Menoufia Medical Journal

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 33  |  Issue : 3  |  Page : 766--771

Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis


Hassan A Ahmed, Ahmed M Zahran, Rasha A. A. H. Issawi 
 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Correspondence Address:
Rasha A. A. H. Issawi
Zagazig, El-Sharkia 44511
Egypt

Abstract

Objectives The objective of this work is to study the prevalence and etiology of end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD) in a central governmental Hospital of El-Sharkia governorate, Egypt. Background ESRD has become a public health concern worldwide as the total number of ESRD patients requiring renal replacement therapy has been growing dramatically. The main problem in developing countries is the lack and inaccuracy of data registry. Patients and methods This descriptive study had been done in the El-Sharkia governorate central governmental hospitals on adult patients' resident in the El-Sharkia governorate with ESRD on maintenance HD for more than or equal to 3 months. The study was done during the period from February 2017 to November 2017. Results The prevalence of ESRD patients on maintenance HD in the Sharkia governorate is 442 per million populations (pmp). The etiology of the studied ESRD patients: hypertension (30.1%), undetermined etiology (19.5%), diabetes mellitus (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), analgesic nephropathy (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), and gout (1.1%). Of the studied ESRD patients, 44.7% had positive antibodies for hepatitis C virus (+ve) and patients with hepatitis B virus surface antigen (+ve) were 2.2%. Conclusion The total prevalence of ESRD patients on maintenance HD in 2017 in Sharkia governorate, Egypt is 442 per million populations (0.0442%). The highest proportion of patients with ESRD was between 50 and 59 years (30.8%). Most of the ESRD patients were from the rural area (60.4%).



How to cite this article:
Ahmed HA, Zahran AM, Issawi RA. Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis.Menoufia Med J 2020;33:766-771


How to cite this URL:
Ahmed HA, Zahran AM, Issawi RA. Prevalence and etiology of end-stage renal disease patients on maintenance hemodialysis. Menoufia Med J [serial online] 2020 [cited 2024 Mar 29 ];33:766-771
Available from: http://www.mmj.eg.net/text.asp?2020/33/3/766/296684


Full Text



 Introduction



End-stage renal disease (ESRD) has many causes that vary from one patient to another. The key risk factors for chronic kidney disease (CKD) are the increasing age of the population, diabetes mellitus (DM), hypertension (HTN), and medications, such as the use of analgesics regularly over long durations of time resulting in analgesic nephropathy and kidney damage. Polycystic kidney disease is an example of a hereditary cause of CKD [1]. Some studies suggest that tobacco use is positively associated with CKD [2]. Alcohol has been linked as a cause of kidney disorders in some clinical and experimental studies [3]. In many Arab countries, obstructive uropathy constitutes a major cause of ESRD (40%). The two most common underlying causes are renal calculi and schistosomiasis [4].

The main causes of ESRD in Egypt, other than diabetic nephropathy (DN), included HTN, chronic glomerulonephritis, unknown etiology, chronic pyelonephritis, schistosomal obstructive uropathy, and schistosomal nephropathy [5]. Currently, hemodialysis (HD) represents the main mode for the treatment of chronic kidney disease stage 5 (CKD-5). The health-care service in the HD facility extends to include infection control, patients' data recording, and other medical services [6]. Kidney disease is the ninth leading cause of death in the USA. Every year, kidney disease kills more people than breast or prostate cancer; in 2013, more than 47 000 Americans died from kidney disease [7].

Worldwide, the prevalence of ESRD differs greatly. In Europe, the prevalence has increased from 760 per million populations (pmp) in 2004 to 889 pmp in 2008 [8]. In 2013, there were 661 648 prevalent cases of ESRD in the USA. The ESRD prevalence reached 1981 pmp [9]. The prevalence in Taiwan was 2447 pmp, in Japan 2205 pmp, and in Philippines was 110 pmp [10]. In Egypt, the prevalence of ESRD in 2004 was 483 pmp [5].

The aim of this study is to study the prevalence and etiology of ESRD patients on maintenance HD in governmental HD units in Hospital of El-Sharkia governorate, Egypt.

 Patients and Methods



This descriptive study was conducted in Sharkia governorate in Egypt on patients with ESRD on maintenance HD in 21 HD units in central governmental hospitals. Adult patients had been selected from the dialysis units in the different cities and centers of Sharkia governorate central governmental hospitals. The study was done during the period from February 2017 to November 2017. According to Sharkia Health Directorate the total population of Sharkia governorate is about 7 163 824 (year 2017); out of them 2186 adult patients had ESRD on maintenance HD in central governmental HD units, 180 ESRD adult patients in insurance authority hospitals, 102 ESRD adult patients in university hospital, 85 ESRD adult patients in educational authority hospital, and 614 ESRD adult patients on maintenance HD in private HD units.

Selected patients' criteria: adult ESRD patients on maintenance HD for more than or equal to 3 months. Exclusion criteria: patients with acute renal failure, stages 1–4 CKD patients on conservative treatment, ESRD patients on maintenance HD in nongovernorate centers and patients who are not residents in the El-Sharkia governorate. All selected patients were subjected to a predesigned questionnaire that included the following data: personal and sociodemographic data, medical history, HD history, investigations [hemoglobin, antibodies for hepatitis C virus (HCV Ab), hepatitis B virus surface antigen, random blood glucose]; further investigation for diabetic patients (glycated hemoglobin), serum albumin, serum urea, serum creatinine, and pelviabdominal ultrasonography. Informed consent from patients was taken as well as permission from the ethics committee of Sharkia Health Directorate. The diagnosis of the etiology of ESRD was made according to each disease documented criteria.

The collected data were computerized and statistically analyzed using the Statistical Package for the Social Sciences (SPSS) program, version 18.0. (SPSS Incorporated, Chicago, Illinois, USA). Quantitative (numerical) variable data were statistically described as mean ± SD and qualitative (categorical) variables were statistically described as percentage.

 Results



The total population of Sharkia Governorate (year 2017) is 7 163 824. Of the patients 0.0442% (3167 patients) had ESRD on maintenance HD. The prevalence of ESRD patients on maintenance HD in Sharkia governorate is 442 pmp [Figure 1].{Figure 1}

Two thousand one hundred and eighty-six of Sharkia governorate populations have ESRD on maintenance HD in Sharkia governorate central governmental hospitals, 180 ESRD patients in insurance authority hospitals, 102 ESRD patients in university hospital, 85 ESRD patients in educational authority hospital, and 614 ESRD patients on maintenance HD in private HD units [Figure 2].{Figure 2}

The highest percentage of the studied ESRD patients (n = 2186) on maintenance HD in Sharkia governorate central governmental hospitals is found in Alhusienia (10.2%), followed by Hehia (8.6%), Abu Kabir (8.4%), Deyarb Negm (7.9%), and Belbeis (6.3%). On the other hand, Alsaleheyah, Zagazig Alhomyat (Fever hospital), Alsofya, and Tal Rak demonstrated the lowest percent (1.9, 1.9, 1.8, and 1.8%) [Figure 3].{Figure 3}

The sociodemographic characteristics of the studied ESRD patients are tabulated in [Table 1]; the mean age is 52.69 ± 11.71, most of the studied ESRD patients in Sharkia governorate central governmental hospitals are above 50 years old. The highest proportion of them is in the age group between 50 and 59 years (30.8%). Most of the ESRD patients were from rural areas (60.4%). The male sex represents the highest percentage (54.8%); 88.6% of the studied ESRD patients are married; 37.1% are uneducated; 47.5% are unemployed, 68.3% have low income, 75.8% are independent, and 72.5% are nonsmokers.{Table 1}

The main known cause of ESRD in the studied ESRD patients (n = 2186) in Sharkia governorate central governmental hospitals (year 2017) is HTN (30.1%), followed by DM (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), analgesic nephropathy (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), gout (1.1%), and 19.5% of the patients were with ESRD on maintenance HD with unknown etiology [Table 2] and [Figure 4].{Table 2}{Figure 4}

