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- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar Email: [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]
- Nephrology Department, Hamad General Hospital, 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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Utilizing diabetes mellitus risk assessment tool in screening of hemodialysis patients at risk of diabetes mellitus
Background: Hamad General Hospital is the main provider of hemodialysis (HD) in Qatar for approximately 650 patients per year. Over 60% of these patients have Diabetes Mellitus (DM) and 55% of them suffer from end stage renal disease (ESRD). 2% of ESRD patients develop DM after their first year of dialysis1. The aims of this quality improvement study were early DM detection risk factors modifications and reduction of diabetes complications in our patients. Methods: A risk assessment tool was adapted to identify the risk level of HD patients to develop DM2. They were screened to determine their risk score across 8 categories. Six categories (gender history of gestational diabetes family history of high blood pressure diabetes physical activity and smoking) were scored 0 to 1 age was scored 0 to 3 and relationship between weight and height scored 1 to 3. (Overall score range: 1-12). Patients were classified into two groups: a low-risk group (score < 5) and a high-risk group (score ≥ 5)3. Patients were referred to different medical specialties for further management according to the risk factor and a lifestyle modification management plan was set individually. Results: 189 non-diabetic dialysis patients were screened in the first quarter of 2020 their mean age was 51 years-old and 69% were male. Forty-three percent of patients were found to be at high risk of developing DM. The most important risk factors were family history (55%) obesity (40%) age >60 years (32%) low physical activity (14%) and smoking (11%) (Figure 1). Thirty-seven percent of patients were referred to the obesity clinic 10% to the smoking cessation clinic 5% to physiotherapy and 100% of patients were referred to the multidisciplinary care (Figure 2). Conclusion: Screening for diabetes is pivotal for early detection and risk factor modification in dialysis patients. We recommend quarterly data assessment and evaluation so patients can be managed according to the findings.
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.
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
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.
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.