Hemodialysis Status in an Egyptian Coastal City, Alexandria: An Epidemiological Study with a 3-year Prospective Mortality Observation

Backgrounds: Hemodialysis (HD) represents the main modality of RRT in Egypt and it constitutes a burden on the health care budget. In Alexandria province of Egypt, HD service is provided through fifty-seven HD units, which are categorized into twenty-one nonprofit units and thirty-six private for-profit HD units. Our aims were to study epidemiology and to assess the three-year survival of ESRD patients treated by HD in governmental hospitals in Alexandria province.

Methods and Design: In the year 2016; the data of the patients were collected from all the governmental hospitals in Alexandria province, which comprised seven HD units containing 687 patients. In a cross-sectional arm of the study, demographic data, vascular access, HIV, HBV and HCV serology, the possible etiology of chronic kidney disease (CKD), associated comorbidities, and the routine laboratory variables were included. Furthermore, in a prospective phase of the study, a three-year-survival rate of the studied HD patients was recorded.

Results: The total number of HD patients in Alexandria province during 2019 was totaled to be 3552 in all HD units, so the estimated HD prevalence rate would be around 710 ppm. Demographic data of the surveyed 687 patients in the governmental HD units showed their mean age; 50.78 years with more males, and their mean duration of HD; 55 months. It was also noted that there was no positive seroconversion regarding HCV, HBV nor HIV. Sixteen HCV antibody-positive patients received direct-acting antiviral drugs and were converted to HCV PCR-negative. HTN was more common etiology of CKD in males, while DM and combined DM and HTN were more common in females. The target hemoglobin level was present in around 37% of the studied HD patients. Most of the studied patients had serum calcium ranged from 8-10 mg /dl and 53% of them had serum phosphorus ranged from 3-5.5 mg /dl. Para-thyroidectomy was done for 2% of the studied patients while 4% of cases received cinacalcet. The 3-year, 5-year and 7-year survival rates were 92.5%, 87%, and 82% respectively.

Conclusion: The epidemiology of hemodialysis patients in Alexandria province is not different in many aspects from other published data about some Egyptian governorates however there is no published new epidemiology about the whole country. 11.2% of HCV Abs positive became PCR negative after antiviral management protocol.