Hemodialysis patients' satisfaction with dialysis care: a cross-sectional prospective study conducted in a non-profitable care facility, Minia Egypt

BACKGROUND

The prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing continuously as a result of the dramatic growth in the prevalence of two main causes of ESKD which are diabetes mellitus (DM) and hypertension, hence, ESKD represents a global concern. Based on the sixth annual report of the Egyptian society of nephrology, the prevalence of ESKD in Egypt is estimated to be 375 per 1000,000. Meanwhile, other studies estimated the prevalence in El-Minia governorate to be around 308 per 1000,000. Hemodialysis (HD) represents the main modality of Kidney replacement therapy (KRT) for sufferers of ESKD in El-Minia governorate. Patients treated with in-center HD attend dialysis care usually three times per week for several hours each time, hence, their experiences during dialysis care will likely have a major impact on living with chronic illness. Hence, measuring patient satisfaction is very important as it is not only an outcome but also a contributor to other outcomes and objectives, it can provide valuable information about problem areas that can be modified to improve patient experience and outcomes.

METHODS

A single-center cross-sectional prospective study was conducted in the HD unit, Minia nephrology and urology university hospital. Demographic data were obtained through face-to-face interviews, Patients received a questionnaire to assess satisfaction with medical staff interactions, as well as care before, during, and after dialysis. An observational checklist of healthcare staff and equipment in the dialysis unit was also given to the patients.

RESULTS

One hundred nineteen patients participated in the study; patients were generally satisfied with the care provided in the dialysis unit (mean = 2.64), patients were most satisfied with aspects of care related to nurses, while they were neutral about aspects related to physicians, and were dissatisfied with nutritional care.

CONCLUSION

There are multiple problem areas in the HD unit affecting patients' experience, and further improvement in the care provided in the dialysis unit is required.

Albuminuria prediction of kidney function outcome in kidney transplant recipients

To investigate the association of albuminuria and kidney function outcome in kidney transplant recipients, we studied 161 kidney transplant recipients; 95 (59%) of them were males and the mean age of the patients was 46 ± 13 years (range 18-70 years). All the patients received allografts from living related kidney donors. The mean body mass index of the patients was 25 ± 4 kg/m 2 . Forty (25%) patients were diabetic and 72 (45%) patients were hypertensive. All the patients had glomerular filtration rate (iGFR) determination by ( 99m Tc-DTPA) clearance and albumiuria was assessed using the first voided morning urine samples. According to the results of albuminuria, the patients were subdivided into three groups: One group of 90 (56%) patients with normoalbuminuria (<30 mg albumin/g. creatinine), a second group of 52 (32%) patients with microalbuminuria (30-300 mg albumin/g. creatinine) and a third group of 19 (12%) patients with macroalbuminuria (>300 mg/g. creatinine). There was a significant increase in the time post transplantation in the patients with macroalbumiuria in comparison with microalbuminuria and normoalbuminuria (90 ± 28, 60 ± 22 and 18 ± 6 months, respectively), P <0.05. There was a significant decrease of iGFR in the macroalbumiuria group as compared with the microalbumiuria and normoalbuminuria groups (57 ± 24, 74 ± 20 and 74 ± 28 mL/min/1.73 m 2 , respectively), P <0.05. We conclude that there was an association between albuminuria and the status of the renal function in our transplant population, which may reflect renal injury due to proteinuria. Prospective studies are warranted to evaluate the effect of albuminuria on the prognosis of the kidney allografts.

