Nursing College

1. Associated Risk Factors Of Renal Failure Among Patients
Attending Hemodialysis Center At Al-thawra Authority Hospital,
Ibb City, Yemen
Republic Of Yemen
J. U. For Medical & Health sci.
Faculty Of Nursing
Jibla – Yemen
2022- 2023
Aisha Mohammad AlMogammer
Raafat Hamoud Abdo Al-Awadi 2
Osama Foud Alshoapi
Mosa Mohammed Al-Shaghdari
Malak Essa Tajaldeen
Basem Mohammed Al-Rymani

2. Jibla – Yemen
2022- 2023
Republic Of Yemen
J. U. For Medical & Health sci.
Faculty Of Nursing
Associated Risk Factors Of Renal Failure Among Patients
Attending Hemodialysis Center At Al-thawra Authority Hospital,
Ibb City, Yemen

3. 1. Introduction
2. Literature Review
3. Objectives of the study
4. Research Methodology
5. Results
6. Discussion
7. Conclusion & Recommendations
8. References
9. Appendixes
Index

4. INTRODUCTION
It is a bean shape located against
the dorsal body wall in a
retroperitoneal position in the
superior lumbar region they extend
from the t12 to the l3 vertebra
(fig.1)
Figure 1: Location of the kidney

5. The Kidneys perform several vital functions besides formation of
urine which are listed as the following:
 Excretion of wastes.
 Maintenance of blood osmolarity.
 Production of hormones
 Regulation of btlood ionic composition.
 Regulation of blood ph.
 Regulation of blood volume.
 Regulation of blood pressure.
 Regulation of blood glucose level.
Functions of kidney

6.  It means that kidney filtration is impaired. This can be caused by
underlying conditions such as hypertension, diabetes or congenital
conditions. Kidney disease increases a patient’s risk for heart disease,
stroke, and other conditions.
 Acute kidney diseases(AKD):
They are conditions that come on rapidly and may be reversible such
as acute renal failure, tubular necrosis, obstructive uropathies… etc.
 Chronic kidney disease (CKD):
It is defined as the presence of kidney damage or an estimated
glomerular filtration rate
Kidney Diseases

7. Renal Failure
 It is a complete loss of kidney functioning and is the destruction of
the glomerular that are responsible for the filtration of the fluids in
the body.
 Types of Renal failure
 Acute renal failure (ARF)
 Chronic renal failure (CRF)

8.  Renal replacement therapy (RRT)
It may be required on a temporary basis in patients with AKI or on a
permanent basis for those with advanced CKD.
 Dialysis
Dialysis is an artificial process involving the removal of wastes and
excess water from the blood.
Types of dialysis
Hemodialysis (HD), and Peritoneal dialysis (PD).
Renal Failure Treatment

9.  Hemodialysis: it is the most common
form of renal replacement therapy in
ESRD and is also used in AKD, it
involves gaining access to the circulation,
either a central venous catheter (cvc), an
arteriovenous fistula (avf) or
arteriovenous graft (avg) (fig. 2) Figure 2. Hemodialysis Access. a) CVC b) AVF c) AVG
Renal Failure Treatment

10. Renal Failure Treatment
Figure 5. Peritoneal dialysis
 Peritoneal dialysis:
 It is a renal replacement therapy
based on infusing a sterile solution
into the peritoneal cavity through a
catheter and provides for the
removal of solutes and water using
the peritoneal membrane as the

11. Literature Review:
 Globally in 2017, there were 697.5 million cases of CKD. One in
three people in the general population worldwide is at increased risk
of CKD, and the report estimates that 9 in 10 of those with CKD are
unaware of their condition.
 Among high-income countries, Saudi Arabia and Belgium have the
highest estimated CKD prevalence (24%), followed by Poland (18%),
Germany (17%) and the UK and Singapore (16%).

12.  Norway and the Netherlands have the lowest estimates at 5%. The
United States’ estimated prevalence is 14%, while Canada and
Australia are 13%.
 Globally, estimated CKD prevalence worldwide varies from 7% in
South Asia and 8% in Africa to as high as 11% in North America and
12% in Europe, The Middle East, and East Asia, and Latin America.
Literature Review:

13. Worldwide, an estimated 1 million people die each year from untreated
kidney failure. Kidney diseases are a leading cause of death in the
United States. In total, up to an estimated 434.3 million adults had CKD
in Eastern, Southern and South-Eastern Asia 315.2 million. As expected,
the absolute number of people with CKD was estimated to be highest in
China (31.9 million) and India (17.9 million).
Literature Review:

14.  The estimated number of people with CKD and advanced CKD in the
remaining 24 countries was up to 134.4 million and 21.3 million,
respectively. About (253) person per million population Egypt, (462)
patients per million populations, in Saudi, (120) patients per million
populations, in Jorden, (243) patients per million populations in
Lebanon are infected with .In Yemen, renal failure remains a
significant cause of mortality and the incidence rate of end-stage renal
disease is 120 cases per million per year. About 5234 patients
registered in renal dialysis centers of the Yemeni Ministry of Public
Health and Population.
Literature Review:

15.  The rapid increase of renal failure represents a great socio- economic
and public health burden in low income countries (Poudyal et al.,
2022) such as, Yemen. Ibb Governorate is located in the central part of
the Republic of Yemen. It is about (193 km) away from the capital
city, Sana'a. The governorate is known as the "green/ fertile province"
due to its heavy rainfall and green landscape.
Study Justifications:

16.  It is the most densely populated governorate in Yemen outside of
Sana'a city (The Editors of Encyclopaedia Britannica, 1998). Al-
Thawra General Hospital Authority in Ibb city was established in
2010 and is considered the reference hospital for Ibb Governorate and
the neighboring governorates.
Study Justifications:

17.  It contains the only governmental dialysis center in the region, which
is considered one of the most important dialysis centers spread in
Yemen, which number is 32 centers. Because of the war in Yemen
since 2015, Ibb governorate received many people fleeing from the
war from different regions of Yemen, including patients with kidney
failure. To our knowledge, there is a paucity of data regarding to the
risk factors of renal failure in Yemen and understanding of risk factors
of renal failure especially in Ibb city.
Study Justifications:

18. General objective:
 This study aimed to highlight the risk factors associated with chronic
renal failure for patients attending hemodialysis center at Al-Thawra
Authority Hospital in Ibb City, Yemen.

19.  Study sitting:
 A descriptive cross-sectional study was conducted and a total 100
renal failure patents, attending renal dialysis center at Al-Thwra
authority hospital, Ibb city, were selected randomly.
 Sociodemographic data, health status, life style, source of drinking
water collected by structured questionnaire.
 Collected data were analyzed by using (SPSS 22). Frequencies,
percentage and Chi squar (P value) of variables were included in the
analysis.
Research Methodology

20. Variable Frequency (%)
Age (years)
20-28 12 (12%)
29-37 18 (18%)
38-46 26 (26%)
47-55 20 (20%)
56-64 14 (14%)
65-74 8 (8%)
>74 2 (2%)
Gender
Female 40 (40%)
Male 60 (60%)
Social status
Married 86 (86%)
Single 14 (14%)
Educational status
Illiteracy 35 (35%)
Primary 38 (38%)
Secondary 17 (17%)
Type of drinking water Frequency (%)
Mineral water 17 (17%)
Tape water 83 (83%)
Drinking soft drink
Yes 75 (75%)
No 25 (25%)
Khat chewing
Yes 86 (86%)
No 14 (14%)
Smoking
Yes 51 (51%)
No 49 (49%)
Hypertension
No 44 (44%)
Yes 46 (46%)
Diabetes
Yes 16 (16%)
No 84 (84%)
Result:Table2 Description of Socio demography characteristics of study
patients

21.  Figure 6 showed that 48% of renal
failure infected previously with urinary
tract infection (UTI), 30% urinary
stones and 39% exposure for sudden
fright, whereas 14% infected
previously with malaria and 5% with
schistosomiasis. participants who used
non-steroidal anti-inflammatory drugs
represent 29% of the sample, and 18%
had heart disease
5
14
18
30
48
39
95
86
82
70
52
61
0
20
40
60
80
100
schitosomaisis
Previous malaria
Heart diseases
urinary stones
UTI
Sudden Fright
percentage of infection
Non
infected
Infected
Fig. 5. Risk factors of renal failure

