RENAL DATA FROM THE ARAB WORLD
|Year : 2021 | Volume
| Issue : 1 | Page : 183-190
|Epidemiology of End-Stage Kidney Disease on Renal Replacement Therapy: 35 Years Analysis Study Nephrologists
Ruqiya K Al-Za abi1, Elizabeth P Tolmie2, Ann Marie Rice2, Nabil Mohsin3, Ahmed Said Al-Busadi4
1 Department of Nursing, Oman College of Health Sciences, North Batinah Governorate, Oman; School of Nursing and Health Care, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
2 School of Nursing and Health Care, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
3 Department of Medicine and Nephrology, Sultan Qaboos University, Muscat, Oman
4 Department of Primary Care, Ministry of Health, Muscat, Oman
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|Date of Web Publication||16-Jun-2021|
| Abstract|| |
Incidence and prevalence of end-stage kidney disease (ESKD) population on renal replacement therapy (RRT) for some of the nations are well published. Oman’s publication on this aspect is limited and therefore, this study was conducted. This study analyzed the data obtained from the RRT register in Oman. The main measurements and aim are to identify the incidence and prevalence of Oman’s treated RRT population (1983–2018) with a major focus on the hemodialysis (HD) cohort. The year 1983 is the year when renal care was started in Oman. The total number of patients registered on Oman’s RRT register of the central renal dialysis center from 1983 to 2010 was 3524, distributed among the following treatment cohorts; HD, 2328 patients (66%); kidney transplant, 1,144 patients (32.5%); peritoneal dialysis, 52 patients (1.5%). However, the treated patients alive on HD by end of 2018 were 2023. The dialysis sub-population increased from 35 patients in 1983 to 2023 patients in 2018. The recorded incidence registered in 1983 was 34 patients, in 1986 was 33, in 2013 was 168, in 2015 was 230, and in 2018 was 350 RRT treated patients per million population of Oman. There is a progressive rise of the incidence and prevalence of Oman’s RRT population. This rise is similar to many nations, especially developing countries that are being faced with the rising trend of noncommunicable diseases (NCD). The health system and other stakeholders ought to take various stringent policies to ameliorate the progressive increase of NCD and hence, reduce the burden of chronic kidney disease and ESKD.
|How to cite this article:|
Al-Za abi RK, Tolmie EP, Rice AM, Mohsin N, Al-Busadi AS. Epidemiology of End-Stage Kidney Disease on Renal Replacement Therapy: 35 Years Analysis Study Nephrologists. Saudi J Kidney Dis Transpl 2021;32:183-90
|How to cite this URL:|
Al-Za abi RK, Tolmie EP, Rice AM, Mohsin N, Al-Busadi AS. Epidemiology of End-Stage Kidney Disease on Renal Replacement Therapy: 35 Years Analysis Study Nephrologists. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Dec 8];32:183-90. Available from: https://www.sjkdt.org/text.asp?2021/32/1/183/318521
| Introduction|| |
Oman is situated in the South-Eastern corner of the Arabian Peninsula., It has an area of 309,500 km2 (almost the size of Poland or Italy), which is surrounded by Yemen, Saudi Arabia, and the United Arab Emirates (UAE). Oman’s coastline is about 3165 km starting from the Strait of Hormuz and extending to the Arabian Gulf, the Sea of Oman, and the Arabian Sea., Oman bonds the coastline of the Arabian Gulf with UAE, Qatar, Bahrain, Kuwait, and Saudi Arabia. Therefore, the six of them are called Gulf Cooperation Council (GCC) countries.,
The Oman health-care system is based on the public sector fund and therefore, it is free of service charge. At present, Oman’s health indicators have developed from the earlier years. For example, the life expectancy at birth increased from 40 years in 1970 to be 76.6 in 2014. The demographic analysis of the Ministry of Health (MOH), Oman vision 2050, displayed that the total population is predicted to be more than seven million by 2050. There will be an age shift where the elderly ratio will increase to be 13.1% compared to 10.7% in 2014. Furthermore, the epidemiological profile of the country is rapidly changing to an increase in noncommunicable diseases (NCD) which is similar to the shift occurring in the developing countries.,
End-stage kidney disease (ESKD) or renal replacement therapy (RRT) register in Oman is established and maintained well in the main renal dialysis center (RDC) in Baushar city. This register includes the baseline data of registered ESKD patients since the initiation of RRT and updated annually until the patient’s death. This register tool of data collection utilizes the tool adapted by the United States Renal Data System (USRDS) register (form 2728).,,
Disease epidemiology is a crucial science that most of the research pathways start with and build future research on its indications. As a result, the research question for this study was established to focus on: identifying the main epidemiological variables of the ESKD problem in Oman, mainly incidence and prevalence at this stage.
