Assessment of management and treatment responses in haemodialysis patients from Tehran province, Iran.
BACKGROUND
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as globally important public health problems, and will necessitate improvements in health-care policy. ESRD incidence/prevalence data are not available from large parts of the developing world. The main objective of this study is to describe and assess the current clinical practices for patients on maintenance haemodialysis (HD) living in the province of Tehran.


METHODS
In December 2005, an observational study was performed with 2630 patients (1505 males and 1125 females) from 56 different centres in the province of Tehran (the entire HD population), which has a population of 13.5 million inhabitants.


RESULTS
The prevalence/incidence of HD was 194.8/77.3 p.m.p. The leading causes of ESRD were diabetes and hypertension. Population of 90.3 and 9% received three and two sessions per week, respectively, with a KT/V mean value of 0.97+/-0.25. All centres used synthetic membranes, and 68% of the sessions were performed using bicarbonate as a buffer. The type of vascular access was autogenous arteriovenous fistula in 91% of patients. Our findings indicated that compliance with the K/DOQI recommendations for calcium-phosphorus management is difficult to achieve. Only 1.8% of patients achieved all four target laboratory tests. For the management of anaemia, ferritin was the most commonly performed measure of iron status (76.7%). Iron deficiency was seen in <20% of patients (ferritin <or=200) and the mean value of haemoglobin (Hb) was 10.14+/-2.00 g/dl.


CONCLUSIONS
The achieved standard of renal replacement therapy (RRT) in Tehran province, Iran is acceptable and in some aspects is comparable with European countries, but the number of ESRD patients is increasing in Tehran and worldwide. Increases in the number of HD centres, machines, shifts and kidney transplantations are taking place but cannot keep pace with the increasing number of patients. It is highly recommended that we try to increase peritoneal dialysis (PD) coverage and cadaveric transplantation, while keeping in mind that the prevalent population of individuals with CKD is estimated to be at least 20 times the number with ESRD. It is not too ambitious to consider CKD prevention, and we should place initial focus on strategies and treatments that slow disease progression, in order to postpone RRT.
Mahdavi-Mazdeh
Mitra
M
Department of Nephrology, Medical Sciences, Tehran University, Tehran, Iran. mmahdavi@tums.ac.ir
Zamyadi
Mahnaz
M
Nafar
Mohsen
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007492:Iran; D007674:Kidney Diseases / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis