Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM THE ARAB WORLD
Year
: 2016  |  Volume : 27  |  Issue : 6  |  Page : 1207--1210

Basic description of the dialysis population of Kuwait: The 2015 data


Ali AlSahow1, Anas AlYousef2, Bassam AlHelal3, Monther AlSharekh4, Ayaman Marzouq1,  
1 Nephrology Division, Jahra Hospital, Al Jahra, Kuwait
2 Department of Medicine, Nephrology Division, Farwaniya Hospital, Sabah Al Nasser, Kuwait
3 Department of Medicine, Nephrology Division, Adan Hospital, Hadiya, Kuwait
4 Department of Medicine, Nephrology Division, Mubarak Al Kabeer Hospital, Jabriya, Kuwait

Correspondence Address:
Ali AlSahow
Nephrology Division, Jahra Hospital, P. O Box 2675, Jahra Central, 01028, Al Jahra
Kuwait

Abstract

Kuwait has a small, relatively young population plagued with diabetes, hypertension, and obesity, making the risk of development and progression of chronic kidney disease (CKD) very high. The total dialysis population of Kuwait in 2015 was 1720. The Ministry of Health (MOH) has divided the country into six health regions. The total number of dialysis population has been increasing slowly from 1600 in 2013 to 1650 in 2014 to 1720 in 2015, with 4% increase from 2014 to 2015. We describe some salient features among the dialysis population in Kuwait.



How to cite this article:
AlSahow A, AlYousef A, AlHelal B, AlSharekh M, Marzouq A. Basic description of the dialysis population of Kuwait: The 2015 data.Saudi J Kidney Dis Transpl 2016;27:1207-1210


How to cite this URL:
AlSahow A, AlYousef A, AlHelal B, AlSharekh M, Marzouq A. Basic description of the dialysis population of Kuwait: The 2015 data. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Oct 24 ];27:1207-1210
Available from: https://www.sjkdt.org/text.asp?2016/27/6/1207/194614


Full Text

 Introduction



Kuwait has a small, relatively young population plagued with diabetes, hypertension, and obesity, making the risk of development and progression of chronic kidney disease (CKD) very high. The total dialysis population of Kuwait in 2015 was 1720 with 70% of them being Kuwaiti citizens, thus making the prevalence and incidence rates high. Hemodialysis (HD) was the preferred modality in 88% of the population, although the use of peritoneal dialysis (PD) is rising. The annual mortality rate for 2015 was 12.5%. We describe the nephrology services provided in Kuwait by both the public and the private sectors and we describe the demographics and the key clinical characteristics of the total dialysis population in Kuwait for 2015.

 Nephrology Services in Kuwait



Kuwait is located in the northwestern part of the Arabian Gulf and has a total area of 17,818 km 2 . [1] The total population at the end of 2015 was 4.3 million, of whom 30% were Kuwaiti citizens and 70% were non-Kuwaitis, mostly expatriates, but some are Bedoons (stateless persons). [2] Kuwait was one of the first few countries that introduced kidney replacement therapy in the Middle East. HD was started in Kuwait in 1976 and continuous ambulatory PD (CAPD) was introduced in 1982. Transplantation program was started in 1979 and currently it is one of the most active transplant programs in the region.

The Ministry of Health (MOH) has divided the country into six health regions. Each region has a general hospital that provides full adult nephrology services except for transplantation services which are provided by one hospital only. Only two hospitals provide pediatric nephrology services (Mubarak, Jahra). Each nephrology unit provides HD and PD. Of the six MOH dialysis centers, one is community based and not hospital based (Amiri).

Acute dialysis is free of charge for all in all MOH hospitals. However, access to long-term dialysis is free of charge only to Kuwaiti citizens, children of Kuwaiti women married to non-Kuwaiti men, and patients from other Gulf Co-operation Council countries (Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, and Oman), who live in Kuwait and have a valid civil identification card. Bedoons and expatriates who come from failed countries (e.g., Afghanistan, Somalia, and Palestine) can access long-term dialysis in MOH dialysis units. However, they have to pay ~US$ 80 per HD session. A charity group usually takes care of the MOH fees. PD is provided free for all of the above-mentioned groups. Expatriates from other countries are allowed to stay for up to six months after they start dialysis to get their affairs in order and then they are asked to leave the country because long-term dialysis services will not be provided for them any longer in MOH units even when cost is covered. However, some expatriates who have lived their entire lives in Kuwait and do not know other countries may get exempted and allowed access to long-term PD, provided they pay ~US$ 300 monthly.

