Palestinian Medical and Pharmaceutical Journal (PMPJ)

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https://hdl.handle.net/20.500.11888/814

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Browsing Palestinian Medical and Pharmaceutical Journal (PMPJ) by Author "Bayan Namourah"

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    Evaluation of Compliance to Treatment Guidelines and Goals of Therapy among Palestinian Hemodialysis Patients
    (2016) Bayan Namourah; Rowa Al-Ramahi
    Patients on hemodialysis usually need management of diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder. This study was conducted to asses prescribing pattern, to evaluate compliance to treatment guidelines and goals of therapy in hemodialysis patients. This study was an observational retrospective cohort study; it was conducted at Hebron governmental hospital / Palestine. All adult patients on chronic hemodialysis were included. All information were collected from governmental electronic health record (AviCenna HIS program), and patients were asked to answer some questions. During the study period 158 patients were prescribed 1567 medication orders with a mean of 9.92±2.94. The majority of the patients (72.2%) had Hypertension. The target predialysis blood pressure was achieved in 77.2% of the patients (70.5% of the males vs 87.3% of the females; P- value =0.014), and post dialysis blood pressure was achieved in 57.6% cases. Diabetes was a comorbid disease in 36.7% patients and hemoglobin A1c (HbA1c) test was not performed for these patients. Patients with total cholesterol levels of < 200 mg/dl were 78.3% patients. Regarding triglycerides levels, 96.2% had levels of < 500 mg/dl. In the management of anemia, patients who reached goal hemoglobin (Hb) of 11-12 mg/dl according to the national kidney foundation (NKF) guidelines were 8.9% patients only. If kidney disease improving global outcome (KDIGO) guidelines are used (Hb 9-11.5 mg/dl) the patients in this range were 43.0% cases. Transferrin levels were not measured. Iron was used by 69.9% of the patients, and erythropoietin stimulating agents (ESA) by 5.1% of the patients as it was not available in the hospital. No data was available for calcium, and parathyroid hormone levels. Target phosphorus level was obtained in 12.0% of the patients according to the NKF guidelines. If serum phosphorus normal range of 2.5–4.5 mg/dl is used according to KDIGO guidelines, this target was achieved in 4.4% patients only. The results reflect a poor compliance to treatment guidelines. The target levels for treatment are not achieved in many HD patients. The medications are not prescribed optimally to the patients and many investigations and laboratory tests are not performed