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Renal Replacement TherapyRenal Replacement Therapy
in Sudanin Sudan
Hasan Abu-Aisha, FRCP
Head of Sudan PD program
THE SUDAN KIDNEY DISEASES DATA BASE (SKDDB)THE SUDAN KIDNEY DISEASES DATA BASE (SKDDB)
EDITORS:
Hasan Abu-Aisha, Sarra Ela...
THE SUDAN KIDNEY DISEASESTHE SUDAN KIDNEY DISEASES
DATA BASE (SKDDB)DATA BASE (SKDDB)
•Data for (nation wide)
•2250 HD pat...
The global burden of ESRDThe global burden of ESRD
Before the era of dialysis and kidney transplantation,
kidney failure w...
The global burden of ESRDThe global burden of ESRD
Unfortunately, dialysis and transplantation are
expensive. Even in rela...
The global burden of ESRDThe global burden of ESRD
Global surveys have long revealed the positive
correlation between the ...
Correlation between national income (GDP)Correlation between national income (GDP)
and prevalence of treated ESRDand preva...
Most African countries are located here, indicating that
the numbers of treated ESRD patients are limited by
economic cons...
Some countries with GDP of > 30,000 $ tended to have
ESRD prevalence of >2000 pmp
* Fresenius Medical Care. ESRD patients ...
Treatment of ESRD in AfricaTreatment of ESRD in Africa
The relationship between national income and the
prevalence of trea...
Correlation between national income and prevalentCorrelation between national income and prevalent
dialysis patients in so...
* Abu-Aisha et al. Peritoneal dialysis in Africa. PDI 2010 Jan
Relatively wealthy African countries with high
prevalence o...
The African dialysis populationThe African dialysis population
* Abu-Aisha H and Elamin S. Peritoneal dialysis in Africa. ...
The start of renal services in SudanThe start of renal services in Sudan
Intermittent peritoneal dialysis (IPD) was introd...
Renal services in SudanRenal services in Sudan
In 1995 there were only 16 working HD machines in
Sudan, serving 56 patient...
Renal services in SudanRenal services in Sudan
Currently, more than 4000 kidney failure patients are
on various forms of R...
Prevalence of RRT in SudanPrevalence of RRT in Sudan
Causes of kidney failureCauses of kidney failure
Causes of kidney failureCauses of kidney failure
Hypertensive nephrosclerosis was the most commonly
reported cause of ESRD...
Causes of kidney failure in other developingCauses of kidney failure in other developing
countriescountries
* Barsoum RS. ...
Family history of renal impairmentFamily history of renal impairment
19% of surveyed ESRD patients had a first- or second-...
Utilization of different RRT modalities by ESRDUtilization of different RRT modalities by ESRD
patients in Sudanpatients i...
Utilization of different RRT modalities by ESRDUtilization of different RRT modalities by ESRD
patients in Sudanpatients i...
Gender of ESRD patients in SudanGender of ESRD patients in Sudan
Gender of ESRD patients in SudanGender of ESRD patients in Sudan
This male predominance among the ESRD population is
a poo...
Age of prevalent ESRD patients in SudanAge of prevalent ESRD patients in Sudan
Mean age for HD 46 ± 17 years
Mean age for ...
Children on RRT in SudanChildren on RRT in Sudan
Children on RRT in SudanChildren on RRT in Sudan
Children dialysis
wards are limited,
most children are
dialyzed in center...
Prevalent HD patientsPrevalent HD patients
The private sector has contributed significantly to the
provision of HD over th...
Prevalent HD patientsPrevalent HD patients
The majority of HD patients are dialyzed via AV fistulae,
in agreement with the...
Prevalent HD patientsPrevalent HD patients
The prevalence of HCV is much lower than values
previously reported in limited ...
Prevalent HD patientsPrevalent HD patients
In June 2009, 83.8% of HD patients were offered twice-
weekly HD, due mainly to...
HD patients’ evaluation of their healthHD patients’ evaluation of their health
The social impact of HDThe social impact of HD
HD is usually the first dialysis option in Sudan.
