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

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Abir Farouk Megahed
Reem Mohamed Farouk Saleh
Afaf Mohamed Fahmy
Nagy Sayed- Ahmed


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.

Epidemiology of HD, Alexandria, Egypt, mortality.

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How to Cite
Megahed, A. F., Saleh, R. M. F., Fahmy, A. M., & Ahmed, N. S.-. (2020). Hemodialysis Status in an Egyptian Coastal City, Alexandria: An Epidemiological Study with a 3-year Prospective Mortality Observation. Asian Journal of Medicine and Health, 18(10), 52-64. https://doi.org/10.9734/ajmah/2020/v18i1030252
Original Research Article


Afifi A, Kareem MA. Renal replacement therapy in Egypt: First annual report of the Egyptian society of nephrology, 1996. East Mediterranean Health Journal. 1999;5(5): 1023-9.

Rashad S. Barsoum. Burden of chronic kidney disease: North Africa. International Society of Nephrology. 2013;3(2):164-66.

Hassan AT, Hamed AF, Waer SM. Epidemiology of end stage renal failure in Sohag Governorate, Upper Egypt, an update. JESN. 2011;12:54-63.

El Minshawy O. End-stage renal disease in the El-Minia Governorate, Upper Egypt: An epidemiological study. Saudi J Kidney Dis Transpl. 2011;22(5):1048-54.

Ahmed HA, Yassine YS, Tawafe AR, Ebazaway MM. Epidemiological study of patients on regular haemodialysis at the Kafer El-Shakh Governorate, Egypt, Menoufia. Med J. 2015;28:267-71.

Hamza AM. Epidemiology of end stage renal disease (ESRD) patients on hemodialysis in Dakahlia governorate [dissertation]. Supervised by: Prof Dr. Ali Elsayed Badr, Prof Dr. Nagy Abdel-Hay Sayed-Ahmed, and Prof Dr. Adel Elwehedy Ibrahem. Egypt: Mansoura University; 2015.

El-Arbagy AR, Kora MA, El-Barbary HS, Gabr HM, Selim AA, Kora El-A, et al. Prevalence of end stage renal disease in Menoufia Governorate. Nature and Science. 2015;13(6).

El-Zorkany KMA. Maintenance hemodialysis in Menoufia governorate, Egypt: Is there any progress? J Egypt Soc Nephrol Transplant. 2017;17(2):58-63.

El-Arbagy AR, Yassin YS, Boshra BN. Study of prevalence of end-stage renal disease in Assiut governorate, Upper Egypt. Menoufia Med J. 2016;29:222-27.

Ghonemy TA, Farag SE, Soliman SA, El-okely A, El-Hendy Y. Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt. Saudi J Kidney Dis Transpl. 2016;27(1):111-17.

El-Ballat MA, El-Sayed MA, Kamel H, Emam A. Epidemiology of end stage renal disease patients on regular hemodialysis in El-Beheira Governorate, Egypt. The Egyptian Journal of Hospital Medicine. 2019;76(3):3618-25.

Egyptian Renal Data System (ERDS) 1st Annual Report of End Stage Renal Disease in Egypt; 2018. Available:https://www.esnt-online.com/images/files/ERDS-2018-final.pdf?fbclid=IwAR1WaNZfjlUZnAMobM0NeMIeAi9xUwM3NOquesxSFxnTcpsqHFmYZZC0HQM


National Institute of Urban Planning; 2017.

Central Agency for Public Mobilization and Statistics. Available:https://www.capmas.gov.eg/Pages/populationClock.aspx

World Meters. Population of Egypt (2019 and Historical). Available:https://www.worldometers.info/world-population/egypt-population/

Tsai MH, Hsu CY, Lin MY, Yen MF, Chen HH, Chiu YH, et al. Incidence, prevalence, and duration of chronic kidney disease in Taiwan: Results from a community-based screening program of 106,094 individuals. Nephron. 2018;140:175-84.

Tang SCW. Chronic kidney disease in disadvantaged populations. ESRD in South-East Asia. 2017;149-56.

Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of kidney disease in the United States. Am J Kidney Dis. 2019;73(3 Suppl 1):A7-A8. DOI: 10.1053/j.ajkd.2019.01.001

Stel VS, van de Luijtgaarden MW, Wanner C, Jager K. Jon. Behalf of the European Renal Registry Investigators. The 2008 ERA-EDTA Registry Annual Report-a précis. NDT Plus. 2011;4:1-13.

