Year : 1997 | Volume
: 8 | Issue : 4 | Page : 436--437
Renal Replacement Therapy in Syria
Department of Urology and Renal Transplantation, Tashreen Military Hospital, Damascus, Syria
Department of Urology and Renal Transplantation, Tashreen Military Hospital, Damascus
|How to cite this article:|
Ayash Z. Renal Replacement Therapy in Syria.Saudi J Kidney Dis Transpl 1997;8:436-437
|How to cite this URL:|
Ayash Z. Renal Replacement Therapy in Syria. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2021 Apr 10 ];8:436-437
Available from: https://www.sjkdt.org/text.asp?1997/8/4/436/39345
Syria is an Arab Republic located in the eastern side of the Mediterranean sea with an area of 185,408 square kilometers, and a population of 16 million. It is a developing country with medical services rendered mostly by governmental hospitals and medical care centers, although private medical services are also available. Services for renal replacement therapy are mostly provided free by the governmental hospitals and chargeable by some of the private hospitals.
The established incidence of end-stage renal failure in Syria is roughly about 75 new cases/million population/year. The etiology of renal failure is mostly designated as "unknown", since most cases reach medical attention late in the course of the renal disease. The second most common cause is chronic glomerulonephritis. Diabetes is much less common in hemodialysis patients accounting for only 2% of the total population.
Hemodialysis was introduced to Syria in the early seventies. The first hemodialysis was performed in Harasta hospital near Damascus in 1973. Currently, there are not less than 20 public and private dialysis centers with more than 150 machines, distributed all over the country. At present, there are more than 600 patients being dialyzed in these centers. Bicarbonate dialysis is only used for four patients in limited centers, but the majority of centers still use acetate-buffer hemodialysis. Furthermore, erythropoietin therapy is used in approximately 2% of the total number of patients.
Fistula, in the non-dominant arm, is the most common type of permanent access for hemodialysis. The patients receive on the average 10 hours of hemodialysis per patient per week.
Around 20% of hemodialysis patients have positive anti-hepatitis C antibodies, while the percentage of patients with positive hepatitis B surface antigen is approximately 15%. The average annual mortality of patients on hemodialysis is approximately 5%. The most common cause for such mortality is cardiovascular disease.
B. Peritoneal Dialysis
The first intermittent peritoneal dialysis was performed in Ibn-Nafis hospital in Damascus in 1981. Later, the same hospital introduced continuous ambulatory peritoneal dialysis (CAPD) in 1982. Despite this early introduction of CAPD, it has not gained popularity up till now. There is still only one CAPD center in the country. There are very few patients on CAPD or IPD. So the evaluation of the quality care using this method is not possible.
The first renal transplant was performed at Harasta Hospital in 1978. It was a living related renal transplant. At present, there are only two renal transplant centers in the country and both are in Damascus, the capital. More than 320 renal transplants from living related donors have been performed up till now. Though 120 patients received cadaveric grafts, all of them were performed abroad, since there is no cadaver renal transplant program in Syria. Living unrelated renal transplantation is not practiced in Syria. The patients who had such donation, received these transplants abroad. Currently, there are more than 135 of such patients followed up in this country.
The most common regimen of immunosuppression used for the renal transplant patients includes prednisolone, Cyclosporine and Azathioprine. Mortality of the transplanted patients is approximately 2% annually, while the rate of graft loss is 15%. The most common cause of mortality of the transplanted patients is cardiovascular disease, and infection-Prospective
CAPD and cadaveric renal transplant are still lacking in Syria. CAPD has a potential in this country, but needs motivation of doctors and patients to increase the use of this method of renal replacement therapy. Cadaveric renal transplant needs the motivation of people including those related to the legal and constitutional sectors. The debate should be settled soon and a legislation to organize cadaver organ donation should be issued in order to cope with the increasing number of the renal failure patients and to reach the selfsufficiency in renal transplantation.