End-stage renal disease in Tabuk Area, Saudi Arabia: an epidemiological study

The purpose of this study was to determine the prevalence, etiology and risk factors of treated end-stage renal disease (ESRD) in the region of Tabuk, Saudi Arabia. We studied 460 renal replacement therapy patients through a review of medical records and patient interviews and obtained patient demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. The estimated prevalence of treated ESRD was 460 per million populations (PMP); 350 (76%) were treated by hemodialysis, 30 (7%) by peritoneal dialysis and 80 (17%) by kidney transplantation. The mean age was 48 ± 17 years, body mass index was 25 ± 2 kg/m 2 and the male vs. female ratio was 64% vs. 36%. Most patients (55%) were living in rural areas. Etiology of the ESRD was unknown in 33%, hypertension in 24%, chronic glomerulonephritis in 8%, obstructive uropathy in 3.5%, analgesic nephropathy in 5%, Bilhaziasis in 0.5%, chronic pyelonephritis in 2% and diabetic nephropathy in 18%. Other causes such as gouty nephropathy, collagen diseases, toxemia of pregnancy and lupus nephritis constituted 6% of the cases. We conclude that the epidemiology of the treated ESRD in Tabuk area is similar to that in Egypt, but very different from that in the United States.

End-stage renal disease in the El-Minia Governorate, upper Egypt: an epidemiological study

We had earlier conducted two cross-sectional studies on the epidemiology of endstage renal disease (ESRD) in the El-Minia Governorate. The aim of this study is to assess the prevalence, etiology and risk factors for ESRD in the El-Minia Governorate during the year 2006. Patients on renal replacement therapy (RRT), numbering 1356, were recruited into this study. A standardized questionnaire was completed including demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. Only 800 (59%) of the 1356 patients agreed to participate in this study. Their mean age was 46 ± 13 years, median 43 (range 18-80). The male vs. female ratio was 65% vs. 35%. The etiology of ESRD was unknown in 27%, hypertension in 20%, chronic glomerulonephritis in 11%, obstructive uropathy in 12%, bilhaziasis in 3%, analgesic nephropathy in 5%, chronic pyelonephritis in 5%, diabetic nephropathy in 8% and others, e.g. lupus in 9%. The overall prevalence of ESRD was 308 per million population (pmp). The modalities of RRT used on the study patients included hemodialysis (HD) in 1315 (97%), peritoneal dialysis (PD) in 27 (2%) and renal transplantation in 14 patients (1%). The death rate was 190/1000. Our study suggests that the epidemiology of ESRD in the El-Minia Governorate is different from that in European countries and the US and thus, region-specific interventions must be developed to control the epidemic of ESRD in the world.

T-cell receptor-stimulated calcineurin activity is inhibited in isolated T cells from transplant patients

The addition of calcineurin inhibitors, including cyclosporine A (CsA) and FK-506 (tacrolimus), to transplant protocols has markedly reduced acute allograft rejection and prolonged patient survival. Although monitoring of serum drug levels has been shown to be a poor indicator of efficacy, there is little data on calcineurin enzymatic activity in humans. Therefore, we measured calcineurin in isolated CD3(+)/4(+) T cells from 81 non-transplant controls and 39 renal allograft patients by using a (32)PO(4)-labeled calcineurin-specific substrate. A gender difference was observed in the control cohort, with activity in males significantly higher than that in females (1073 +/- 134 versus 758 +/- 75 fmol/microg/min, respectively). Activity of both groups was comparably inhibited by 5 ng/ml tacrolimus (27 +/- 4 versus 30 +/- 4%). Calcineurin is a downstream target of the T-cell receptor (TCR). Therefore, activity was measured in isolated T cells after incubation with anti-CD3/CD28 antibodies to stimulate the TCR. Calcineurin activity increased significantly from 1214 +/- 111 to 1652 +/- 138 fmol/microg/min; addition of either tacrolimus or CsA (500 ng/ml) blocked CD3/CD28 stimulation. Despite therapeutic levels of tacrolimus and CsA (mean 11.4 and 172 ng/ml), basal calcineurin activity was significantly higher among renal transplant recipients than controls (1776 +/- 175 versus 914 +/- 78 fmol/microg/min). In contrast, anti-CD3/CD28 antibodies failed to stimulate calcineurin activity in transplant subjects. Finally, we found that basal and stimulated calcineurin activities are inversely related. Consistent with this finding, basal activity in resting T cells rose over time after transplant but stimulation fell (r(2) = 0.785, p < 0.05). These data suggest that examination of TCR-stimulated calcineurin activity after renal transplantation may be useful for monitoring immunosuppression of individual patients.