The military hospital has a HD unit catering for all personnel working in the Ministry of Defense and their immediate families, regardless of their nationalities. Kuwait oil company hospital provides free outpatient and acute dialysis services for the employees of the company and their immediate families, but does not provide long-term dialysis services.

Although the private sector is thriving, the nephrology services have not grown satisfactorily. Only three hospitals (out of 12 private hospitals) provide outpatient nephrology service (Salam, Shifa, and Mowasat), only two hospitals provide acute HD service (Salam and Shifa), and only one hospital provides longterm HD services (Salam). It is provided to expatriates for a fee of ~US$ 250 per session, which does not include medications. They get their medications (including erythropoiesisstimulating agents (ESA) and intravenous iron) from the MOH hospital to which they belong according to the place of residence. [3] Currently, private health insurance is not clear about coverage for dialysis, and there is only one non-Kuwaiti patient whose health insurance covers his HD costs.

 Health Status of the Population in Kuwait



[Table 1] shows the health of the population in Kuwait. It shows a relatively young population, but plagued with diabetes, hypertension, and obesity with high rates of smoking. All are significant risk factors for the development and progression of CKD.{Table 1}

 Dialysis Population in Kuwait



[Table 2] shows the total dialysis population in Kuwait in 2015, with the percentage of Kuwaiti patients, male patients, patients on HD, patients with diabetes (DM), patients infected with hepatitis viruses B and C (HBV, HCV), and mortality. The total number of dialysis population has been increasing slowly from 1600 in 2013 to 1650 in 2014 to 1720 in 2015, with 4% increase from 2014 to 2015. The number of new patients starting dialysis in 2015 was 410 with 85% of them were Kuwaitis. Although the majority of the population is non-Kuwaiti, most of the dialysis patients are Kuwaitis due to the fact that access of non-citizens to longterm dialysis is restricted. Because of this reason, incidence and prevalence rates of the Kuwaiti population are much higher than the incidence and rates of the entire population. The population was 4.3 million in 2015, giving a prevalence rate of 405 per million population (PMP) and incidence rates of 95 PMP. However, when we calculate the rates for the Kuwaiti population only (1.3 million Kuwaiti citizens, 1200 total Kuwaiti dialysis patients, and 355 new Kuwaiti dialysis patients started in 2015), we get a prevalence rate of 930 PMP and incidence rate of 275 PMP.{Table 2}

It must be pointed out that although 63% of patients have DM, <50% of patients are on dialysis due to DM. Patients with a history of transplantation were 6.5%. Although HCV is still a problem (7%), we hope that the new direct-acting antiviral drugs can reduce the number of infected patients. The number of patients infected with HBV is small (2%), and only three patients in Kuwait infected with the human immunodeficiency virus are on HD.

For HD access, 42% had arteriovenous fistula, 7.5% had arteriovenous graft, and unfortunately, 50% were receiving dialysis through tunneled catheters (PC). HD was offered to patients with low flux dialyzers in 32%, high flux in 20%, and hemodialfiltration in 48% of the patients. Dialysate calcium was 1.75 mmol/L in 65% of the cases, 1.5 mmol/L in 15% of the cases, and 1.25 mmol/L in 20% of the cases. The MOH provides only long-acting ESAs, and 98% of HD patients and 80% of PD patients who are on ESA were receiving darbepoetin.

PD penetration has been increasing steadily from 9.5% in 2013 to 10.5% in 2014 to 12% in 2015. CAPD patients constitute 44%, with 56% doing automated PD.

The number of children on dialysis in Kuwait is only 13. We should point out that the age for transfer from pediatrics to adults in Kuwait is 12 years. However, the number of children between the ages of 12 and 18 years on dialysis is only seven. No case of DM, HCV, or HBV was seen among those children.

 Conclusion



Kuwait is a small country with a small relatively young population that is plagued with diabetes, hypertension, and obesity, making the risk of development and progression of CKD very high. That is why the prevalence and incidence rates of dialysis are high. Data show an increasing use of PD. It also shows a low prevalence of HBV and HCV. Rate of tunneled catheter use is very high and poses a challenge. [5]

Conflict of interest: None declared.

References

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2Public Authority for Civil Information. Available from: http://www.paci.gov.kw/en/. Last accessed 3/Mar/2016.
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4World Health Organization (WHO) Country Report. Available from: http://www.who.int/countries/en/. Last accessed 3 March 2016.
5International Diabetes Federation (IDF) Diabetes Atlas. 6th ed. Available from: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf Last accessed 3 March 2016.