Pippias M, Kramer A, Noordzij M, Afentakis N, de la Torre RA, Patrice M, et al. The European Renal Association – European Dialysis and Transplant Association Registry Annual Report 2014: A summary. Clinical Kidney Journal. 2017;10(2):154-69.

Megahed AF, Azzawi H. MOH hemodialysis Registry: Comparing Services 2016 VS 2017. 1st Acute Renal Dialysis Symposium, Baxter Company, 20th & 21st July. Alexandria, Egypt; 2017.

Afifi A. Annual reports of the Egyptian renal registry; 1996-2008. Available:http://www.esnonline.net

Collins AJ, Foley RN, Gilbertson DT, Chen SC. United States renal data system public health surveillance of chronic kidney disease and end-stage renal disease. International Society of Nephrology. 2015;5(1):2-7.

Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M. The prevalence of hepatitis C virus infection in Egypt 2015: Implications for future policy on prevention and treatment. Liver Int. 2017;37(1):45- 53.

Fissell RB, Bragg-Gresham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS. Kidney Int. 2004;65:2335-42.

Di Napoli A, Pezzotti P, Di Lallo D, Petrosillo N, Trivelloni C, Di Giulio S. Epidemiology of hepatitis C virus among long-term dialysis patients: A 9-year study in an Italian region. Am J Kidney Dis. 2006;48:629-37.

Sun J, Yu R, Zhu B, Wu J, Larsen S, Zhao W. Hepatitis C infection and related factors in hemodialysis patients in China: Systematic review and meta-analysis. Ren Fail. 2009;31:610-20.

Alavian SM, Kabir A, Ahmadi AB, Lankarani KB, Shahbabaie MA, Ahmadzad-Asl M. Hepatitis C infection in hemodialysis patients in Iran: A systematic review. Hemodial Int. 2010;14:253-62.

Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis. 2010;56:371-78.

Qadi AA, Tamim H, Ameen G, Bu-Ali A, Al-Arrayed S, Fawaz NA. Hepatitis B and hepatitis C virus prevalence among dialysis patients in Bahrain and Saudi Arabia: A survey by serologic and molecular methods Author links open overlay panel. American Journal of Infection Control. 2004;32(8):493-95.

Moukeh G, Yacoub R, Fahdi F, Rastam S, Albitar S. Epidemiology of hemodialysis patients in Aleppo City. Renal Data from the Arab World. 2009;20:140-46.

El-Ottol AY, Elmanama AA, Ayes BM. Prevalence and risk factors of hepatitis B and C viruses among haemodialysis patients in Gaza strip, Palestine. Virology Journal. 2010;7:210.

Fabrizi F, Messa P, Martin P. Hepatitis B virus infection and the dialysis patient. Seminars in Dialysis. 2008;21(5):440-6.

Al Hijazat M, Ajlouni YM. Hepatitis B infection among patients receiving chronic hemodialysis at the Royal Medical Services in Jordan. Renal Data from the Arab World. 2008;19:260-67.

Soliman AR, Fathy A, Roshd D. The growing burden of end-stage renal disease in Egypt. Renal Failure. 2012;34(4):425-8.

Al Alawi I, Al Salmi I, Al Mawali A, Al Maimani Y, Sayer JA. End-stage kidney failure in Oman: An analysis of registry data with an emphasis on congenital and inherited renal diseases. Int J Nephrol. 2017;6403985.

Ketteler M, Block GF, Evenepoel P, Fukagawa M, Herzog CA, McCann L. Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: What’s changed and why it matters. Kidney International. 2017;92:26-36.

Gregorio T. CKD-related Anemia Conclusion from Kdigo controversies Conference. Nefrologia; 2017.

Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. US Renal Data System 2011 Annual Data Report. Am J Kidney Dis. 2012; 59(1 Suppl 1):A7,e1-420. DOI: 10.1053/j.ajkd.2011.11.015

Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan and the United States: The Dialysis Outcomesand Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270-7.

Msaad R, Essadik R, Mohtadi K, Meftah H, Lebrazi H, Taki H, et at. Predictors of mortality in hemodialysis patients. Pan African Medical Journal. 2019;33:61.