Of the studied ESRD patients, 83.8% take 4 h in the HD session; 99% of the studied ESRD patients have three HD sessions per week; and 94% of the studied ESRD patients have arteriovenous fistula. The most used dialyzer surface area for the studied patients is 1.3 m 2 (41.72%) [Table 3]; 978 (44.7%) of the studied ESRD patients were HCV Ab + ve and 47 patients with hepatitis B virus surface antigen + ve (2.2%).{Table 3}

 Discussion



Köttgen [11] reported that several countries have observation programmers to monitor kidney failure treated by dialysis and transplantation. Incidence and prevalence vary because of the differences in the underlying disease rates and availability of government-sponsored treatment. Eckardt [12] reported that the incidence of ESRD requiring renal replacement therapy is steadily increasing and poses a massive burden on health-care budget even in developed countries.

In this study, the prevalence of ESRD patients on regular HD in Sharkia governmental HD units is 442 pmp (0.0442%).

The prevalence of ESRD in Egypt varies from one governorate to another. El Minshawy [13] reported that in the El-Minia governorate the prevalence was 308 pmp. Hassan et al. [14] reported that in Sohag governorate the prevalence was 316 pmp. Boshra et al. [15] reported that in Assiut governorate it was 366 pmp; El-Zorkany [16] reported that in Menoufia governorate the prevalence was 483 pmp; and Hamouda [17] reported that in Beheira the prevalence of ESRD patients on regular HD in the governmental HD units was 390 pmp.

Saran et al. [18] reported that the prevalence of ESRD differs greatly worldwide. The highest prevalence was found in Taiwan with 3317 pmp, followed by 2529 pmp in Japan and the lowest prevalence was 119–211 pmp in Bangladesh. In the USA, the prevalence was 2138 pmp. Pippias et al. [19] reported that the prevalence in Europe was 889 pmp.

These higher values in ESRD prevalence in some countries could result from not only an increasing number of incident cases, but also longer survival between ESRD patients because the prevalence shows both the incidence and course of the illness. Low prevalence values could result from lack of registration and documentation programs for ESRD patients and also due to the short life expectancy for these patients.

In our study, the mean age of the studied patients is 52.69 ± 11.71 years. Hamouda [17] reported that in Beheira the mean age was 52.53 ± 16.46 years. El-Zorkany [16] reported that in Menoufia the mean age was 53.18 ± 13.26 years.

Collins et al. [9] reported that the mean age in USA was 59.2 years. Pippias et al. [19] reported that the mean age in Europe was 60.3 years.

In our study, the percentage of patients with ESRD has increased with age, particularly after 50 years of age, the highest proportion of patients with ESRD is in the age group of 50–59 years (30.8%), followed by the age group of 60–69 years (24.7%). El-Zorkany [16] reported that in Menoufia governorate, the highest proportion of patients (36.6%) was aged between 50 and 60 years. Saran et al. [18] reported that in USA the highest percentage of patients with ESRD was in the age group of 45–64 years (44%), followed by the age group of 65–74 years (23.8%).

The decline in percentage in patients with ESRD above 69 years of age could be due to the high mortality rate among these oldest ESRD patients.

In the present study, the main known cause of ESRD is HTN (30.1%), followed by DN (17.6%). This result is similar to that reported a number of governorates in Egypt. El-Zorkany [16] reported that in Menoufia the main known cause of ESRD was HTN (33.4%), followed by DN (9.2%). Hamouda [17] reported that in Beheira the main known cause of ESRD was HTN (27.8%), followed by DN (20.1%). El Minshawy [13] reported that in Cairo the main cause of ESRD was HTN with 29.7%, followed by DN 12.5%; in Canal governorates HTN was the main cause of ESRD (27.3%) followed by DN (10.7%) and in El-Minia governorate the main cause was also HTN (20%), followed by DN (8%).

Consistent with the result of the current study, Naicker [20] reported that HTN is a leading cause of CKD in sub-Saharan Africa, ranging from 25% in Senegal to 29.8% in Nigeria, 45.6% in South Africa, and 48.7% in Ghana, especially within the black patients.

