Mohamed Abdikarim Hussein, Jeele Mohamed Osman Omar
Urology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.
Internal Medicine Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.
Int J Gen Med. 2022 Jul 21;15:6259-6267. doi: 10.2147/IJGM.S375280. eCollection 2022.
End-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis.
This cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed.
The mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825-5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507-13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%.
The prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.
由于缺乏国家登记系统，索马里的终末期肾病（ESRD）情况仍未得到调查，该国该疾病的影响也尚未评估。本研究是首份旨在评估接受常规血液透析的ESRD患者再入院相关的流行病学特征、病因及透析相关因素的报告。
这项横断面观察性研究纳入了208例ESRD患者。此外，本研究调查了纳入血液透析后再次入院的患者（n = 135）。回顾了这些患者的社会人口学特征、危险因素及合并症。还评估了常规血液透析项目开始后头六个月内与再入院相关的入院科室、住院时间、结局及透析相关因素。
患者的平均年龄为52.7±15.0岁，43.3%的患者年龄>60岁，61.5%为男性。最常见的病因是糖尿病，占39.4%，其次是高血压（35.6%），肾后梗阻占12.5%。6个月内再次入院的患病率为65%。与再入院相关的最常见透析相关因素是血液透析疗程遗漏导致的尿毒症并发症（40%）、血管通路/导管感染（20%）及贫血（17.8%）（95%置信区间：0.825 - 5.357，比值比：3.017，p < 0.04）。女性患者更易发生血管导管部位感染、贫血及低钠血症（p < 0.001）。27.5%的患者入住重症监护病房（ICU），入住ICU最常见的原因是肺水肿（53.8%）、败血症（42.8%）及血液透析遗漏导致的尿毒症（26.4%）（95%置信区间：1.507 - 13.632，比值比：2.08，p = 0.01）。死亡率为5.2%。
六个月内非计划再次入院的患病率非常高，血液透析疗程遗漏被确定为主要原因。透析知识不足、对透析概念的错误社会认知以及缺乏涵盖每次透析较高费用的医疗保险系统被认为是透析疗程遗漏的原因。
