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- Department of Medicine, Division of Nephrology, Hamad Medical Corporation, Doha, Qatar. E-mail: [email protected]; ORCID: (0000-0003-4677-7686) [1]
- Department of Quality and Patient Safety, Hamad Medical Corporation, Doha, Qatar. [1]
- Division of Nephrology, Department of Medicine, Al Khor Hospital, Al Khor, Qatar [1]
- Division of Nephrology, Department of Medicine, Al Wakra Hospital, Al Wakra, Qatar [1]
- Division of Nephrology, Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hamad General Hospital, Doha, Qatar Email: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar Email: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hazm Mebaireek General Hospital, Doha, Qatar [1]
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar [1]
- Hamad General Hospital, Hamad Medical Corporation, Qatar. Email and ORCID ID: [email protected] & https://orcid.org/0000-0002-7289-4942 [1]
- Nephrology Division, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Nephrology Division, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Nephrology Division, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
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Safe and ethical living kidney donation in Qatar: A national health system's approach
The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however raises a number of social ethical and legal concerns surrounding informed consent voluntarism psychosocial evaluation perioperative care and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government healthcare authorities and transplant community have adopted to address these issues.
Risk factors associated with chronic kidney disease progression: Long-term retrospective analysis from Qatar
Introduction: The risk factors influencing the natural course of chronic kidney disease (CKD) are complex and heterogeneous. Recognizing the factors associated with CKD progression can enable the identification of high-risk patients for more intensive treatment.
Patients and methods: A retrospective evaluation of CKD patients was performed under follow-up between January 1 2001 and December 31 2016 at a tertiary health care center.
Results: Among 5370 screened patients 1020 patients with complete data were included in the analysis. The median follow-up period for the studied patients was 9.3 years. Based on the analysis 120 (11.8%) patients had reached end-stage kidney disease “ESKD” or death. The study revealed that the risk factors associated with reaching ESKD and/or death using Kaplan–Meier survival curve and log rank test included higher hemoglobin A1c among diabetic patients higher grade of proteinuria and non use of renin-angiotensin system blockers. The patients with CKD progression constituted 77.2% of all CKD patients. The study findings indicated that older age Arab ethnicity smoking habit diabetes mellitus and hypertension (presumed as original kidney diseases) are among the significant risk factors associated with a further decline of the estimated glomerular filtration rate (eGFR) and further CKD progression.
Conclusion: This study summarized the demographic and clinical risk factors associated with CKD progression and patients’ outcomes among a unique and heterogeneous population in the state of Qatar. Intensive treatment of modifiable risk factors could be of value in halting the progression of CKD. However prospective studies are warranted to confirm our findings.
Dialysis and advanced chronic kidney disease population Free from Hepatitis C virus infection: A safe nephrology approach
Background: One of the most prevalent viruses among dialysis patients is Hepatitis C as it affects 8.4% of the dialysis patients in Qatar1. It causes serious complications including end-stage liver disease. There is no available vaccine to protect against the transmission of the Hepatitis C virus (HCV). However antiviral drugs lead to precious benefits including reducing the risk of morbidity/mortality increasing life expectancy and eventually nominating them for kidney transplant2.
The Qatar National Plan for HCV control by 2020 was launched in December 2014. In 2017 the World Health Organization accepted to support the development and implementation of national multispectral policies and strategies for its prevention and control in Qatar3. The treatment of HCV in dialysis patients has been a challenge since its launch in 2020. Methods: This is a single-center cohort study including a retrospective collection of data from 70 dialysis patients infected with Hepatitis C virus. 44 of them were treated with Ombitasvir 12.5 mg Paritaprevir 75 mg and Ritonavir 50 mg over 12 weeks and 12-week follow up period. As per all guidelines of the American Association for the Study of Liver Disease (AASLD) the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) sustained virological response indicates a patient has cured. Results: From the 70 HCV-positive patients the 44 patients who received the 12-week treatments were cured (Figure 1). During the treatment phase their biochemical values were normal (Figure 2). Conclusion: The outcome of the first phase treatment of Hepatitis C in dialysis patients is highly effective. Moreover the successful HCV antiviral treatment will decrease the risk of infection transmission within dialysis patients and reduce the occurrence of complications occurring after kidney transplantation.
