RESUMEN
The Gulf Cooperation Council (GCC) is a regional organisation, consisting of six Arab countries that share common objectives and cultural identities, with a total population of 57.3 million. The prevalence of patients requiring dialysis in GCC countries is increasing, with a current mean prevalence of 551 per million population. Despite the several patient-level and healthcare system benefits of peritoneal dialysis (PD) compared to in-centre haemodialysis, the growth in PD utilisation has been limited. This is related to several factors, including deficiencies in modality education for chronic kidney disease patients, nephrology training and governmental policies advocating for this dialysis modality. Establishing a detailed PD registry in GCC countries is an important step towards understanding our patients' characteristics, outcomes, current PD practices and challenges in order to increase the use of PD and to facilitate future initiatives aimed at optimising the management of PD patients in this part of the world. This article reviews common challenges around PD practices and utilisation in GCC countries and provides possible solutions to overcome these challenges. It should be noted that the literature on PD patients, outcomes and treatment practices in GCC countries is limited, and as a result, many of our recommendations and discussion are based on clinical observations, experience and data when available.
RESUMEN
INTRODUCTION: Permanent arteriovenous fistula and graft are considered the best options for hemodialysis in end-stage renal disease patients. Temporary access using the internal jugular or femoral veins is the feasible option in acute cases of dialysis and if permanent access is unavailable. Occasionally, however, these access sites are unusable after consecutive blockage of the upper and lower extremities veins. A transhepatic or translumbar approach might be the only unconventional way to ensure a sufficient blood flow for adequate dialysis. METHOD: Retrospective data on all transhepatic catheters (THCs) in patients at the King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia were collected. The catheters were inserted over a 10-year period (2009-2019). A minimum of 1 year of follow-up from the last catheter insertion was considered for analysis. RESULTS: A total of 12 patients had THCs with a mean age of 42.5 ± 12.2 and pre-insertion mean dialysis duration of 130.0 ± 72.9 months. All catheters were functional from the start with no immediate complications. A total of 35 catheter replacements over guidewires were made with a median of 2.0 catheters (range of 0-10). The mean blood flow was 300 ± 30 ml/minute with a mean Kt/v of 1.4 ± 0.4. The median initial (primary) device service interval was 68 (range 6-1531 days) and the median total access site service interval was 392 (range 76-2698 days). Catheter complications included catheter migration, thrombosis, and bloodstream infection occurring at a rate of 0.12, 0.18, and 0.046 per 100 catheter days respectively. CONCLUSIONS: Transhepatic catheters provide safe, feasible access in patients with exhausted vascular access. Patients who undergo THC insertion should be worked up for innovative permanent vascular access or urgent transplantation utilizing unconventional vascular techniques to avoid death due to lack of access.
RESUMEN
Hepatitis C Virus (HCV) infection constitutes a major health issue in many hemodialysis (HD) units all over the world, including Saudi Arabia. Despite the isolation policy practiced in many dialysis units, the prevalence is still high. Current literature does not support isolation policy and actually points to the role of health care providers in transmitting the disease. This study has been conducted in a questionnaire format to investigate the nurses' knowledge about HCV and their practice inside the HD units. Structured questionnaires were distributed among 36 nurses in units with high prevalence for HCV (Group I) and 34 nurses in units with low prevalence (Group II). Comparison was made between the two groups. In both groups, 54% of nurses received their HCV education by nurse educator, 13% by physicians, 10% by both and 23% had no targeted education. There is no statistical difference in the providers of education between the two groups. Most nurses in both groups isolate patients on the line of HCV serostatus. The difference was observed in the method of isolation and the use of dedicated machines. Twenty-five nurses (69%) of group I practice ward isolation while 16 nurses (47%) of group II use this practice (P = .04). Twenty-five nurses (69%) of group I reported using HCV-dedicated machines in comparison to only seven nurses (20.5%) of group II (P = .001). All nurses in group II cleaned the machine surfaces and HD tables after each patient, while only 58% of nurses in group I did so after each patient, 39% at the end of the day and three percent never cleaned the surfaces (P .003). In conclusion, HCV infection in high prevalence units is probably related to poor application of standard health precautions and that isolation does not prevent spread of the disease inside HD units. Improving the nurse: patient ratio and encouraging the liberal use of gloves, together with well implemented policies and practices, will result in a better control of HCV transmission in dialysis units.
RESUMEN
We describe four patients with chronic renal failure (CRF) who developed significant neurotoxicity after receiving short-term ciprofloxacin. Three of them had developed encephalopathy with myoclonic jerks and one patient had delirium. All patients had advanced chronic renal failure (mean estimated creatinine clearance 16 +/- 6 ml/minute), although they were not yet on renal replacement therapy. The mean received dose of ciprofloxacin was 2150 +/- 1300 mg and symptoms started to appear after the first 24 hours of drug intake. Investigations ruled out other possible causes of these neurological presentations, and withdrawal of ciprofloxacin was followed by complete resolution, after a mean of 8.5 +/- 4 days. Advanced renal failure in all patients and underlying neurologic diseases in two patients may have predisposed them to the neurotoxicity. The report of these cases should help to draw the attention of clinicians to the potential occurrence of these adverse effects in patients with CRF.