However, HD centers are f...
Sudan PD ProgramSudan PD Program
CAPD in SudanCAPD in Sudan
In 2005, CAPD was
introduced as a dialysis
option for Sudanese ESRD
patients.
It is meant to he...
The CAPD populationThe CAPD population
CAPD patient’s number have increased slowly, but
steadily over the last 5 years
CAPD patient distribution in Sudan statesCAPD patient distribution in Sudan states
Reason for referral to CAPDReason for referral to CAPD
04/15/14 40
Quality of life in CAPDQuality of life in CAPD
Quality of life in CAPDQuality of life in CAPD
Quality of life in PD
Kidney transplantation in SudanKidney transplantation in Sudan
Approximately one third of prevalent kidney transplant
reci...
Renal transplant placeRenal transplant place
Kidney donorsKidney donors
Kidney transplantation in SudanKidney transplantation in Sudan
Expanding the kidney transplant program is expected to
offe...
Kidney transplant plans among HD patientsKidney transplant plans among HD patients
Kidney transplant plans among HD patientsKidney transplant plans among HD patients
Cost of RRT in SudanCost of RRT in Sudan
In Sudan, the government is committed to the
provision of dialysis treatment to a...
ConclusionsConclusions
1. There is an active organized program for RRT in
Sudan
2. HD takes the lead: some 3000 active pat...
Conclusions : organizationConclusions : organization
1. The National Kidney Center organizes all
RRT in the country
2. All...
Conclusions : Staff and facilitiesConclusions : Staff and facilities
1. There are 18 qualified nephrologists
2. Over 20 qu...
Conclusions : Education and TrainingConclusions : Education and Training
1. Regular PD training courses: 3-levels going on...
Conclusions : FinanceConclusions : Finance
1. Full support by the state (annual
prescribed fund from the State) (Since
199...
Conclusions : Standards and Quality of CareConclusions : Standards and Quality of Care
1. Data base for RRT
2. Standards o...
Consider this advice from a wiseConsider this advice from a wise
person:person:
To cross the SAHARA desert:
DO NOT RUSH !
...
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Renal Replacement Therapy in Sudan

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Renal replacement therapy status in African countries . Renal replacement therapy in Sudan a model of enthusiasm and dedication . CAPD program from scratch to full power.

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  • Transcript of "Renal Replacement Therapy in Sudan"

    1. 1. Renal Replacement TherapyRenal Replacement Therapy in Sudanin Sudan Hasan Abu-Aisha, FRCP Head of Sudan PD program
    2. 2. THE SUDAN KIDNEY DISEASES DATA BASE (SKDDB)THE SUDAN KIDNEY DISEASES DATA BASE (SKDDB) EDITORS: Hasan Abu-Aisha, Sarra Elamin, Wafaa Obeid RESEARCHERS: Aalaa Salahuldin A. Osman Abeer Ali Al-Badawi Ahmed Amin A. Alhag Ahmed Bashir Abbas Ahmed Hashim M. Nasr Ahmed Murtaja Al-Fatih Abdeen Al-Tigani Saifeldin Amin Mahmouddin Ahmed Amir Hasabo Asma Abbas Atiya Ata Al-Zain Awad Al-Tayeb Ali Bashair Mohammed Bashir Gihan Amin Salih Hiba Habib-Alla Hiba Ibrahim A. Al-Shiekh Hiba Mustafa Al-Hag Husein Hamid Al-Awad Khadiga Mohammed Abdulla Khalid Bakhit Khalid Mohammed Mahmoud Maysoon Al-Amin Khalafalla Maysoon Osman Mohammed A. Elsherif Mohammed Abdulmunim Mohammed Adam Mohammed Musa Mohammed Tagelsir Mohammed Widat-Alla Osman Nazar Osama Nazik Kamaleddin Nuha Mohammed Ali Rasha Hassan H. Hamad Rami Ibrahim Abulkailik Rawia Abdul-Rahman Rushdi Basheri Jamal Sally Rabie M. Abdalaal Selma Yassin Elagib Shaza Yassin Siddiq Al-Khider Sumaya Abdul-Rahman Tumader Tageldin Umalhasan M. Abdulla Wisal Ahmed Fadl-Alla
    3. 3. THE SUDAN KIDNEY DISEASESTHE SUDAN KIDNEY DISEASES DATA BASE (SKDDB)DATA BASE (SKDDB) •Data for (nation wide) •2250 HD patients •1750 Transplant patients •244 PD patients
    4. 4. The global burden of ESRDThe global burden of ESRD Before the era of dialysis and kidney transplantation, kidney failure was an invariably fatal condition.