Challenges to improve the Coronavirus disease 2019 (COVID-19) Immunization among dialysis population in Hamad General Hospital in the Nephrology Division, Hamad Medical Corporation, Doha, State of Qatar
Background: Hamad General Hospital (HGH) Nephrology Department is the main provider for dialysis services in Qatar serving almost 900 patients. The introduction of the COVID-19 vaccination is a crucial step in protecting End Stage Renal Disease (ESRD) patients who are vulnerable and prone to infections due to their immunocompromised status.1 They are at high risk because they are unable to practice adequate safe physical distancing as the majority of them are dependent on others due to age and the medical condition.
During the first wave of the COVID 19 pandemic the mortality rate was 20-30% among the dialysis population.2 Several challenges were faced since February 2020 to manage and control COVID-19 infection in dialysis units. Vaccination is the most important preventive measure in facing COVID-19. Hence a multidisciplinary team was formulated in March 2020 aiming to raise the patients and staff awareness of the importance of COVID-19 vaccination. Methods: The assessment of dialysis patients’ knowledge and educational needs was done by conducting multidisciplinary focus group activities providing educational materials in many languages education through hospital TV channels WhatsApp group activities with patient educators and direct education during physicians’ monthly dialysis assessment. Monitoring the compliance rate was done by monthly data collection and targeting non-compliant groups. Results: After the implementation of COVID-19 immunization strategic plan by the end of June 2021 75% (666 patients) out of 884 dialysis patients were vaccinated (Figure 1). The current vaccination update for over 16-year-old in Qatar is 62.8% 3. Moreover COVID-19 positive patients were properly managed since the beginning of 2020 by following Ministry of Public Health (MOPH) guidelines to control the spread among the dialysis population and the successful initiation of COVID-19 vaccination program (Figure 2). Conclusion: Continuous educational activities and awareness campaigns have increased COVID-19 immunization percentage among the dialysis population and probably contributed to saving lives.
Impact of COVID-19 on dialysis patients: Reported experience in Qatar
Background: Patient-centered care is a concept focussing on meeting the specific health needs of patients as expressed by them. Patients Reported Experience Measures (PREM) is another concept associated with patient-centered care. PREM surveys capture information about the healthcare experience as perceived by patients.1 Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution.2 Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit. In 2020 the COVID-19 impacted dialysis services and resulted in many challenges including staff shortage and deployment. Yet the patients’ feedback was evaluated continuously and compared with previous years before the pandemic. Methods: A validated questionnaire from the National Health Service in London was used.3 It consisted of 7 questions covering demographics dialysis options patient portal patient's relationship with the staff teamwork and traveling abroad. The survey involved 317 randomly selected patients who have been at least one year on dialysis. A comparison between 2019 and 2020 results was conducted using the chi-square test. Results: A drop in patients’ experience was observed in many survey components like education on dialysis medication side effects access to the patient portal access to physicians and nurses from home (Figure 2). However in other areas some positive experiences remained unchanged like communication and knowledge among the staff.:Conclusion: Patients’ reported experience helps in the evaluation of health services. After exploring dialysis patients’ experiences it was possible to identify what is going well and how COVID-19 impacted the patients’ perspectives. The PREM survey conducted in this work showed a significant decline in many parameters likely attributed to COVID-19 consequences including the staff shortages.
Cardiovascular calcification in hemodialysis patients: A Qatar-based prevalence and risk factors study
Background: Patients with end-stage kidney disease on hemodialysis (HD) have an increased risk of death due to the high prevalence of cardiovascular disease. Vascular calcification (VC) is predictive of cardiovascular disease and mortality. We conducted a study to evaluate the prevalence and risk factors for VC in dialysis patients in Qatar.
Methods: This is a retrospective nationwide study including all chronic ambulatory dialysis patients in Qatar from 2020 to 2022. We used our national electronic medical record to track demographics clinical characteristics comorbidities laboratory values and diagnostic data for each patient. Calcifications were assessed by echocardiography (routinely done for all our dialysis population per national protocol) computed tomography X-ray and ultrasound. The study protocol was approved by the local medical research ethics committee (MRC-01-20-377).
