| Abstract|| |
The purpose of this study was to determine the prevalence, etiology and risk factors of treated end-stage renal disease (ESRD) in the region of Tabuk, Saudi Arabia. We studied 460 renal replacement therapy patients through a review of medical records and patient interviews and obtained patient demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. The estimated prevalence of treated ESRD was 460 per million populations (PMP); 350 (76%) were treated by hemodialysis, 30 (7%) by peritoneal dialysis and 80 (17%) by kidney transplantation. The mean age was 48 ± 17 years, body mass index was 25 ± 2 kg/m 2 and the male vs. female ratio was 64% vs. 36%. Most patients (55%) were living in rural areas. Etiology of the ESRD was unknown in 33%, hypertension in 24%, chronic glomerulonephritis in 8%, obstructive uropathy in 3.5%, analgesic nephropathy in 5%, Bilhaziasis in 0.5%, chronic pyelonephritis in 2% and diabetic nephropathy in 18%. Other causes such as gouty nephropathy, collagen diseases, toxemia of pregnancy and lupus nephritis constituted 6% of the cases. We conclude that the epidemiology of the treated ESRD in Tabuk area is similar to that in Egypt, but very different from that in the United States.
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2014 [cited 2020 Dec 1];25:192-5. Available from: https://www.sjkdt.org/text.asp?2014/25/1/192/124574
Dr. Osama El Minshawy and Dr. Eman El Bassuoni are both on sabbatical leave from El-Minia University School of Medicine, Egypt.
| Introduction|| |
The increasing global prevalence of treated end-stage renal disease (ESRD) over the years indicates a general increase in the number of incident patients with kidney failure as well as a gradual improvement in the access to treatment. ,,,,,,,,
In 2007, more than 1.6 million patients were undergoing dialysis treatment worldwide, and another half a million patients were living with a functioning kidney allograft. However, access to treatment is still limited in many countries. 
The Kingdom of Saudi Arabia (KSA) is a country with marked rise in prevalence and incidence of ESRD; this rise exceeds those reported from many countries due to enormous and rapid changes in lifestyle, high population growth, fast increase in life expectancy and massive urbanization over the last three decades.  The epidemiology of ESRD in Tabuk area has not been extensively examined.
The aim of this study is to describe the ESRD population in the area of Tabuk and to compare the epidemiology of ESRD in Tabuk area with that elsewhere.
| Materials and Methods|| |
Tabuk region is located along the north-west coast of KSA; it has an area of 108,000 km² and comprises five governorates including 170 villages. In the area of Tabuk, there are seven dialysis centers with variable capacities; six are affiliated with the Ministry of Health and one is in the Prince Sultan Kidney Center. The population of Tabuk is 691,517 (census 2004) and in 2012 it is estimated to be approximately one million persons. In 2012, we conducted a cross-sectional study of all treated ESRD patients undergoing renal replacement therapy (RRT) in the area of Tabuk, Saudi Arabia. Medical records and patient interviews were the primary source of demographic and clinical information on the patients.
| Statistical Analysis|| |
Analysis of the demographics and clinical characteristics of the dialysis population was restricted to patients who were maintained on hemodialysis (HD) modality for more than five consecutive HD sessions. Statistical analyses were conducted using SPSS software for windows (SPSS-X).
| Results|| |
In 2012, a total of 460 patients were on RRT in the area of Tabuk. All were eligible for inclusion in this study. The prevalence of treated ESRD was 460 PMP. RRT modality was HD in 350 (76%), peritoneal dialysis in 30 (7%) and renal transplantation in 80 (17%) patients.