| Subjects and Methods|| |
Setting, sample and definitions
This is a prospective analytical study of data that was being collected retrospectively and prospectively during the period 1983 till 2018. This study examined the raw data that was mainly obtained from the RRT register in Oman. This study measured the incidence and prevalence of Omanis who are treated on RRT (1983–2018). The incidence and prevalence of Omani who are treated on RRT (1983–2018) are defined by this study as the number of new and existing treated kidney failure cases that reported on RRT treatment in Oman’s population annually from 1983 to 2018. The midyear population estimates were obtained from the National Center of Information and Statistics of Oman.
The Oman RRT register data are retrieved in a central RDC in the capital, and the data are collected using USRDS 2728 survey form, which must be completed by the assigned nephrologists in all RDCs around the country once a patient is started onRRT., This study population included all the treated RRT patients registered on Oman’s RRT register of the central RDC from the time the register started in 1983, until December 31, 2018.,
Data collection procedure
Ethical permission was obtained from two ethical committees; the “Research and Ethical Review and Approval Committee” MOH, Oman and from the ethical committee of the University of Glasgow (letter MH/DGP/ R&S/PROPOSAL_Approved/17/2014). All the data obtained from Oman’s ESKD register were received anonymously from the central RDC nephrologist in charge. For this study, all the data obtained were largely statistical numerals; no names and no addresses or other personal identification was accessed.,
| Statistical Analysis|| |
The data from this design were analyzed statistically by the principle investigator (PI) using Excel spreadsheet. The incidence and the prevalence were calculated by dividing, for example, the prevalence value for a period by the population at risk value, and then multiplying by 100,000 population to identify the rate of RRT cases per 100,000 population, or multiplying by 1,000,000 if the rate required is per million population (pmp). The values used in this study are merely for Omani populations and do not include non-Omanis because the MOH do not provide dialysis for non-Omanis; also, most of RRT non-Omanis travel back to their home country for dialysis. Furthermore, this study included data from the public sector only since the majority of the treated patients are dialyzing at MOH dialysis centers.
| Results|| |
Prevalence of Oman’s overall renal replacement therapy population (1983–2014)
The total number of patients registered in the Oman’s RRT register from 1983 to 2010 was 3524 patients on RRT distributed among the following treatment cohorts; hemodialysis (HD), 2328 patients (66%); kidney transplant, 1144 patients (32.5%); peritoneal dialysis (PD), 52 patients (1.5%). Accordingly, the estimated average number of patients for these 27 years was around 131 patients per year. There were no data provided for how many of each gender were in each of the treatment cohorts, but overall, males constituted 1904 patients (54%), and females were 1620 patients (46%). Of the 3524 (100%) registered patients between 1983 and 2010, only 1818 (51.6%) patients were alive in 2010; 1,542 patients (43.7%) had died, and 164 patients (4.7%) were lost to follow-up or could not be traced because they did not come back for their dialysis and did not provide any information on their treatment outcomes. By the end of December 2013, the total RRT patients alive and registered on Oman’s RRT register was 2069 distributed as 1117 dialysis patients (54%) and 952 (46%) kidney transplanted patients. Accordingly, the patients alive increased 13.8% between 2010 and 2013. The last RRT prevalence the author was able to record prospectively was the point prevalence on November 4, 2014. The total recorded RRT patients were 4228 (100%) including the deceased patients, however the point prevalence for existing patients alive was 2192 (42.3%) across the country. Accordingly, the average annual number of patients increased from 131 to 136 patients per year. As a result, 123 RRT patients were added to the preva lence from end of 2013 to November 4, 2014. The 2192 RRT patients were distributed in three main cohorts. The HD cohort had 1161 patients (52.9%), the PD cohort had 76 patients (3.5%), and the cohort who had functional kidney transplants had 955 patients (43.6%), as shown in [Table 1]. The number of male patients was higher in all cohorts except in the PD cohort. The total population of Oman in 2014 was 3.993 million in general or 2.261 million Omani. According to the previous statistics, the prevalence rate could be 549 pmp in 2014 if calculated across the total population or 969.5 pmp if calculated across the Omani population only.
