Hypertension in UAE Citizens - Preliminary Results of a Prospective Study.

This report from the National Epidemiological Study of Hypertension in the United Arab Emirates (NESH-UAE) represents the preliminary results of phase I, comprising the prevalence, awareness, treatment and control of hypertension among UAE citizens (adults aged 18-75 years). The data reported in this study represent only the region of the Sharjah district, UAE. There were 3150 individuals enrolled for the study. Hypertension was defined as systolic pressure > 140 mmHg, and/or diastolic pressure> 90 mmHg, and/or reported treatment with one or more antihypertensive medications. The overall prevalence in this screened sample was 36.6%. Most of the study subjects were in the productive age, from 30-50 years. In the hypertensive group there are more females than males (53% vs. 47% respectively). Overall, 26% of hypertensive persons were aware that they had high blood pressure, 41% being treated with antihypertensive medications, and 19 % were under control (systolic pressure < 140 and diastolic pressure < 90 mmHg). We plan to extend the study to other regions in the country in order to attain a representative sample and results about this disease. These preliminary results indicate that hypertension is highly prevalent in the UAE. The rates of awareness, treatment and control are relatively low. Furthermore, they argue for a nation-wide effort to prevent and control high blood pressure in the UAE in order to prevent the related complications.

Is peritonitis a limiting factor in the widespread use of CAPD in the developing countries?

Although continuous ambulatory peritoneal dialysis (CAPD) is now an established form of treatment for patients with end-stage renal failure (ESRF), it is not being used on a large scale in developing countries (DC). One of the limiting factors in this regard is peritonitis which is the most common complication of CAPD. Data on 70 patients on CAPD in our center were analyzed to study the impact of peritonitis on long-term outcome of this treatment. The mean age of the study patients was 37.2 years and the mean follow-up was 32.8 months per patient. A total of 41 patients (58.6%) received CAPD as first choice, 27 (38.6%) were started on CAPD after being on hemodialysis earlier and two (2.8%) were started on CAPD after a failed renal transplantation. Thirty three patients (47.1%) used safe-leur lock system, 23 (32.9%) used the spike system and 14 (20%) used safe-leur system initially and subsequently were changed to spike system. The overall incidence of peritonitis encountered was one episode per 32.3 patients months and was higher among patients who started CAPD as second choice. The incidence of peritonitis was not influenced by sex, age, profession or presence of diabetes mellitus or cardiovascular disease. This study shows that peritonitis rate in CAPD patients in our hospital is low and compares favorably with results from established centers in the developed countries. Thus, worries about recerrent peritonitis should not hinder CAPD programs in DC.

The impact of catheter design on preventing CAPD complications.

Continuous ambulatory peritoneal dialysis has become a practical and safe mode of therapy for patients with end-stage renal disease. The creation of a durable, safe and efficient peritoneal access has been made possible through refinements in catheter design. The Tenckhoff catheter and its modifications has remained the most popular peritoneal access devise over the last 25 years. The major objectives' in catheter design include ensuring biocompatibility, ease with which the catheter can be implanted and removed as well as esthetic appeal. The other features in a peritoneal dialysis catheter are those that reduce catheter related complications such as catheter migration, exit-site and tunnel infections, flow restriction and catheter cuff erosion. Although the perfect peritoneal catheter remains elusive as yet, refinements in design and manufacturing materials have facilitated the implantation and maintenance of the catheter resulting in better dialysis technique survival, lesser morbidity and greater patient acceptance.

Hepatitis C virus infection among dialysis patients in United arab emirates.

To evaluate the incidence of positivity of anti-hepatitis C virus (anti-HCV) antibodies in the hemodialysis (HD) patients, and the impact of isolation of the anti-HCV positive patients, we studied 262 HD patients in our unit between January 1991 and December 1993. There were 64 patients with anti-HCV positivity. Forty nine of them were males, and 15 were females, with mean ages of 41.8 +/- 8.6 years. The mean dialysis period was 20.9 +/- 2.5 months. The serum anti-HCV antibodies were detected with second generation HCV enzyme linked immunosorbent assay. The test was repeated every three months for the patients, and every six months for the dialysis staff members. Dialyzers were not reused. Isolation of the positive patients by using designated HD machines was performed, besides adopting the universal precautions of infection. At the time of the inclusion to the study 45 patients out of 64 (70.3%) were anti-HCV positive. In this group 42% received blood transfusions, 17.5% started hemodialysis in another dialysis unit. Nineteen patients (29.7%) seroconverted during the study period. In this group, nine patients (47.6%) received blood transfusions (1.7 + 0.5 units). Of the seroconverted patients, eight (42%) travelled abroad and received HD during their holidays. Eight of the seroconverted patients did not have identifiable risk factors except HD. The overall seroconversion rate was 0.95 per 100 patient months. The rate decreased to 0.4 per 100 patient months if the identifiable causes for seroconversion (blood transfusion, duration of dialysis, holiday dialysis) were excluded. We conclude that HCV infection is frequent in hemodialysis patients. Strict follow up of the universal precautions together with isolation of anti-HCV positive patients with designated machines may be sufficient to prevent nosocomial transmission of HCV infection. The risk of transfusion may be minimized by using r-Human erythropoietin in the treatment of anemia in this population.

[Continuous ambulatory peritoneal dialysis (CAPD). 3 years' therapeutic experience in 100 patients]. / Kontinuierliche ambulante Peritonealdialyse (CAPD). 3jährige Behandlungserfahrungen an 100 Patienten.

The pros and cons of CAPD are weighed up on the basis of a 3-year study on 100 patients with renal insufficiency (61 men, 36 women and 3 children). If equal groups are compared, the survival rate corresponds to that of haemodialysis. Continuous detoxication and dehydration lead to a good uraemic metabolic situation (creatinine 960 mumol/l, urea 24 mmol/l, haemoglobin 98 g/l, albumin 31 g/l. The serum electrolytes are well-balanced, anorganic phosphate is normal. The rise in cholesterol and triglycerides observed is a possible negative influence with regard to arterial sclerosis. The functioning of the kidneys is not affected by CAPD. The main risks of this method of therapy are peritonitis and loss of protein via the peritoneal dialysate, which can be favourably influenced by strictly antiseptic handling when changing the dialysate bag and a sufficient protein supply in the diet. In France 10-15% of all patients with terminal renal insufficiency will be treated with CAPD in future.

Visual function can be preserved in insulin-dependent diabetic patients treated by maintenance haemodialysis.

Evolution of visual function was assessed in 43 insulin-dependent diabetic (IDD) patients treated by maintenance haemodialysis (MH) for a cumulative duration of 1248 patient-months. At start of MH, 23 patients (46 eyes) still had good vision, 20 patients (40 eyes) were blind. All 40 blind eyes had severe proliferative retinopathy (PR) with additional irreversible complications in 32. Of the 46 eyes with preserved vision, PR was present in 24 (52.2%) with only 2 additional severe complications. Restoration of sight was obtained either spontaneously or after ophthalmic surgery in 6 eyes (7%). Stabilisation was achieved in 74% of eyes which retained vision at the start of MH. Two patients with eyesight at start of MH became blind (8.7%). Aggravation of visual function is mainly related to development of PR and not to haemodialysis per se. Careful ophthalmic follow-up, together with close control of diabetes, blood-pressure and uraemia can ensure preservation of vision in most IDD patients treated by MH.