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- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Nephrology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Nephrology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
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Mortality of dialysis patients in Qatar: A retrospective epidemiologic study
Background: End-stage kidney disease (ESKD) patients on maintenance renal replacement therapy (RRT) have far lower life spans than those of the general population. No previous studies have been performed to assess the mortality of dialysis patients in the State of Qatar. We designed this study to assess the mortality of dialysis patients in Qatar and the impact of dialysis modality.
Methods: All chronic ambulatory dialysis patients (both on hemodialysis (HD) and peritoneal dialysis (PD) between 2014 and 2016) were included in the study whereas patients undergoing dialysis for less than 3 months were excluded. We reviewed patients’ demographics comorbidities and general laboratory investigations through our electronic record system and collected and analyzed them. We identified patients who died during that period and compared them to those who survived. We performed a subanalysis for HD versus PD patients who died.
Results: The total number of deceased dialysis patients was 164 with an overall crude mortality rate of 6.4%. They were significantly older than those who survived (p = 0.0001). The mortality rate was significantly higher in female than in male patients (51.2% and 38.9% respectively) (p = 0.004) but significantly lower in PD than HD patients (1.36% PD; 5.0% HD; p = 0.007). It was also significantly higher in natives than in the expats (60.3% and 39.6% respectively) (p = 0.0008); however no significant differences were noted between deceased natives and expats in most demographic and laboratory characteristics. The most common cause of patient death was CVD (62 patients 37.8%) followed by sepsis (44 patients 26.8%). Diabetes cerebrovascular accident and dyslipidemia were more common in HD deceased patients than in PD patients (80.6% 47% and 59% respectively in HD patients vs 68.5% 42% and 31% respectively in PD patients). Albumin and potassium levels in deceased PD patients were significantly lower than in HD patients (p = 0.001).
Conclusion: Our study found that the high-risk population had a significant mortality which was higher in HD than PD patients. This is the first study to look at these outcomes in Qatar. We identified multiple mortality associated factors such as comorbid conditions and old age. We believe that improving treatment and close monitoring for comorbid conditions in the dialysis population might improve survival.
Vascular calcification: “The silent killer” in the hemodialysis population in Qatar
Background: Calcification is an abnormal deposition of calcium salts in vascular tissue including valves blood vessels and the heart which is highly prevalent in End Stage Renal Disease (ESRD) patients. Vascular calcification is an independent and important risk factor for cardiovascular events in hemodialysis patients and investigators have demonstrated that the extent and histo-anatomic type of vascular calcification are predictors of subsequent vascular mortality1. Cardiovascular mortality risk is elevated 5-10-fold in ESRD patients compared to the general population2. As we recognized the importance of early detection and delaying the complication of calcification this study was initiated in March 2020 among 650 haemodialysis patients in Hamad General Hospital in Qatar. Methods: The haemodialysis multidisciplinary team identified patients with vascular calcification. Data was collected on available imaging study which included echocardiography X-rays and computed tomography (CT) to detect any kind of vascular calcification (e.g. valvular calcified vessels). Our management protocol was updated to decrease the calcium load and active vitamin D. Abnormal serum calcium management was initiated to monitor and delay the progression of vascular calcification through interventions which included dietary control medication and dialysate bath. Results: We were able to screen 86% of dialysis patients (n = 559). Following the interventions the percentage of patients with a calcium level of 2.1-2.55 mmol/l increased by 5 percentage points from 83% in March 2020 to 88% in September 2020 (p value = 0.004). Phosphorus level was maintained in the range of 0.81-1.8 mmol/l for 82% of patients (Figure 1) and parathyroid hormone (PTH) level in the range 150-400 pg/ml for 72% of patients (Figure 2). Conclusion: We implemented a successful screening program for vascular calcification in dialysis patients combined with specific interventions. Reduced hypercalcemia episodes can delay vascular calcification. Serum calcium level was improved and maintained within the target range (2.1 - 2.55 mmol/l) for a larger number of patients.
Effective approach to manage COVID-19 challenges in Hamad General Hospital dialysis facilities
Background: Hamad Medical Corporation (HMC) is providing dialysis treatment to approximately 1050 patients. COVID-19 started from China in December 201912 and the first case in Qatar was confirmed on 27th February 2020. There were challenges to provide dialysis treatment for COVID-19 positive and negative patients during the pandemic due to severe staff shortage3 staff fear and psychological distress workload lack of dialysis slots prolonged working hours and staff fatigue. Some staff were even deployed to COVID-19 facilities (modular dialysis services hotel and quarantine facilities) to provide treatment. Methods:
- 1) A COVID-19 management committee was established
- 2) An on-call team was assigned to manage new cases and review dialysis slots availability.
- 3) Staff performance and adherence to safety measures was monitored.
- 4) A hierarchy model was implemented for COVID-19.
- – Confirmed COVID-19 patients were not to receive dialysis at Ambulatory Dialysis centres.
- – Unit meetings were only held online.
- – Dialysis services were to be provided in HMC dialysis facilities COVID-19 hospitals and isolation/quarantine facilities (home/hotels).
- – Administrators with chronic disease worked from home.
- – Reduce number of chairs in tearoom and waiting area
- – Rearrange offices working spaces and conference room to keep everyone 2 meters apart.
- – Staff patient and family education
- – Screening by using visual triaging scale
- – Deployment of staff
- – Managing staff mental health and psychosocial well-being