    5. 5. The global burden of ESRDThe global burden of ESRD Unfortunately, dialysis and transplantation are expensive. Even in relatively wealthy economics, the provision of dialysis constitutes a heavy burden on health systems. Dialysis provision is not considered a health priority by countries that are struggling to provide the basic health requirements for their citizens.
    6. 6. The global burden of ESRDThe global burden of ESRD Global surveys have long revealed the positive correlation between the national income and the prevalence of dialysis treatment, particularly in countries with a GDP of less than 10,000 US$ per person per year* * Grassmann A and Brown G. Nephrol Dial Transplant. 2005;20:2587–93
    7. 7. Correlation between national income (GDP)Correlation between national income (GDP) and prevalence of treated ESRDand prevalence of treated ESRD * Fresenius Medical Care. ESRD patients in 2007: a global perspective. Fresenius Medical Care Deutschland GmbH; 2008
    8. 8. Most African countries are located here, indicating that the numbers of treated ESRD patients are limited by economic constrains * Fresenius Medical Care. ESRD patients in 2007: a global perspective. Fresenius Medical Care Deutschland GmbH; 2008
    9. 9. Some countries with GDP of > 30,000 $ tended to have ESRD prevalence of >2000 pmp * Fresenius Medical Care. ESRD patients in 2007: a global perspective. Fresenius Medical Care Deutschland GmbH; 2008
    10. 10. Treatment of ESRD in AfricaTreatment of ESRD in Africa The relationship between national income and the prevalence of treated ESRD is also observed in African countries. However, the high prevalence of HIV/AIDS in some African countries had a severely negative impact on the provision of dialysis treatment. * Joint United Nations Programme on HIV/AIDS and World Health Organization; 2007 Dec
    11. 11. Correlation between national income and prevalentCorrelation between national income and prevalent dialysis patients in some African countriesdialysis patients in some African countries * Abu-Aisha et al. Peritoneal dialysis in Africa. PDI 2010 Jan
    12. 12. * Abu-Aisha et al. Peritoneal dialysis in Africa. PDI 2010 Jan Relatively wealthy African countries with high prevalence of HIV/AIDS have lower than expected numbers of dialysis patients
    13. 13. The African dialysis populationThe African dialysis population * Abu-Aisha H and Elamin S. Peritoneal dialysis in Africa. Perit Dial Int 2010 Jan;30:23-8.
    14. 14. The start of renal services in SudanThe start of renal services in Sudan Intermittent peritoneal dialysis (IPD) was introduced in Sudan in 1968. In the same year, a personal set-up for home hemodialysis (HD) marked the start of HD in Sudan. The first renal unit was opened in Khartoum Teaching Hospital in 1970, where the first kidney transplant in Sudan and the second kidney transplant in the Middle East took place in 1974.
    15. 15. Renal services in SudanRenal services in Sudan In 1995 there were only 16 working HD machines in Sudan, serving 56 patients in two centers (both in Khartoum). There were 15 PD beds offering IPD in three centers (all in Khartoum). CAPD was not available at the time. About 70 patients were maintained on chronic IPD. There were about 200 kidney transplant recipients, and the majority had their kidney transplant outside Sudan. * Suliman et al. Saudi J Kidney Dis Transplant 1996;6(3):312-4
    16. 16. Renal services in SudanRenal services in Sudan Currently, more than 4000 kidney failure patients are on various forms of RRT in Sudan. This reflects improved access to treatment rather than a true increase in kidney failure patients. This increase is largely due to government commitment to the provision of dialysis treatment free of charge to all citizens.