The findings of the current study are also consistent with results from other Arab countries. Banaga et al. [21] reported that in Khartoum State, Sudan the most common cause of ESRD was HTN (34.6%), followed by chronic glomerulonephritis (17.6%), DM (12.8%), obstructive uropathy (9.6%), autosomal dominant polycystic kidney disease (4.7%), chronic pyelonephritis (4.6%), analgesic nephropathy (3.5%), and 10.7% were with unknown cause. Moukeh et al. [22] reported that in Aleppo, Syria HTN represented the main cause of ESRD (21.5%), followed by chronic glomerulonephritis (20.5%) and DN as a cause of ESRD was found to be 19.5% and counts the third cause.

In contrast to the current result, Hassanien et al. [23] reported that in the Gulf Cooperation Council countries it has been found that the leading cause of ESKD was DN (17%), followed by glomerulonephritis (13%) and HTN (8%). Yao et al. [24] reported that the incidence of DM in China was 17.2% and counts the second cause of ESRD after chronic glomerulonephritis. Kramer et al. [25] reported that the most common identifiable cause of ESKD in European countries was glomerulonephritis (20.4%), followed by diabetes (15.6%), etiology uncertain (14.6%), and HTN (10.7%). Saran et al. [18] reported that in USA diabetes was reported as the main cause of ESRD with 38.2%, followed with HTN (25.5%).

In this study, undetermined etiology constitutes19.5% of all causes of ESRD. Hamouda [17] reported that in Beheira undetermined etiology was estimated to be 24.2% of all causes of ESRD. El Minshawy [13] reported that in El-Minia governorate undetermined etiology was 27% and 18.1% in Cairo governorate. In earlier registry by Afifi [5] in Egypt the undetermined etiology was estimated to be 15.2%. Malekmakan et al. [26] reported that in Iran uncertain etiology of ESRD was 14.4%; Shigidi et al. [27] reported that in Qatar it was 14%, and Saran et al. [18] reported that in USA uncertain causes represent 16.8%.

In this study, a remarkable percentage of patients discovered their kidney deterioration just when they must endure on HD without benefit of prior nephrology care. This reflects the lack of awareness in patients about the proper time of request a medical counsel and also lack of awareness among the physicians of primary health care about early detection of CKD in its early stages especially for patients at high risk of deterioration in renal function.

In this study, the prevalence of HCV in the studied patients was found to be 44.7%. Hamouda [17] reported that in Beheira governorate, the prevalence of HCV in the ESRD patients was found to be 38.1% and El-Zorkany [16] reported that in Menoufia the prevalence of HCV in the ESRD patients was found to be 36.8%. The prevalence of HCV in dialysis patients showed wide variations worldwide. Afifi [5] reported that in Egypt it was 52.1%, Moukeh et al. [22] reported that in Aleppo, Syria it was 54.4%, Nakai et al. [28] reported that in Japan it was 9.83%, and Sesso et al. [29] reported that it was 5.8% in Brazil.

The high prevalence of HCV in our study may be attributed to the high prevalence of HCV in the general population of the governorate.

 Conclusion



The prevalence of ESRD patients on maintenance HD in El-Sharkia governorate, Egypt is 442 pmp (0.0442%) in 2017. The highest proportion of patients with ESRD was in the age group of between 50 and 59 years (30.8%). Most of the ESRD patients were from rural areas (60.4%).

