for ESRD in Aleppo city during the 2006 period were 550 patients (pts). Accordingly, the HD IR was 60 pmp, PR 226 pmp, and the new cases in 2006 were 145 patients.
Gender and age statistics
The female and male patients were 280, 270 pts (50.9%, 49.1%), respectively. The patients' age and gender are shown in [Table 2], and the patients' age distribution is shown in [Figure 1].
The duration of patients on HD was as follow: less or equal to 5 years in 445(80.9%) patients, 6-10 years in 82 (14.9%), and more than 10 years 23(4.2%). The distribution of patients between private and public centers was as follows: 387 patients (70.4%) in public centers and 117 pts. (21.3%) in private centers; 46 patients (8.4%) have HD in multicenter programs moving between public and private centers.
There were 500 (90.9%) patients with AVfistula, and whereas central vein catheter in 50 (9.1%). In addition, 473 (86%) patients were dialyzed against bicarbonate dialysate.
The albumin status in 174 patients showed that 131 (75.3%) had albumin > 35 g/L, whereas 43 (24.7%) had < 3.5 g/L.
The supplemental iron, calcium, 1a-OH calcifirol, and Erythropoietin are shown in [Table 3]. We excluded patients who used EPO iregularly and less than 50 U/Kg three times weekly; almost all patients received EPO after they were started on HD due to economic issues.
We calculated the Kt/V [4] and distribution for 48 patients, which showed Kt/V < 1.2 was in 25 (52.1%) patients, between 1.2-1.6 in 18 (37.5%), and > 1.6 in 5 (10.42%).
The primary causes of ESRD of the study patients are shown in [Table 4].
The subdivisions for each primary renal disease were as follow:
- Diabetes mellitus: DM-1 (5.6%), and DM2 (94.4%), with a mean age when beginning HD (years) for DM-1 (30 ± 5.8) and for DM-2 (58.5 ± 8.5).
- Obstructive Nephropathy: stones (63.6%), prostate (15.8%), and others (21.1%), with a mean age when beginning HD (years) for stones (40.7 ± 17.2), prostate (63.1 ± 6.7), and others (25.5 ± 8.5).
- Hereditary: Polycystic Kidney Disease (PKD) (85.3%), Alport's syndrome (11.4%), and others (2.9%), with a mean age when beginning HD (years) for PKD was (43.1 ± 15.1), and for Alport's syndrome (18 ± 3.5).
- Tublointerstitial Nephritis: Drugs (46.8%), vesicourthral reflux (4.8%), urate nephropathy (3.2%), neurologic bladder (30.6%), chronic pyelonephritis (14.5%), with a mean age at starting HD (years) for drugs (36.9 ± 15.9), vesicourtheral reflux (14 ± 5.2), urate nephropathy (50.5 ± 27.5), neurologic bladder (19.8 ± 7.5), and chronic pyelonephritis (41.8 ± 16).
Comorbidity
The causes of comorbidity of our HD patients are shown in [Table 5].
Hepatitis epidemiology
The data about hepatitis is summarized in [Table 6]. We counted only those who had the 3 shots of HBV vaccine (2 mL/shot). HBV and HCV hepatitis investigations were performed twice with 6 months period apart.
By using Backwald logistic regression for possible risk factors of HBV, and HCV we found that:
- Odd ratio (OR) for acquiring HBV in the absence of HBV vaccination was 8.3 with CI 95% (3.4-20.2), and p< (0.000).
- OR for acquiring Anti-HCV positive with respect HD duration was 1.55 with CI 95% (1.392-1.728), and p< (0.000). The Anti-HVC distribution according to HD duration is shown in [Figure 2].
- OR for acquiring anti-HCV positive according to the affiliation of the dialysis center 0.297 for private CI 95% (0.1750.506) and p= 0.000, and for multicenter odd ratio equals 0.651 with CI 95% (0.286-1.480) and P-value (0.306) in comparison with the public centers.