    17. 17. Prevalence of RRT in SudanPrevalence of RRT in Sudan
    18. 18. Causes of kidney failureCauses of kidney failure
    19. 19. Causes of kidney failureCauses of kidney failure Hypertensive nephrosclerosis was the most commonly reported cause of ESRD, commoner than DM. This is similar to reports from other African countries: Egypt, Tunisia and South Africa* . GN was the reported cause in a small proportion of patients, and is probably the true underlying etiology in many of cases currently labeled as “unknown”. * Barsoum RS. Artificial Organs 2002;26(9):737-46
    20. 20. Causes of kidney failure in other developingCauses of kidney failure in other developing countriescountries * Barsoum RS. Artificial Organs 2002;26(9):737-46 current survey published data*
    21. 21. Family history of renal impairmentFamily history of renal impairment 19% of surveyed ESRD patients had a first- or second- degree relative with renal impairment. In a USA survey of 4365 HD patients in two states, 20% reported having a first- or second-degree relative with ESRD* . This suggests that close relatives of ESRD patients may benefit from directed screening and preventive efforts. * Freedman et al. JASN1997;1942-5
    22. 22. Utilization of different RRT modalities by ESRDUtilization of different RRT modalities by ESRD patients in Sudanpatients in Sudan
    23. 23. Utilization of different RRT modalities by ESRDUtilization of different RRT modalities by ESRD patients in Sudanpatients in Sudan 28.2% of all ESRD patients in Sudan are living with a functioning allograft. This proportion is comparable to the global average in 2007, whereby 23.3% of the world ESRD population were kidney transplant recipients.* In USA and UK the proportion is 30.1% and 46.6% respectively. * Fresenius Medical Care. ESRD patients in 2007: a global perspective. Fresenius Medical Care Deutschland GmbH; 2008
    24. 24. Gender of ESRD patients in SudanGender of ESRD patients in Sudan
    25. 25. Gender of ESRD patients in SudanGender of ESRD patients in Sudan This male predominance among the ESRD population is a poorly explained global phenomenon. In the USA and UK 2007 renal registry reports, males constituted 56.1% and 60% of ESRD patients respectively. Sudan figures are about 70% in favor of males.
    26. 26. Age of prevalent ESRD patients in SudanAge of prevalent ESRD patients in Sudan Mean age for HD 46 ± 17 years Mean age for PD 42 ± 22 years Mean age for KTR 39 ± 13 years
    27. 27. Children on RRT in SudanChildren on RRT in Sudan
    28. 28. Children on RRT in SudanChildren on RRT in Sudan Children dialysis wards are limited, most children are dialyzed in centers that mainly provide treatment for adult patients. Nora renal unit in Soba University Hospital
    29. 29. Prevalent HD patientsPrevalent HD patients The private sector has contributed significantly to the provision of HD over the last years
    30. 30. Prevalent HD patientsPrevalent HD patients The majority of HD patients are dialyzed via AV fistulae, in agreement with the NKF/KDOQI guidelines
    31. 31. Prevalent HD patientsPrevalent HD patients The prevalence of HCV is much lower than values previously reported in limited surveys (23.7%)* . * Mekki MO. Saudi J Kidney Dis Transplant 2007;18(1):106-8
    32. 32. Prevalent HD patientsPrevalent HD patients In June 2009, 83.8% of HD patients were offered twice- weekly HD, due mainly to financial constrains and limited HD capacity. Many patients didn’t achieve the target BP, HB, and PO levels.
    33. 33. HD patients’ evaluation of their healthHD patients’ evaluation of their health
    34. 34. The social impact of HDThe social impact of HD HD is usually the first dialysis option in Sudan. However, HD centers are focused in big cities, and some states have no HD centers. 35.2% of the prevalent HD population in Sudan had to change their living place in order to re-locate near to dialysis centers. This often results in family disruption and loss of working opportunities for young patients, in addition to school drop-out among children.