The main etiologies of ESRD are HTN (30.1%), followed by undetermined etiology (19.5%), DM (17.6%), recurrent urinary stone (10.3%), recurrent urinary tract infection (8.5%), drugs (4.3%), chronic glomerulonephritis (4.1%), autosomal dominant polycystic kidney disease (2.9%), systemic lupus erythematosus (1.5%), and gout (1.1%).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physician 2005; 72:1723–1732.
2Shankar A, Klein R, Klein BE. The association among smoking, heavy drinking, and chronic kidney disease. Am J Epidemiol 2006; 164:263–271.
3Schaeffner ES, Kurth T, de Jong PE, Glynn RJ, Buring JE, Gaziano JM. Alcohol consumption and the risk of renal dysfunction in apparently healthy men. Arch Intern Med 2005; 165:1048–1053.
4Ulasi II, Arodiwe EB, Ijoma CK. Left ventricular hypertrophy in African Black patients with chronic renal failure at first evaluation. Ethn Dis 2006; 16:859–864.
5Afifi A. Egyptian renal registry 9th Annual Reports 2008. Available at: http://www.esnonline.net. [Last accessed on 2017 Jun 06].
6Ahmed AMA, Allam MF, Habil ES, Metwally AM, Ibrahiem NA, Radwan M et al. Development of practice guidelines for hemodialysis in Egypt. Indian J Nephrol 2010; 20:193–202.
7Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep 2016; 64:1–119.
8Stel VS, van de Luijtgaarden MW, Wanner C, Jager KJ; on behalf of the European Renal Registry Investigators. The 2008 ERA-EDTA registry annual report-a précis. NDT Plus 2011; 4:1–13.
9Collins AJ, Foley RN, Gilbertson DT, Chen SC. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl 2015; 5:2–7.
10Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. United States Renal Data System 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Am J Kidney Dis 2012; 59(A7):e1–e420.
11Köttgen A. Genome-wide association studies in nephrology research. Am J Kidney Dis 2010; 56:743–758.
12Eckardt KU. Frontiers in the pathogenesis of kidney disease. J Mol Med 2009; 87:837–839.
13El Minshawy O. End stage renal disease in El-Minia Governorate, Upper Egypt: an epidemiological study. Saudi J Kidney Dis Transpl 2011; 22:1048–1054.
14Hassan AT, Hamed AF, Waer SM. Epidemiology of end stage renal failure in Sohag governorate, Upper Egypt, an update. JESN 2011; 12:54–63.
15Boshra BN, El-Arbagy AR, Yassin YS. Study of prevalence of end-stage renal disease in Assiut governorate, Upper Egypt. Menoufia Med J 2016; 29:222–227.
16El-Zorkany KM. Maintenance hemodialysis in Menoufia governorate, Egypt: Is there any progress? J Egypt Soc Nephrol Transplant 2017; 17:58–63.
17Hamouda AFMM. Prevalence of end-stage renal disease patients on regular haemodialysis in Beheira Governorate, Egypt. Thesis submitted for partial fulfilment of master degree in Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, 2016.
18Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2017; 69:A7–A8.
19Pippias M, Stel VS, Abad Diez JM, Afentakis N, Herrero Calvo JA, Arias M. Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report. Clin Kidney J 2015; 8:248–261.
20Naicker S. End-stage renal disease in sub-Saharan Africa. Kidney Int Suppl 2013; 3:161–163.
21Banaga AS, Mohammed EB, Siddig RM, Salama DE, Elbashir SB, Khojali MO. Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan. BMC Res Notes 2015; 8:502.
22Moukeh G, Yacoub R, Fahdi F, Rastam S, Albitar S. Epidemiology of hemodialysis patients in Aleppo city. Saudi J Kidney Dis Transpl 2009; 20:140–146.
23Hassanien AA, Al-Shaikh F, Vamos EP, Yadegarfar G, Majeed A. Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review. JRSM Short Rep 2012; 6:1–38.
24Yao Q, Zhang W, Qian J. Dialysis status in China: a report from the Shanghai Dialysis Registry (2000-2005). Ethn Dis 2009; 19(Suppl 1):23–26.
25Kramer A, Pippias M, Stel VS, Bonthuis M, Diez A, Maria J, et al. Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus. Clin Kidney J 2016; 9:457–469.
26Malekmakan L, Haghpanah S, Pakfetrat M, Malekmakan A, Khajehdehi P. Causes of chronic renal failure among Iranian hemodialysis patients. Saudi J Kidney Dis Transpl 2009; 20:501–504.
27Shigidi MM, Ramachandiran G, Rashed AH, Fituri OM. Demographic data and hemodialysis population dynamics in Qatar: a five-year survey. Saudi J Kidney Dis Transpl 2009; 20:493–500.
28Nakai S, Masakane I, Shigematsu T, Hamano T, Yamagata K. An overview of regular dialysis treatment in Japan. Ther Apher Dial 2009; 13:457–504.
29Sesso RC, Lopes AA, Thomé FS, Lugon JR Santos DR. Report of the Brazilian dialysis census. J Bras Nefrol 2011; 33:442–447.