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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 1  |  Page : 141-143
Diabetic nephropathy in hemodialysis patients in Constantine, Algeria


1 Department of Medicine, Nephrology Unit, Military Hospital of Constantine, Constantine, Algeria
2 Department of Epidemiology, UHC, Constantine, Algeria
3 Department of Internal Medicine, UHC, Constantine, Algeria
4 Department of Reanimation, UHC, Constantine, Algeria

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Date of Web Publication8-Jan-2015
 

How to cite this article:
Bouhabel A, Saadi N, Bendjeddou J, Laib Z, Hannache K, Aberkane A. Diabetic nephropathy in hemodialysis patients in Constantine, Algeria. Saudi J Kidney Dis Transpl 2015;26:141-3

How to cite this URL:
Bouhabel A, Saadi N, Bendjeddou J, Laib Z, Hannache K, Aberkane A. Diabetic nephropathy in hemodialysis patients in Constantine, Algeria. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Feb 25];26:141-3. Available from: https://www.sjkdt.org/text.asp?2015/26/1/141/148765
To the Editor,

Chronic kidney disease (CKD) is one of the most common and potentially devastating complications of diabetes. Diabetes mellitus has become the most common cause of endstage renal disease (ESRD) in both developed and emerging nations. The World Health Organization predicted that in 2025 more than 300 million persons will have type-2 diabetes. [1],[2],[3]

The incidence and prevalence of ESRD attributed to diabetic nephropathy have increased over the years, as reported in both regional and national registries. Our study was conducted to determine the prevalence of diabetic nephropathy in the dialysis population, to analyze the epidemiological and clinical characteristics and to evaluate its management in Constantine, which is the third biggest town in Algeria with one million inhabitants. In this questionnairebased study, the following parameters were studied: Age, gender, type of diabetes, first and actual vascular access, number of arteriovenous fistula (AVF), dose of dialysis, viral serology and hemoglobin level.

The data were analyzed using the Epi-Info software, version 3.3.2. As on 31 December 2011, there were 576 patients on chronic hemodialysis in eight dialysis centers in Constantine, with a prevalence of 667 per million population (pmp). Diabetic nephropathy was seen in 124 patients (21.5%, type-2; 63%), and constituted the second most common cause after hypertensive nephropathy (25.2%). Their mean age was 57.5 years; 60% were male and 40% were female.

AVF was the vascular access in 95% of the patients; 2.5% each had permanent catheter and AV grafts. The dose of dialysis was 720 min/week in 78% of patients with three sessions/week in 97%. Hepatitis C virus (HCV) was positive in 14.5% of the patients and hepatitis B virus (HBV) in 3.2%. The mean hemoglobin was 9.7 g/dL and 93.5% of the patients had one or more co-morbidities. The prevalence of ESRD in our study (667 pmp) is lower than that in developed countries, but it is expected to increase due to the ageing population and epidemiological transition in our country. Chronic hemodialysis was the most common modality of renal replacement therapy (95%). Renal transplantation and continuous ambulatory peritoneal dialysis (CAPD) were used in 3.5% and 1.5% of the patients, respectively.

Diabetic nephropathy was the second most common etiology of ESRD after nephroangiosclerosis. This data are similar to reports from other countries; in the USA in 2006, 44% of new patients were diabetics, in France in 2010, the prevalence was 22% [4] and in the Kingdom of Saudi Arabia, the prevalence of diabetes was 37.3% in 2011. [5] The mean age of our study patients was lower than that from developed nations; 69.2 years in USA; 61 years in Switzerland; [6] 63.1 years in Australia, [7] but older than in Casablanca (Morroco) [8] with 49.5 years.

The age at initiation of dialysis was higher in diabetics than in non-diabetic patients (55 years versus 48 years). Vascular access remains a serious problem in diabetic patients, and is largely contributed by delayed referral of the patients to the nephrologist. This will result in increasing the cost of treatment and increased morbidity and mortality in these patients. [9],[10],[11] Majority of our study patients had AVF in accordance with the prevailing guidelines. [12],[13]

The dose of dialysis is in accordance with the recommendations of the existing guidelines, [14],[15] with three sessions per week being offered to 97% of patients.

The prevalence of viral infections was less in non-diabetic patients, and may be due the short duration of the survey (3.3 years) and infrequent use of blood transfusions. Worldwide, the prevalence of HCV in hemodialysis units is quite variable, ranging from 5% to over 60%. [16],[17]

The prevalence of HBV in our study patients was similar to that published in the literature. [18] The prevalence of viral infection in dialysis patients can be reduced by following international recommendations, [19],[20],[21] like application of basic hygienic precautions by all staff members, systematic hand washing and change of gloves before caring for new patients, avoidance of sharing of articles between patients as well as cleaning and disinfection of environmental surfaces and monitors. [22]


   Acknowledgments Top


The authors are highly thankful to all members of the local care network for their collaboration in this study.

 
   References Top

1.
Panzetta G, Basile C, Santoro A, et al. Diabetics on dialysis in Italy: A nationwide epidemiological study. Nephrol Dial Transplant 2008;23:3988-95.  Back to cited text no. 1
    
2.
Atkins RC, Zimmet P. Diabetic kidney disease: Act now or pay later. Nephrol Dial Transplant 2010;25:331-3.  Back to cited text no. 2
    
3.
Friedman EA, Friedman AL, Eggers P. Endstage renal disease in diabetic person: Is the pandemic subsiding? KI 2006;70:551-4.  Back to cited text no. 3
    
4.
Agence de Biomédecine. Rapport annuel. Réseau Epidémiologie et Information en Néphrologie (REIN). 2010.  Back to cited text no. 4
    
5.
Dialysis in the Kingdom of Saudi Arabia. Saudi J Kidney Dis Transpl 2012;23:881-9.  Back to cited text no. 5
    
6.
Golshayan D, Paccaud F, Wauters JP. Epidemiology of end-stage renal failure: Comparison between 2 Swiss cantons. Néphrologie 2002;23:179-84.  Back to cited text no. 6
    
7.
ANZDATA Registry 2011 Report.  Back to cited text no. 7
    
8.
Khanfri N, Medkouri G, Aghai R, et al. Diabetic nephropathy in hemodialysis patients in Casablanca. Saudi J Kidney Dis Transpl 2005;16:89-92.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J; CHOICE Study. Type of vascular access and survival among incident hemodialysis patients: The choices for healthy outcomes in caring for ESRD (CHOICE) study. J Am Soc Nephrol 2005;16:1449-55.  Back to cited text no. 9
    
10.
Jengers P. Late referral: Loss of chance for patient, loss of money for society. Nephrol Dial Transplant 2002;17:371-5.  Back to cited text no. 10
    
11.
Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney disease referred late to nephrologists: A meta-analysis. Am J Med 2007;120:1063-70.  Back to cited text no. 11
    
12.
Huck R, Kumwenda M. Clinical practice guidlines. Vascular access for hemadialysis. UK renal association. 5th edition 2008-2011.  Back to cited text no. 12
    
13.
Besarab A. Tack Work. Vascular access 2006. Am J Kidney Dis 2006;48:S180-247.  Back to cited text no. 13
    
14.
Jindal K, Chan CT, Deziel C, et al. Hemodialysis adequacy in adults. J Am Soc Nephrol 2006;17 Suppl 1:S1-7.  Back to cited text no. 14
    
15.
Lacatelli F, Buonecristiani U, Canaud B, Kohler H, Peticlerc T, Zuccelli P. Dialysis dose and frequency. Nephrol Dial Transplant 2005;20:285-96.  Back to cited text no. 15
    
16.
Perico N, Cattaneo D, Bikbov B, Remuzzi G. Hepatitis C infection and chronic renal diseases. Clin J Am Soc Nephrol 2009;4:207-20.  Back to cited text no. 16
    
17.
Paul M, Fabrizio F. Hepatitis C virus and kidney disease. J Hepatol 2008;49:613-24.  Back to cited text no. 17
    
18.
Burdick RA, Bragg-Gresham JL, Woods JD, et al. Patters of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS. Kidney Int 2003;63:2222-9.  Back to cited text no. 18
    
19.
Center for disease control and prevention. Recommandations for preventing transmission of infections among chronic hemodialysis patients. MMWR 2001;50:1-46.  Back to cited text no. 19
    
20.
Kociuba K, Suranyi M. Recommandations for hepatitis B, C, G and HIV in maintenance dialysis patients. Consensus statement 2001.  Back to cited text no. 20
    
21.
Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008;109: S1-99.  Back to cited text no. 21
    
22.
Jadoul M. Epidemiology and mecanisms of transmission of the hepatitis C virus in hemodialysis. Nephrol Dial Transplant 2000;15(Suppl 8):39-41.  Back to cited text no. 22
    

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Correspondence Address:
Dr. Abdelouahab Bouhabel
Department of Medicine, Nephrology Unit, Military Hospital of Constatine
Algeria
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DOI: 10.4103/1319-2442.148765

PMID: 25579737

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