title: Dialysis-treated end-stage kidney disease in Libya: epidemiology and risk factors.
abstract: OBJECTIVE
  End-stage kidney disease (ESKD) is now a worldwide pandemic. In concert with this, ESKD in Libya has also increased exponentially in recent decades. This review aims to define the magnitude of and risks for this ESKD epidemic among Libyans as there is a dearth of published data on this subject.
  
  
  METHODS
  A systematic review was conducted by searching PubMed, EMBASE and Google scholar databases to identify all relevant papers published in English from 2003 to 2012, using the following keywords: end stage, terminal, chronic, renal, kidney, risk factors, Arab, North Africa and Libya.
  
  
  RESULTS
  In 2003, the reported incidence of ESKD and prevalence of dialysis-treated ESKD in Libya were the same at 200 per million population (pmp). In 2007, the prevalence of dialysis-treated ESKD was 350 pmp, but the true incidence of ESKD was not available. The most recent published WHO data in 2012 showed the incidence of dialysis-treated ESKD had risen to 282 pmp and the prevalence of dialysis-treated ESKD had reached 624 pmp. The leading causes of ESKD were diabetic kidney disease (26.5 %), chronic glomerulonephritis (21.1 %), hypertensive nephropathy (14.6 %) and congenital/hereditary disease (12.3 %). The total number of dialysis centers was 40 with 61 nephrologists. Nephrologist/internist to patient ratio was 1:40, and nurse to patient ratio was 1:3.7. Only 135 living-related kidney transplants had been performed between 2004 and 2007. There were no published data on most macroeconomic and renal service factors.
  
  
  CONCLUSIONS
  ESKD is a major public health problem in Libya with diabetic kidney disease and chronic glomerulonephritis being the leading causes. The most frequent co-morbidities were hypertension, obesity and the metabolic syndrome. In addition to provision of RRT, preventive strategies are also urgently needed for a holistic integrated renal care system.
authors.affiliation: Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, National University of Malaysia, Jalaln Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Fathea Abobker
authors.initials: FA
authors.lastname: Goleg
authors.forename: Norella Chiew-Tong
authors.initials: NC
authors.lastname: Kong
authors.forename: Ramesh
authors.initials: R
authors.lastname: Sahathevan
mesh_terms: D003928:Diabetic Nephropathies / Q000150:complications; D030342:Genetic Diseases, Inborn / Q000150:complications; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D016030:Kidney Transplantation; D008002:Libya / Q000453:epidemiology; D009393:Nephritis / Q000150:complications; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors