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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]
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- 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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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
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.