Abdelwahab Hisham, Shigidi Mazin, El-Tohami Alyaa, Ibrahim Lamees
Khartoum Teaching Hospital, Ministry of Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Arab J Nephrol Transplant. 2013 May;6(2):99-104.
Hemodialysis (HD) is a complex procedure with many specifications and requires adherence to a set of particular clinical practice guidelines. These guidelines had already been established by globally acclaimed renal authorities and their implementation was shown to correlate with patients' morbidity and mortality. This study was conducted to evaluate the adherence of healthcare professionals to the evidence-based clinical practice patterns in Khartoum State HD units.
A cross-sectional study was conducted in Khartoum State HD units during the period from September 2010 to January of 2011. Data was collected from the healthcare professionals using a specially designed checklist. The checklist included the evidence-based clinical practice guidelines for the HD vascular access, HD adequacy, anemia of chronic kidney disease (CKD), nutrition, cardiovascular risk assessment, and hepatitis B and C virus infection control. Implementation of these guidelines was evaluated, and further graded using a Likert-type scale.
Four randomly selected HD units were included in the study. The rate of implementation of the HD vascular access guidelines was 54.8%, adequacy guidelines 57%, anemia of CKD 68.8%, nutrition 58.4%, cardiovascular risk assessment 57%, and hepatitis B and C infection control guidelines was 79.2%. Overall, the four HD units assessed showed moderate deviations from the practice guidelines of anemia of CKD and hepatitis B and C infection control. Extreme deviations from the clinical practice guidelines were seen in HD vascular access practices, adequacy assessments, nutrition and cardiovascular risk assessment.
Hemodialysis services in Khartoum State are in need of great improvements regarding adherence to protocols and the standards of care.
血液透析（HD）是一个具有许多规范的复杂程序，需要遵循一套特定的临床实践指南。这些指南已由全球知名的肾脏权威机构制定，其实施情况与患者的发病率和死亡率相关。本研究旨在评估喀土穆州血液透析单位医护人员对循证临床实践模式的遵循情况。
2010年9月至2011年1月期间，在喀土穆州血液透析单位进行了一项横断面研究。使用专门设计的检查表从医护人员那里收集数据。检查表包括血液透析血管通路、透析充分性、慢性肾脏病（CKD）贫血、营养、心血管风险评估以及乙型和丙型肝炎病毒感染控制的循证临床实践指南。对这些指南的实施情况进行了评估，并使用李克特量表进一步分级。
研究纳入了四个随机选择的血液透析单位。血液透析血管通路指南的实施率为54.8%，充分性指南为57%，CKD贫血为68.8%，营养为58.4%，心血管风险评估为57%，乙型和丙型肝炎感染控制指南为79.2%。总体而言，所评估的四个血液透析单位在CKD贫血和乙型和丙型肝炎感染控制的实践指南方面存在中度偏差。在血液透析血管通路实践、充分性评估、营养和心血管风险评估方面，与临床实践指南存在极端偏差。
喀土穆州的血液透析服务在遵循方案和护理标准方面急需大幅改进。