|Table 1: Oman’s RRT population distributed across the three treatment cohorts on November 4, 2014 ©18.|
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Prevalence of Oman’s hemodialysis treatment (1983–2018)
The prevalence of HD treatment from 1983 to 1997 was not available on Oman’s MOH website and could not be found by using all search engines of the literature. The prevalence during 1998–2003 was established by searching the hard copies of the Oman’s MOH annual reports (which are later made electronically available on MOH website), and those from 2004 to 2018 were available on the MOH website (www.moh.gov.om); MOH, 2004–2018.,,,,,,,,,,,,,,
Furthermore, the prevalence for 1983 and 1985 was collected from an article published in the Oman Medical Journal in 1985.
The prevalence statistics from 1998 to 2018 showed an overall increase in HD treatment in Oman, as shown in [Figure 1]. The HD sub-population increased from 35 patients in 1983 to 2023 patients in 2018. The mean prevalence for all years (1983–2018) was 1003.3 HD treatments (i.e. patients) per annum. Since 2007, the prevalence of HD treatment is steadily and clearly increasing. For the past three years, the prevalence increased from 1739 (2016), 1831 (2017), to 2023 patients (2018).,,,
|Figure 1: Prevalence of HD treatment in Oman (1983–2018).|
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It was possible to calculate the prevalence rate for dialysis treatment since the estimated census for the Omani population and total population at risk was available for the years 1986 and onward. However, to identify the point of comparison, the prevalence for the years 2003, 2013, 2015, and 2018 were selected and calculated to the available census, as shown in [Table 2].
|Table 2: Prevalence rates for hemodialysis treated alive patients in certain years ©|
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Incidence of renal replacement therapy treatment (1983–2018)
Statistics of the treated RRT incidence were available for the years 1983 to 2018. The new RRT patients registered in 1983 were 34 patients, in 1986 were 33, in 2013 were 168, in 2015 were 230, and in 2018 were 350 patients per total population. The incidence of treated RRT patients across the years per Omani population is displayed in [Figure 2].
|Figure 2: Incidence of renal replacement therapy treatment in Oman (1983–2018).|
RRT: Renal replacement therapy treatment.
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This study aimed to calculate the incidence rates from the year 1986 and onward as the population census for Oman were available for these years, as shown in [Table 3]. Oman’s RRT register reported a grand total of 3524 new RRT patients during the period of 1983–2010 (27 years), which gives mean incidence rate of 131 treated RRT patients per year per total population of Oman.
|Table 3: Incidence rate for treated renal replacement therapy patients across certain years ©|
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| Discussion|| |
ESKD is classified as an NCD. Worldwide, the rates of NCDs are rising due to the aging population and the increased prevalence of diabetes, hypertension, and obesity.,, This increase in rates of ESKD puts the health systems in great burden to provide equitable access to RRT, especially in public sectors that provide RRT free of charge. One more added challenge is that patients on RRT are several times prone to death due to cardiovascular diseases secondary to RRT.
This study agrees with the few studies published recently on the landscapes of ESKD epidemiology in Oman.,, All of these data showed an increase in the incidence and prevalence of treated ESKD initiating RRT across Oman as presented in [Table 4]. It is anticipated that even these rates would go higher secondary to the progressive increase in NCDs in Oman.,, According to the World Health Organization, Oman is the 51st country among the top world countries where CKD is critical cause of death and in the country, it is reported as the 6th cause of death at 2.97%.