Prevalent RRT patients had a mean age of was 48 ± 17 years, median 50 years, range (20-93 years). There were nearly twice the number of males to females (64% vs 36%), and the patients were more likely to live in rural vs urban areas (55% and 45%, respectively). Renal biopsy was performed in 56 patients (12%) at some time during the course of their sickness. The etiology of treated ESRD was unknown in 33%, hypertension in 24%, chronic glomerulonephritis (GN) in 8%, obstructive uropathy in 3.5%, analgesic nephropathy in 5%, bilhaziasis in 0.5%, chronic pyelonephritis in 2% and diabetic nephropathy (DN) in 18%. Other causes such as gouty nephropathy, collagen diseases, toxemia of pregnancy and lupus nephritis constituted 6% of the cases. [Table 1] shows the primary etiology of ESRD among the male and female patients in Tabuk area.
|Table 1: Comparison between males and females regarding the etiology of the ESRD.|
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[Figure 1] shows the comparison of the different etiologies between rural and urban areas in the area of Tabuk. The prevalence of hypertension was higher in the urban (16%) than in the rural areas (8%), and analgesic nephropathy was more prevalent in the urban (3%) than in the rural areas (2%). ESRD due to diabetic nephropathy was significantly higher in the urban (12%) than in the rural areas (6%).
|Figure 1: Different etiology between rural and urban areas in Tabuk area.|
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Only 25% of the prevalent HD patients had a documented measurement of urea reduction ratio (URR), and only 65% achieved a URR ≥65%. The number of ESRD patients with a functioning kidney graft in 2012 was 80 (17%) patients.
| Discussion|| |
The results of our study showed that the prevalence of treated ESRD in males was almost twice that of females (64% vs 36%). This male predominance among the ESRD population, almost a global phenomenon, is poorly explained, with males constituting 56% in the US,  60% in the UK  and 54.5% in the KSA. 
Etiology of treated ESRD was unknown in 33% of the patients in the area of Tabuk in 2012. In Sudan, more than 40% of the surveyed patients had no identified cause for their renal impairment  and in El-Minia Governorate, Egypt, 27% of the patients with treated ESRD had unknown etiology,  while the unknown etiology of ESRD in the US is only 3.9%.  This difference may be attributed to environmental factors as described previously. 
In the current study, hypertension was responsible for about 24% of the causes of treated ESRD in the area of Tabuk. In Sudan, hypertension was responsible for about 26% of the causes of treated ESRD.  Similarly, hypertension was the cause of treated ESRD in 28% of ESRD cases in the US.  In Iran, the most common cause of treated ESRD among HD patients was hypertension (30.5%),  but this is likely an overestimate as the diagnosis of hypertensive nephrosclerosis is difficult to ascertain even in patients with long-standing hypertension. Such patients may have had secondary hypertension due to undiagnosed kidney disease.
Hypertension was reported as a cause of kidney failure in 21% of patients on RRT in the South African registry  and 20% of the causes of treated ESRD in El-Minia Governorate, Egypt.  A similarly wide variation is noted in the reported rates of hypertension as the primary renal diagnosis of ESRD patients in the US and UK (28% and 5.8%, respectively). ,, The variation in the reported rates of hypertensive nephrosclerosis likely results from the different definitions of these conditions rather than a true variation of prevalence.
In Sudan, GN was the reported cause of treated ESRD in 5.5% of the patients,  3% in the US  and 11% in El-Minia Governorate, Egypt,  compared with 8% in our study.
In our study, schistosomiasis (bilharzia) was responsible for about 0.5% of the etiology of treated ESRD in the area of Tabuk. In Egypt, schistosomiasis was responsible for 1.5-6.6% of the treated ESRD. 
In the current study, 10% of our patients reported a family history of renal dysfunction, 19% of treated ESRD patients in Sudan and 20% of the patients in the US. 
DN as a cause of treated ESRD in the area of Tabuk constituted 8% of causes of treated ESRD in 2009, and increased to 18% according to the results of the current study. The prevalence of DN among treated ESRD patients was 16% in Egypt in 2008,  48% in Qatar  and 38% in the US. 
We conclude that our study found a similar epidemiology of treated ESRD in the area of Tabuk as in Egypt, but this was very different from the epidemiology of ESRD in the US.
Conflict of interest: None declared
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Osama El Minshawy
Department of Internal Medicine, School of Medicine, University of Tabuk, Tabuk 71421