    35. 35. Sudan PD ProgramSudan PD Program
    36. 36. CAPD in SudanCAPD in Sudan In 2005, CAPD was introduced as a dialysis option for Sudanese ESRD patients. It is meant to help in fulfilling the dialysis needs of children with kidney failure and active adult patients, particularly those living in rural setting.
    37. 37. The CAPD populationThe CAPD population CAPD patient’s number have increased slowly, but steadily over the last 5 years
    38. 38. CAPD patient distribution in Sudan statesCAPD patient distribution in Sudan states
    39. 39. Reason for referral to CAPDReason for referral to CAPD
    40. 40. 04/15/14 40 Quality of life in CAPDQuality of life in CAPD
    41. 41. Quality of life in CAPDQuality of life in CAPD
    42. 42. Quality of life in PD
    43. 43. Kidney transplantation in SudanKidney transplantation in Sudan Approximately one third of prevalent kidney transplant recipients had their transplant surgery inside Sudan. Transplant operations are funded by the government, as well as most of the cost of immunosuppressive medications.
    44. 44. Renal transplant placeRenal transplant place
    45. 45. Kidney donorsKidney donors
    46. 46. Kidney transplantation in SudanKidney transplantation in Sudan Expanding the kidney transplant program is expected to offer an economic advantage to the provision of RRT in the long term.
    47. 47. Kidney transplant plans among HD patientsKidney transplant plans among HD patients
    48. 48. Kidney transplant plans among HD patientsKidney transplant plans among HD patients
    49. 49. Cost of RRT in SudanCost of RRT in Sudan In Sudan, the government is committed to the provision of dialysis treatment to all ESRD by a presidential declaration. This has resulted in marked national expansion of dialysis treatment. The long term maintenance of this expansion rate requires the involvement of other funding systems.
    50. 50. ConclusionsConclusions 1. There is an active organized program for RRT in Sudan 2. HD takes the lead: some 3000 active patients of HD 3. Transplantation rates have improved: 80-100 / year • 2/3rds of transplants were carried out abroad. • Patients on the active Tx follow-up list are 1750 1. Sudan PD program is relatively young: 5 years old now (all CAPD so far. APD will start this year) • Over 300 patients have benefitted from its services • Active patients are 107
    51. 51. Conclusions : organizationConclusions : organization 1. The National Kidney Center organizes all RRT in the country 2. All forms of RRT are provided free of charge by the State. 3. The private sector covers about 35% of HD services (paid for by the State)
    52. 52. Conclusions : Staff and facilitiesConclusions : Staff and facilities 1. There are 18 qualified nephrologists 2. Over 20 qualified internists helping in RRT 3. 45 HD centers, 3 major training centers for HD 4. 7 PD centers (organized as a network) 5. 3 Transplant centers
    53. 53. Conclusions : Education and TrainingConclusions : Education and Training 1. Regular PD training courses: 3-levels going on quarterly in collaboration with Baxter International 2. Regular HD training activities in collaboration with Fresenius Medical Care 3. ISN “Sister Renal Centers programs”: pediatric nephrology 4. Fellowship in Nephrology (in progress) 5. Institute of Kidney Diseases and Urology: “research, education and training”
    54. 54. Conclusions : FinanceConclusions : Finance 1. Full support by the state (annual prescribed fund from the State) (Since 1995) 2. + Now partially supported by medical insurance (2010) 3. + The National Kidney Diseases Fund (prevention, education, training, research and RRT) (2010)
    55. 55. Conclusions : Standards and Quality of CareConclusions : Standards and Quality of Care 1. Data base for RRT 2. Standards of quality-care (KDOQI, European Best Practices Guidelines, ISPD Guidelines) 3. Data base for GN (in progress) 4. Data base for CKD (in progress)
    56. 56. Consider this advice from a wiseConsider this advice from a wise person:person: To cross the SAHARA desert: DO NOT RUSH ! Be Careful ! Be Patient ! Yours Truly:
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