In comparing prevalence of the HD cohort reported by this study (582 pmp/2013) and reported by USRDS (USRDS - 358.5/2013), it is showed that Oman’s prevalence is more than Saudi Arabia (499.4 pmp/2012 – no figure for 2013), United Kingdom (UK) (432.2 pmp/2013), Bahrain (250.2/2011 – no figure reported for 2013), and Qatar (316.7/2013). The prevalence figure of this study is higher than the prevalence figure of the USRDS.,,
The overall incidence rates were fluctuating as also demonstrated by the cumulative incidence of the years 2010 and which were respectively 0.007% of ESKD event in 2010 and 0.004% of ESKD event in 2013 across the total population. This study reported a mean incidence rate of approximately 131 treated ESKD per year per Omani population. On the other hand, the USRDS annual report (2015) reported an incidence rate of 120 pmp in 2013 which is lower than what is reported by this study.,
Similarly, this study results are compared to data published from many of the GCC countries. Oman is part of the GCC countries which are all neighboring countries whose population shares many characteristics with that of Oman, such as religion, language, borders, weather, and more. Furthermore, it is seen fruitful to compare Oman’s statistics with Italy or Poland, since Oman’s land area is similar to that of Italy or Poland, though their population is far larger (~38 million in Poland vs. ~65 million in Italy/2013) than Oman’s population (~four million). Accordingly, Oman’s incidence rate (76 pmp/2013) was the lowest when compared to KSA (127.3 pmp/2013), Bahrain (207.5/2011 – no figure for 2013), Qatar (100 pmp/2013), Italy (162 pmp/2010 – this was the only reported incidence for Italy across years), Poland (126.2 pmp/2013), and UK (112.5 pmp/2013). In addition, all figures described here are only for the treated population and definitely there are some proportion of this population who are missed because of not being under treatment or having the disease and not yet detected.,,,
This study and the other studies from Oman found approximately that treated ESKD male patients(56 %) were higher compared to females (44 %), which is compatible with data from KSA (55% males to 45% females). The USRDS (2015) had no data on the genders ratio of Qatar and Poland, and for the UK, it was 61.8% treated males to 38.2% treated females. This data imply that there is a need to investigate the reasons behind having higher ESKD prevalence among males than females. Although the difference was not high in Oman’s context and it could be a result of having a higher male population compared to females in the general population. Higher prevalence among males of Oman could be because they are at high risk of getting the ESKD or it could be because they have long duration of disease and so they live longer and add up to the prevalence (cumulative), or it could be because the incidence of ESKD is higher in men than woman.
Furthermore, possible explanation could be that ESKD among men is detected earlier secondary to their early attendance for medical check-up compared to women in Oman and therefore, the proportion of prevalence in men appears higher because they are diagnosed earlier than women. However, studying gender differences in a disease context can provide valuable understanding on differential susceptibility. Comparing different variables such as the role of genes or the effect of identical treatments in males to females can discover valuable data such as the protective factors that exist in females that could protect them against diseases or how treatment can be modified to best treat each gender. Furthermore, the increase in incidence and prevalence of ESKD figures will increase the demand for renal care, and will cause a rise in related costs; for example increased demands on renal care staff who will need to increase in number with associated training and salary costs. The results of the study suggest to the renal care team, especially renal nurses, to keep themselves up to date and be prepared for more load and challenges in dealing with the treated ESKD population on RRT. The evidence from this research can be used to inform renal care leadership to undertake other cost-effective modalities, such as PD, which may have better outcomes for the ESKD population. The current proportion of PD patients in Oman is small and did not help to reduce the workload and cost very much. As reported frequently in the literature, PD is a patient self-managing treatment and is also a cost-effective treatment. This should be a motivator for the Oman’s MOH to undertake this type of treatment to a greater extent. The health system and other stakeholders ought to take various stringent policies to ameliorate the progressive increase of NCD and hence reduce the burden of chronic kidney disease and ESKD.
| Conclusion|| |
This study recognized that the data archived in the Oman’s ESKD register is worthwhile and clinically significant. Potentially, the data provided in this study and with complementary data from Oman’s ESKD register can have the potential to form the base for an official Oman Renal Registry. Furthermore, there is a need to conduct studies to measure the present situation of supply and demand of renal care.
| Support|| |
This study is conducted as part of a scholarship funded by MOH, Oman.
Conflict of interest: None declared.
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Ruqiya K Al-Za abi
Department of Nursing, Oman College of Health Sciences, North Batinah Governorate
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
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