Results: 842 HD patients were included in this study. Vascular calcifications (VC) were prevalent in 52.6% of patients. The main site of VC was Mitral valve calcifications in 55.5% of patients. Patients with VC were significantly older and had more prevalence of diabetes mellitus (p = 0.001 and p = 0.006 respectively). There was no statistically significant difference between patients with calcifications and patients without calcifications regarding serum calcium phosphorus and PTH level. In multivariate analysis age and diabetes significantly increased the risk factor for calcification (95% CI 1.033–1.065 p < 0.0001 and 95% CI 1.128–2.272 p < 0001 respectively). Moreover higher vitamin D levels and higher doses of IV Alfacalcidol were significant risk factors for calcifications (95% CI 1.005–1.030 p < 0.007 and 95% CI 1.092–1.270 p < 0.0001 respectively).
Conclusion: Our study found that vascular calcification was widespread among our dialysis population in Qatar. Implementing the practice of echocardiography in dialysis patients was extremely helpful and the most productive in detecting vascular calcification. Diabetes mellitus almost doubles the risk for vascular calcifications in dialysis patients. These results are beneficial in identifying risk factors for vascular calcification which can help stratify dialysis patients’ risk of cardiovascular disease and optimize prevention efforts.
National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar
The coronavirus disease (COVID-19) pandemic has had a significant worldwide impact since its emergence in 2019. End-stage kidney disease patients have been among the most vulnerable population affected and have a higher risk of acquiring infection and developing more severe disease. We have encountered three major COVID-19 waves in Qatar and they have required different strategies to overcome. The most recent wave was due to the Omicron variant characterized by higher transmissibility. The monthly incidence of COVID-19 infection during the Omicron wave in patients with end-stage renal disease peaked at 256 patients compared to 35 and 39 patients during the first and second waves respectively. In addition more than one-third of our dialysis staff became infected during this wave. Unlike the previous two waves COVID-19 due to the Omicron variant was less severe with only 5% of hemodialysis patients requiring admission to the intensive care unit compared to 25% during the previous waves. The Omicron variant wave resulted in a crisis in our country due to the high number of non-hospitalized COVID-19 hemodialysis patients and the severe staff shortage. Several measures were taken to overcome the crisis such as designating one facility to dialyze all COVID-19 ambulatory patients reducing dialysis sessions to 3 hours and introducing a fourth dialysis shift.
This article describes the challenges we faced in the ambulatory hemodialysis service during the Omicron wave and the measures taken in the COVID-19 and non-COVID-19 designated facilities to combat the crisis.
Time-Series Forecasting of Hemodialysis Population in the State of Qatar by 2030
Background: There are few statistics on dialysis-dependent individuals with end-stage kidney disease (ESKD) in Qatar. Having access to this information can aid in better understanding the dialysis development model aiding higher-level services in future planning. In order to give data for creating preventive efforts we thus propose a time-series with a definitive endogenous model to predict ESKD patients requiring dialysis.
Methods: In this study we used four mathematical equations linear exponential logarithmic decimal and polynomial regression to make predictions using historical data from 2012 to 2021. These equations were evaluated based on time-series analysis and their prediction performance was assessed using the mean absolute percentage error (MAPE) coefficient of determination (R2) and mean absolute deviation (MAD). Because it remained largely steady for the population at risk of ESKD in this investigation we did not consider the population growth factor to be changeable. (FIFA World Cup 2022 preparation workforce associated growth was in healthy and young workers that did not influence ESKD prevalence).
Result: The polynomial has a high R2 of 0.99 and is consequently the best match for the prevalence dialysis data according to numerical findings. Thus the MAPE is 2.28 and the MAD is 9.87% revealing a small prediction error with good accuracy and variability. The polynomial algorithm is the simplest and best-calculated projection model according to these results. The number of dialysis patients in Qatar is anticipated to increase to 1037 (95% CI 974–1126) in 2022 1245 (95% CI 911–1518) in 2025 and 1611 (95% CI 1378–1954) in 2030 with a 5.67% average yearly percentage change between 2022 and 2030.
Conclusion: Our research offers straightforward and precise mathematical models for predicting the number of patients in Qatar who will require dialysis in the future. We discovered that the polynomial technique outperformed other methods. Future planning for the need for dialysis services can benefit from this forecasting.