22. Variable Status
Gender
P.value
Female Male
Sudden fright
Yes 18 (45) 21 (35)
0.315
No 22 (55) 39 (65)
NSAID using
Yes 12 (30) 17 (28.3)
0.857
No 28 (70) 43 (71.7)
Heart disease*
Yes 11 (27.5) 7 (11.7)
0.043
No 29 (72.5) 53 (88.3)
Previous
schistosomiasis
Yes 2 (5) 3 (5)
1.000
No 83 (95) 57 (95)
Previous malaria
Yes 6 (15) 8 (13.3)
0.814
No 43 (85) 52 (86.7)
Urinary Stone*
Yes 7 (17.5) 23 (38.3)
0.026
No 33 (82.5) 37 (61.7)
UTI
Yes 19 (74.5) 29 (48.3)
0.935
No 21 (52.5) 31 (51.7)
DM
Yes 8 (20) 8 (13.3)
0.373
No 52 (86.7) 52 (68.7)
HTN
Yes 19 (74.5) 26 (43.3)
0.682
No 21 (52.5) 34 (43.3)
Table 3. Distribution of risk factors of renal failure according to
gender
Result

23. Discussion:
The present study revealed that, patient aged between 38-46 years old
represented 26% of target population. Similar studies carried out in
Saudi Arabia (Alzmanan, et al., 2018) and in Yemen (M. Badheeb,
2006) and in Iraq (Al-Abedi, 2020), (Alkhaqani, 2021). This result
could be due decreasing in the glomerular filtration rate (GFR),
weakness of immune system as result of aging.
Discussion:

24. Married subjects represented 86% of target study. The result of this
study is similar to studies conducted in Yemen (Dahnan et al., 2019),
in Iraq (Jawad et al., 2019), (Al-Abedi, 2020) and in Greece (Zyga,
et al., 2015) which show that majority of population study were
married.
Discussion:

25. In the present study majority Renal failure patients 86% were Khat
chewers, the result of this study is similar to that studies conducted in
Jazan city, Saudi Arabia (Alam et al., 2014), and Yemen (Ahmed et
al., 2021) that revealed a higher prevalence of kidney disease due to
Khat chewing. because “Khat users are more susceptible to decreased
urine flow and strength, and to other disturbances in the urination
process, such as difficulty in excreting it and an increase in the number
of times of urination. Reducing drinking water while consuming khat
causes dehydration and sedimentation.

26. These deposits are the cause of stones and urinary bladder infection, in
addition to the store sitting for long periods without movement, and
this in itself is a disastrous problem, and most people are vulnerable In
this study the majority of participants were smoking 51%, which is
similar to that studies conducted in USA (Haroun et al., 2003)
showed that ever smokers were more affected with renal failure than
non-smokers.

27.  Concerning soft drink, about 75% of the study participants were
consumers soft drinks. The result of this study is similar to that studies
conducted in Basrah city. Iraq (M. A. Bahili, 2022), USA (Rebholz et
al 2019), South Jakarta, Indonesia (S. Indrayanti et al., 2019). These
results revealed that consumption of soft drinks is considered as risk
factor for chronic renal failure.
The present study revealed that 16% of the studies renal patient were
diabetics which was higher than study conducted in Yemen (Nassar et
al., 2016) that revealed 9.7% of sample were diabetics.