- OR for acquiring anti-HCV positive according to HD frequency thrice-weekly regimen equals 1.886, with CI 95% (0.9543.328) and P-value (0.068). The same for contracting HBV the odd ratio for thriceweekly regimen at present equals 2.2, with CI 95% (1-4.9), and P-value (0.064).
| Discussion | | |
This epidemiological study was the first extensive study about HD patients in Aleppo city. As we know this medical issue is rapidly growing in all countries, as in the USA, which had PR in 2005 greater than 1.4 times in 1995. [5] Our study can be a baseline for further studies in Syria.
The overall PR and IR were relatively lower than western countries [Table 7]. For USA, [5] and France, [6] but relatively equals to Turkey, [3] and greater than Iran. [7] Keeping in mind that low IR is a result of strict criteria of HD beginning, and low PR is induced by relatively high mortality rate and very low rate of kidney transplantation in Syria.
PMP: Per million population
In our study, the sex ratios (male/female) of PR and IR were 0.96, and 1.12, respectively. That indirectly reflects lower survival rate in males. This estimate is consistent with the USA (1.47, 1.54, [5] and France (1.61, 1.74) [6] studies. We found that the PR and IR were generally increased. The PR at age > 65 years was about 69 times greater than those aged < 14 years. The IR in age > 65 years was 37 times greater than those aged :5 14 years; and that increasing IR was consistent with Ile de France study, which showed that IR in age > 75 years was about 19 times greater than those aged :5 17 years; this indicates indirectly worsening chronic kidney disease (CKD) management in Syria.
The commonest age category was 40-49 years, which is younger than in France [6] and USA, [5] which showed that the most common age category was 70-79 years,
The nutritional status determined by albumin levels was relatively accepted, but still lower than 82% in Turkey. [3] The percentage of EPO was 15.1% that is lower than Turkey (70%), [3] and USA (90%). [8] Almost all these patients received EPO after HD starting, so when we compared that with the USA which was accounted to about 2/3 of patients in 2004, [9] this lead us to economic load on both advanced, and more in developing countries. The standard thrice-weekly regimen was about 13.6% and that was very lower even when compared with developing countries as in Iran (49.6%) in 2002. [7]
The first major comorbidities were (in order) anemia (91.8%), HTN (75.6%), and DM (18.4%). The CAD was founded more in males (19.1%) versus females (11.5%); this probably explains lower PR and higher IR in males when compared with females. Anemia was found more common in females (95.9%) compared with males (87.9%); this may be due to menstrual period.
HBV was found in 7.8% overall, and that was lower than Brazil 12%, [10] Hong Kong 10%, [11] and Taiwan 16.8%, [12] but higher than the USA 1%, [13] Turkey 5%, [3] Iran 5.1%, [7] Japan 1.6%, [14] and Italy 5.9%. [15] Our relatively good results may be due to HBV vaccination policy, which covered 52.9% of the patients.
HCV was found in 54.4% overall, and that is lower than Moldavia 75%, [16] but higher than USA 5.5-10%, [13] France 42%, [17] Italy 13.531%, [18],[19],[20] and Turkey 27%. [3] The prevalence of anti-HCV positive increased from 46.1% to 89% before and after 5 years of HD duration and that is disturbing when compared with the results of a study in the USA, which considered a period of 10 years duration to significantly increase the chance of acquiring HCV infection. [21] The prevalence of anti-HCV positive was relatively equal between males (53.9%) and females (54.8%), and that disagreed with USA studies which showed higher prevalence in males. [22],[23]
The leading primary renal diseases were, in order: HTN (21.1%), GN (20.5%), and DM (19.5%), with GN as a leading disease in males (21.7%), and in females HTN (22.9%). That is relatively consistent with France which showed the order: HTN (22.5%), DM (20.6%), and GN (20.3%). [6] So the leading renal diseases were the same, but the HD starting age were lower in our study when compared with the same study [Table 8], this period (years) was about 22.7 years in HTN, 21.5 in GN, 6.3 in DM, and 13.2 in PKD. This is consistent with the lower level of CKD management, especially with HTN, GN, DM, and PKD (PKD accounted for 7.7%, in France [6] and in our study 5.3%).
This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population.
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Correspondence Address:
Ghamez Moukeh
Aleppo University, P.O. Box 7876, Aleppo
Syria
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PMID: 19112237 
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8] |
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