Capacity for the management of kidney failure in the International Society of Nephrology Middle East region:Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

The highest financial and symptom burdens and the lowest health-related quality of life scores are seen in people with kidney failure. A total of 11 countries in the International Society of Nephrology (ISN) Middle East region responded to the ISN-Global Kidney Health Atlas. The prevalence of chronic kidney disease (CKD) in the region ranged from 4.9% in Yemen to 12.2% in Lebanon, whereas prevalence of kidney failure treated with dialysis or transplantation ranged from 152 per million population (pmp) in the United Ara Emirates to 869 pmp in Kuwait. Overall, the incidence of kidney transplantation was highest in Saudi Arabia (20.2 pmp) and lowest in Oman (2.2 pmp). Chronic hemodialysis (HD) and peritoneal dialysis (PD) services were available in all countries while kidney transplantation was available in most countries of the region. Public government funding that makes acute dialysis, chronic HD, chronic PD, and kidney transplantation medications free at the point of delivery was available in 54.5%, 72.7%, 54.5%, and 54.5% of countries, respectively. Conservative kidney management was available in 45% of countries. Only Oman had a CKD registry while 7 (64 %) countries had dialysis registries and 8 (73%) had kidney transplantation registries. The ISN Middle East region has a high burden of kidney disease and multiple challenges to overcome. Prevention and detection of kidney disease can be improved by the design of tailored guidelines, allocating additional resources, improving early detection at all levels of care, and implementing sustainable health information systems

Peritoneal dialysis for chronic kidney disease patients: A single-center experience in Saudi Arabia

To evaluate the peritoneal dialysis (PD) program in our hospital, we retrospectively studied all patients dialyzed with this modality over the last 5 years. A total of 56 patients having end-stage renal disease (ESRD), with mean age ± SD of 49 ± 20 years (range 16-92 years), were dialyzed with PD: 38 (68%) patients with continuous ambulatory PD and 18 (32%) patients with automated PD. Twenty-six (46%) patients were females. The mean follow-up time of these patients was 17 ± 14 months. The underlying etiologies for ESRD in these patients were diabetes mellitus (48%), glomerulonephritis (9%), and hypertension (7%). Twenty-seven patients (48%) were put on PD from the start, while 29 (52%) patients were switched from hemodialysis (HD) to PD. Nineteen (34%) patients developed a total of 29 episodes of peritonitis. The incidence of peritonitis was 0.4 episode per patient-year. Exit-site infections occurred in 17 (30%) patients. No tunnel infection was observed during the study period. Non-infectious catheter-related complications occurred in 12.5% of the patients; six (11%) patients had hernia (umbilical or inguinal). At the end of the study, 23 (41%) patients continued on PD, 17 (30%) received a renal transplant, 7 (13%) suffered technique failure and subsequently switched to HD, and 9 (16%) patients died. To conclude, our study demonstrates that the rate of PD related complications is found to be quite low in our program, with an acceptable technique failure rate and mortality. Therefore, PD is a safe and an effective treatment modality in the integrated care approach to patients with ESRD

Superiority of peginterferon α-2a and ribavirin combination over peginterferon α-2a monotherapy in the management of hemodialysis patients with chronic Hepatitis C virus infection

Hepatitis C virus (HCV) is a common infection affecting 15% of hemodialysis population in Saudi Arabia resulting in delay in transplantation and long-term complications. The use of peginterferon resulted in sustained virologic response (SVR) in 40%–85% of patients, especially if combined with ribavirin. The treatment is hampered by the high dropout due to anemia and requirement of blood transfusion resulting from this therapy. Some studies have shown that the addition of increasing dose of erythropoiesis-stimulating agents (ESA) and reduced dose of ribavirin results in reduced dropout rate with high SVR. We conducted an open-label prospective study using either peginterferon α-2a alone (Group I, 32 patients) or peginterferon α-2a plus adjusted dose ribavirin (Group II, 26 patients). A total of seven patients dropped from the study (2 in Group I and 5 in Group II). Analysis was done only on patients who completed the study (thirty patients in Group I and 21 in Group II). There was no significant difference in the demographic data, HCV genotype, liver biopsy grade and stage, and laboratory tests between the two groups. Patients received ESA to combat expected anemia. Group II had a better early virologic response than Group I [17 out of 21 (80%) and 14 out of 30 (47%) respectively, P = 0.014] and better SVR [18 out of 21 (85%) and 15 out of 30 (50%) respectively, P = 0.009]. There were no differences in mean white blood cells, hemoglobin, and platelets between the two groups at any time with only four patients dropping out due to anemia or side effect of medications. Alanine aminotransferase was lower in both treatment groups compared to baseline with no difference between the groups. Peginterferon α-2a and ribavirin are superior to peginterferon α-2a alone in treating hemodialysis patients with chronic HCV infection