28. While, the result of current study dissimilar to result of study carried
out in Najran City, Saudi Arabia (Alzamanan et al, 2018), and Taipei
City, Twain (Tsai et al, 2016).
 Diabetes mellitus is the leading cause of CRF and accounts for 50%
of ESRD causes in both developed and developing countries (26, 32).
In the present study revealed that 45% of sample were hypertensive
before renal failure infection. The result of this study is similar to that
studies conducted in Yemen (Nassar et al. 2016), Najran City, Saudi
Arabia (Alzamanan et al, 2018) and Australia (Weldegiorgis and
Woodward, 2020). Hypertension is considered as risk factor for
chronic renal failure

29. Conclusion
This study highlights the most important factors contributing to
chronic renal failure. Khat chewing, consumption of tap water, soft
drink and smoking in Yemen society in addition to aging hypertension,
sudden fright, diabetes, urinary diseases and communicable diseases
infection such as malaria and schistosomiasis could be also risk factors
for renal failure. Thus, national campaigns and early diagnosis and
treatment of urinary disease should be performed to increase
awareness about these factors to possibly reduce the incidence of the
disease
Conclusion & Recommendations

30. Recommendation:
 According to the results of our study we were able to make the
following Recommendations:
 Educating about the dangers of khat chewing, drinking water from
unhealthy sources, smoking, and consuming too much soft drinks that
play an important role in the deterioration of kidney function and the
occurrence of kidney failure through posters, lectures, seminars,
programs ... etc.

31.  Early diagnosis and management of infectious diseases, urinary
stones and chronic diseases, such as heart disease, high blood
pressure and diabetes, which are risk factors for kidney failure that
may cause deterioration of kidney function, must be recognized. In
order to prevent kidney degradation and incidence of kidney failure

32.  Renal failure is one of the serious causes of death in Yemen, where
the incidence of chronic kidney disease is increasing rapidly among
the population of Yemen in the few years past.
 Objective: This study aimed to assessment the risk factors of renal
failure among the patients attending hemodialysis center at Al-
Thawra hospital authority, Ibb, Yemen.
Abstract

33.  Methods: the study is hospital based cross sectional study. A total
of 100 renal failure patients were selected randomly from
hemodialysis center at Al-Thawra general hospital authority.
Sociodemographic data, behavioral factors, medical history
determined by using standardized questionnaire and analyzed by
using IBM SPSS version 22 and Microsoft Excel.
Abstract . . .

34. Result: 26% of renal failure were aged (36 – 47) years while 2% were
aged (74 and above). Majority, 60%, of participants were males and
40% of them were females. Married subjects represented 86%. About
38% of study population had primary education. Most of subject's
drink tap water and soft drinking and smoking 83%, 75%, and 51%
respectively and 86% of them chew khat. Majority, 45% of the
participants had high blood pressure before developing kidney failure.
Abstract . . .

35. Conclusio Khat chewing, consumption of tap water, soft drink and
smoking in Yemen society in addition to aging hypertension, sudden
fright, diabetes, urinary diseases and communicable diseases infection
such as malaria and schistosomiasis could be also risk factors for renal
failure.
Abstract . . .

36. Reference
1. Aadas mediacl knowledge team. chronic renal failure. updated on February 15, 2022.
https://ada.com/conditions/chronic-renal-failure/
2. Ahmed, K. (2021). Adverse Effects of Khat (Catha edulis) Chewing in Yemeni Adults: A
Case-Control Study. https://www.semanticscholar.org/paper/Adverse-Effects-of-Khat-(Catha-
edulis)-Chewing-in-A-Ahmed-Abdoh/9d4ed5edb628670fffd0638b6134084a5b55233a
3. Al-Abedi, H. M. H. (2020). Assessment Self-Care of Patients’ Undergoing Hemodialysis with
end Stage Renal Disease. https://www.semanticscholar.org/paper/Assessment-Self-Care-of-
Patients%E2%80%99-Undergoing-with-AL-Abedi-Al-
Khafajy/5a8909dd642c74679e1bfdf309c5a86a0ed47eab
4. Alam, S., Bin-Jerah, A., Nabi, G., & Husain, Q. (2014). Effect of khat (Catha edulis)
consumption on the functions of liver, kidney and lipid profile in male. . .
ResearchGate.https://www.researchgate.net/publication/303206448_Effect_of_khat_Catha_e
dulis_consumption_on_the_functions_of_liver_kidney_and_lipid_profile_in_male_populatio
n_of_Jazan_Region_of_Kingdom_of_Saudi_Arabia