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The Hashemite Kingdom of JordanMinistry of Health
Non-Communicable Diseases Directorate
National Registry of End Stage Renal Disease
(ESRD)
Annual Report 2016
www.moh.gov.joTel: 5678197 Fax: 5656489
Jordan
The Hashemite Kingdom of JordanMinistry of Health
Non-Communicable Disease Directorate
National Registry of End Stage Renal Disease
(ESRD)
Annual Report 2016
Prepared by:
Dr. Salem Al-Qaisi Dr . Majed Asaad
His Majesty King Abdullah II
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List of the team who participated in producing this ESRD annual report:
Dr. Mohammad Salameh El-LoziSenior Consultant in Internal Medicine,Nephrology and Transplantation. MRCP (UK). FRCP (London). FRCP (Glasgow), Private sector and P.H.H.
Dr. Khaled Ali ZayedNephrologist, MOH.
Dr. Tayseer SahebFamily medicine consultant – MOH/NCD Directorate.
Dr. Kamal Hassan ArkoubSpecialist in Community Medicine. MOH.
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Foreword
It is my great pleasure to present to you the ninth report of the Jordan National End Stage Renal Disease Registry (ESRDR) for the year 2016.We hope that this report will assist health care providers, public health officers, NGOs in their work to prevent and control renal diseases in Jordan.
As a Minister of Health, I will assure that Jordan ESRD Registry will receive all the support that the ministry can offer. The annual report of the Jordan Renal Registry explores the trends and characteristics of (ESRD) in Jordan and clarifies many misconceptions, while providing informative and reliable data to help in policy building at a national level.
The data presented in this report constitutes an organized and systematic data of ESRD registry, it provides prevalence, incidence and burden of ESRD in Jordan, and it will provide readers with information on the epidemiology of ESRD in Jordan and its distribution by age groups, gender, and governorates. It also assists researchers, renal diseases experts, and policy makers in identifying priorities for developing national strategies and programs for renal diseases early detection as well as prevention programs.
I express my gratefulness and appreciation to everyone who helped in the preparation and dissemination of this report, and assures all of you that the Ministry of Health will continue to support National End Stage Renal Diseases Registry by all available resources to make its mission ongoing and of greatest benefit.
Minister of Health
Prof. Dr. Mahmoud Al-sheyyab
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Acknowledgement
The National ESRD Registry operates under the umbrella of the Ministry of Health; however, it works in cooperation with a large number of hospitals from all health sectors, Nephrologists and Nurses working in dialysis units who provide the registry with valuable and vital data required for success.
We would like to thank all those who cooperate with us, report and facilitate our work, namely Nephrologists, Physicians, Nurses and staff of the Dialysis Units. The obvious support of focal points in all dialysis units is highly appreciated.
We would like to thank Mr. Haytham Shgairat and Mrs. Rasha Kokash for their effort in data entry of all ESRD Data to special designed software for the Registry.
Special thanks to our focal points-head of Renal unit in all governmental, private, military and university hospitals for the timely collection and submission of data to the registry.
The interaction between the Registry and the Jordan Society of Nephrolog y is very positive and greatly appreciated.
The dedicated hard work during the process of data collection and data entry of the staff in the registry is acknowledged.
We are very grateful to the Eastern Mediterranean Public Health Net Work (EMPHNET) for its support in preparing and publishing this report.
General Director PHC Director of NCD Directorate
Dr. Ayoub As-sayaideh Dr. Majed Assad
Head of National ESRD Registry
Dr. Salem Al-Qaisi
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Name of Hospitals
Royal Medical ServicesHospital Name Site Phone number
King Hussein Medical center Amman 5804804
Prince Hashem Bin Al Hussein Zarqa’a 3962002
Prince Hashem Bin Abudullah Aqaba 2014111
Prince Ali Bin Al Hussein Karak 2386370
Prince Rashid bin Al Hassan Irbid 7100890
Prince Zeid bin Hussein Tafiela 2242982
Queen Rania Hospital Amman 5804804
Ministry of Health Hospital Name Site Phone number
Al-Basher Hospital Amman 4775111
Abu Obaida Hospital Irbid 026570018
Hussein Hospital Balqa 053551140
Karak Hospital Karak 032386190
Ruweished Hospital Mafraq 026292183
Maan Hospital Maan 032132222
Mafraq Hospital Mafraaq 026231234
Princess Iman Balqa 053584934
AL-Zarqa’a Hospital Zarqa 05398332
Jamel Altotnge Amman 4020096
Yarmouk Hospital Irbid 027585980
Princess Raya Irbid 026521666
Ghor Safi Hospital Karak 032302436
Prince Hamza Hospital Amman 5053826
Queen Rania Al-Abdullah Maan 032150636
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Ramtha Hospital Irbid 027384384
Iman Hospital / Ajloun Ajloun 026421914
Princess Salma Hospital Madaba 053207104
Jerash Hospital Jerash 026351114
Moaz bin Jabal Irbid 026587011
Princess Basma Teaching Irbid 027275555
Nadeem Hospital Madaba 053244008
AL-Shoneh AL-Janobyeh Balqa 053581364
Prince Hussein Balqa 5351731
Al-badeya Hospital Mafraq 026298040
Aqleh Hospital Amman 4642441
AL-Ahli Hospital Amman 5664164
AL-Dleel Hospital Zarqa 053825144
Roum-AlCatholic Hospital Irbid 027257900
AL Haya Hospital Amman 4391111
Prince Faisal Hospital Zarqa 053740251
Al-Qawasmi Hospital Irbid 027243401
Al-Najah Hospital Irbid 027100170
Al-Khansa’a Hospital Amman 4898893
University HospitalsHospital Name Site phone numberJordan University Hospital Amman 5353666King Abdullah University Irbid 027200600
Private Sector HospitalsHospital Name Site Phone Number
Islamic Hospital Amman 5101010
Jordan Hospital Amman 5608080
AL-Qouds Hospital Amman 4387181
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Shmeisani Hospital Amman 5607431
Specialty Hospital Amman 5609609
Aljazeera Hospital Amman 5657581
Ibn al-Haytham Hospital Amman 5205555
Arab Medical Center Amman 5921199
Dr. Ahmed Hamayda Hospital Amman 4785555
AL Esteqlal Hospital Amman 5652600
Luzmila Hospital Amman 4624345
AL Isra Hospital Amman 5300300
Marka Islamic Amman 4893855
Palestine Hospital Amman 5607071
Philadelphia Hospital Amman 5854801
Tla Al Ali Hospital Amman 5339008
AL Hanan Hospital Amman 4750800
Amman Surgical Hospital Amman 4641261
Italian Hospital / Amman Amman 4777101
AL-Rasheid Hospital Amman 4777444
Dar AL-Salam Hospital Amman 5850008
Algardens Hospital Amman 5777111
Almaqased Hospital Amman 4377000
Jordanian Red Crescent Amman 4779131
Italian Hospital / Karak Karak 032355345
AL Mahaba Hospital Madaba 053245541
AL Hekma Hospital Zarqa 053990990
AL Razi Hospital Zarqa 053744167
Jabal Al-Zayton Hospital Zarqa 053655555
Qaser Al-Shibib Hospital Zarqa 053987995
Irbid Specialty Hospital Irbid 027103100
Ibin Al-Nafees Hospital Irbid 027102100
Al-Rahbat Al-Wardyeh Irbid 027102011
Islamic Irbid Hospital Irbid 027273111
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Table of Contents
List of Abbreviations 12List of tables 13List of Figures 14
Part One: 16Introduction 17Geography 18Population 18Jordan Renal Registry 26Methodology 30
Part Two: 32Dialysis Units in Jordan- prevalence 32
Part Three: 34ESRD Patients in Jordan 34Trend of ESRD patients in Jordan during (2008-2016)
Part Four: 48Incidence of ESRD Patients in Jordan 48
Part Five: 56Pediatric ESRD 56
Part Six: 61ESRD patients among Non-Jordanians 61
Part seven: 64ESRD Mortality 64
References 67
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List of Abbreviations
ESRD End Stage Renal Disease
MOH Ministry of Health
CDC Centers of Disease Control and Prevention
WHO World Health Organization
BRFSS Behavioral Risk Factors Surveillance System
NCD Noncommunicable Disease
PHH Prince Hamza Hospital
DOS Department of Statistics (Jordan)
OR Odds Ratios
BMI Body Mass Index
CI Confidence Interval
PS Private Sector
CKD Chronic Kidney Disease
GFR Glomerular Filtration Rate
RRT Renal Replacement Therapy
RMS Royal Medical Services
PPM Prevalence per Million Populations
ASIR Age Specific Incidence Rate
JCR Jordan Cancer Registry
IMR Infant Mortality Rate
AKI Acute Kidney Injury
SLE Systemic Lupus Erythematosus
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List of tables
Table N. Description Page
Table (1) Estimated Population of Jordan 2016 20
Table (2) Population distribution by Governorate and gender, Jordan2016 21
Table (3) Selected Demographic, Socio-economic and Health Indicators 2016 22
Table (4) Distribution of ESRD according to age groups, gender and Prevalence Rate per million (PPM), 2016 38
Tables (5) Distribution of ESRD patients according to marital status and gender 2016 40
Table (6) Distribution of ESRD patients by employment status and gender,2016 41
Table (7) Distribution of ESRD patients by type of insurance and gender 2016 42
Table (8) Distribution of ESRD patients by Governorate and prevalence per million populations (PPM) 43
Table (9) Distribution of primary causes of ESRD for the year 2016 44
Table (10) Prevalence of co-morbidity and some risk factors with ESRD 45
Table (11) Distribution of ESRD patients by fitness for transplantation 47
Table (12) Causes of unfitness for transplantation 48
Table (13) Priority level for patient candidate for transplant 49
Table (14) Prevalence of Hepatitis B and C in ESRD patients 50
Table (15) Distribution and ASIR of ESRD cases by gender and age group Incidence 2016 52
Table (16) Primary causes of ESRD for the year 2016 - Incidence 55
Table(17) Causes of ESRD in Pediatric patients 2016 61
Table (18) Distribution of mortality in ESRD patients by age group and gender 66
Table (19) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2016 69
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List of Figures
Figure N. Description Page
Figure (1) Map of the Hashemite Kingdom of Jordan 19
Figure (2) Population Pyramid – Jordan 2016 20
Figure (3) Distribution of dialysis units by health sector, Jordan 2016 32
Figure (4) Distribution of Dialysis Machines by Health Sector, 2016 33
Figure (5) Number of prevalent ESRD patients in Jordan during (2008-2016) 35
Figure (6) International comparison of prevalence rate of Hemodialysis (PPM) 2016 36
Figure (7) Distribution of ESRD patients by gender 37
Figure (8) ESRD cases according to age groups and gender-2016 39
Figure (9) ) Distribution of ESRD cases by age group -2016 39
Figure(10) Distribution of prevalent ESRD patients by Health sec-tor,2016 42
Figure (11) Distribution of ESRD patients according to Blood group 45
Figure (12) Distribution of ESRD patients by type of Dialysis 46
Figure(13) Distribution of Hemodialysis patients by number of sessions /week 47
Figure(14) Causes of unfitness for transplantation 48
Figure(15) Distribution of fitness of ESRD patients by Priority level for Transplantation 49
Figure(16) Distribution of ESRD patients by availability of a donor 50
Figure(17) Incidence of ESRD Jordanian by gender & age group-2016 53
Figure(18) Distribution of ESRD patients by health sector, 2016 53
Figure(19) Distribution of ESRD patients by gender, 2016 54
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Figure(20) Distribution of ESRD patients by Nationality 2016 56
Figure(21) Distribution of ESRD patients by type of Dialysis, 2016 56
Figure(22) Distribution of ESRD patients by fitness for transplantation 57
Figure(23) Distribution of fitness of ESRD patients by Priority level for transplantation 2016 58
Figure(24) Distribution of mortality in ESRD patients 2016 58
Figures(25) Distribution of ESRD pediatric patients by gender 59
Figure (26) Distribution of Pediatric patients according to type of Dialy-sis 60
Figure (27) Distribution of pediatric patients according to age groups and gender 2016 62
Figure (28) Distribution of Pediatric ESRD by fitness for transplantation 62
Figure (29) Distribution of mortality in Pediatric patients 63
Figure (30) Distribution of mortality in ESRD patients 64
Figure (31) Distribution of mortality in ESRD patients according to gen-der 65
Figure (32) Distribution of mortality in ESRD patients by age group and gender 65
Figure (33) Distribution of ESRD patients by Nationality 67
Figure (34) Distribution of ESRD patients among Non-Jordanians by gender 68
Figure (35) Distribution of ESRD patients among Non-Jordanians ac-cording to age groups and gender, 2016 69
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Part one
Introduction
Geography
Population
Health Status
Jordan Renal Registry
Methodology
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Part One
Introduction ESRD remains one of the leading causes of morbidity and mortality in Jordan. As life expectancy increases in Jordan, the proportion of elderly population is expected to increase; this will lead to higher prevalence of non-communicable diseases including renal diseases that may lead eventually to ESRD, although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, diabetes and hypertension remained the major causes of ESRD.
Chronic kidney disease could not be prevented in most circumstances, but screening and control of chronic diseases mainly diabetes mellitus and hypertension will decrease the occurrence of renal complications of these diseases with resulting reduction of ESRD.
In the ESRD Registry we are collecting all data relevant for ESRD patients and create a data base for the problem in Jordan, this enables us to determine the incidence, prevalence, epidemiologic characteristics of patients including age, sex, governorate; it also enables us to determine mortality and burden of the disease in our country. The Registry provides researchers and scientists with data that help in conducting further research on ESRD, and present important data, figures and statistics for decision makers for the process of planning and implementing preventive programs for ESRD.
With great pleasure we present our 9th annual ESRD report, including prevalence and the incidence of ESRD in Jordan for the year 2016, reviewing the ongoing changes in the ESRD Registry, using the data to give direction to renal-control planning and programs in the fields of prevention, screening, treatment, and to monitor and evaluate the impact of these programs. This report will help understand the ESRD incidence in Jordan and thus will enhance prevention and control efforts of the National Renal Registry Program.
The team involved in producing this report had made great efforts to present the graphics and tables in a clear, very concise and user-friendly way hopping this will facilitate their utilization and comprehension.
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Geography
Jordan is located in the Middle East, between Latitudes 29-33 north and between Longitudes 35-39 east, extending about 500 Kilometers from North to South, it is bounded in the North by Syria, East by Iraq and Saudi Arabia, South also by Saudi Arabia and West by Palestine Authority. The total surface area is 89318 Km2. Out of the total area, 75% is desert along the Eastern part of the country. Mountains height ranged between 1100 – 1854 meters above sea level. The Dead Sea area is the lowest area in the world and it is around 416 meter below sea level.
The climate of the country as a whole is moderate, there are four seasons. The temperature ranged from 0°C in winter to 38°C in summer. Jordan is divided into three regions (Middle, Northern and Southern) and twelve governorates.
Population
The population of Jordan is 9798000(Jordanians 6797000 million (3461000 males and 3336000 females), male: female ratio 1: 1.04 according to the estimated census of 2016. (Department of Statistics Jordan, 2016). About 11.4% of the population under the age of 5 years, 34.3% under the age of 15 years and 61.9% of the population at the age 15-64 years, only 3.6 % of the total population above the age of 65 (Sex Ratio in 2016: 1: 1.04)males for females).Table (1) and figure (2) show the age distribution of Jordan population, 2015 (Jordanian Population Pyramid ).Table (2) shows the population distribution of Jordanians by governorates and gender, which is used to calculate incidence rates for different regions. Jordan divided into three regions: each region consists of four governorates. The Central region (Amman, Balqaa, Zarqa, and Madaba) constitutes about 61% of the total population with population density of (249.7) person per Km2. North region includes (Irbid, Mafraq, Jarash, Ajloun) which constitute 29.6% of the population with a population density of (55) person per Km2. South region includes (Karak, Tafila, Ma’an, Aqaba) which constitutes 9.5% of the population with a population density of 11.7 per km2
.
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Figure (1) Map of the Hashemite Kingdom of Jordan
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Table (1) Population of Jordan 2016
Gender
Age -Group
Male Female Total
N % N % N %
0-4 394831 11.4 376033 11.3 770864 11.35-9 426912 12.3 407914 12.2 834826 12.3
10-14 380656 11.0 358883 10.8 739539 10.915-19 362672 10.5 338913 10.2 701585 10.320-24 346416 10.0 317095 9.5 663511 9.825-29 277227 8.0 260948 7.8 538175 7.930-34 238425 6.9 241723 7.2 480148 7.135-39 219249 6.3 222314 6.7 441563 6.540-44 199112 5.8 201816 6.0 400928 5.945-49 176688 5.1 174905 5.2 351593 5.250-54 134485 3.9 133513 4.0 267998 3.955-59 93988 2.7 94824 2.8 188812 2.860-64 66486 1.9 65221 2.0 131707 1.965+ 143853 4.2 141898 4.3 285751 4.2total 3461000 100.0 3336000 100.0 6797000 100.0
Figure (2) Population Pyramid – Jordan 2016
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Table (2) Population distribution by Governorate and Gender, Jordan, 2016
Gender
Governorate
Male Female Total
N % N % N %
Amman 1331548 38.5 1294241 38.8 2625789 38.6
Balqaa 206643 6.0 201266 6.0 407909 6.0
Zarqa 486255 14.0 463005 13.9 949260 14.0
Madaba 82204 2.4 78950 2.4 161154 2.4
Central Region 2106650 60.9 2037462 61.1 4144112 61.0
Irbid 691474 20.0 661647 19.8 1353121 19.9
Mafraq 165350 4.8 157519 4.7 322869 4.8
Jarash 88436 2.6 83980 2.5 172416 2.5
Ajloun 82256 2.4 79265 2.4 161521 2.4
North Region 1027516 29.7 982411 29.4 2009927 29.6
Karak 141108 4.1 138918 4.2 280026 4.1
Tafileh 47282 1.4 45342 1.4 92624 1.4
Maan 66982 1.9 64551 1.9 131533 1.9
Aqaba 71462 2.1 67316 2.0 138778 2.0
South Region 326834 9.4 316127 9.5 642961 9.5
Total 3461000 100.0 3336000 100.0 6797000 100.0
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Table (3) Selected Demographic, Socio-economic and Health Indicators 2016
Indicators 2016Population 2016 6797000Population Density (Person per km2) 75.2Population Growth Rate 2.4 %Rate of Natural Increase 2.1%Population Doubling Time (Year) 28Population Less Than 15 Year of Age 34.3%Percentage of Population Age 15-64 Years 62.0%Percentage of Population Age 65+ 3.7Dependency Ratio 61.4Percentage of Urban Population 90.3%Percentage of Rural Population 3.9%Total Fertility Rate (Women 15-49 Years) 3.38 Urban 3.4Rural 3.9Sex Ratio 112.5Total Households (000) 2032.8Crude Marriage Rate (Per 1000 Population) 8.3Crude Divorce Rate (Per 1000 Population) 2.2Singulate Mean Age at First Marriage (Year) 29.3Male 31.3Female 26.9Jordanian Married of Total Population 15+ 55.5Male 54.8Female 56.2Average Household Size (person) 4.8Population Median Age (year) 22.4Crude Birth Rate (Per 1000 Population) 22.6Crude Death Rate (Per 1000 Population) 6.0Infant Mortality Rate (Per 1000 Live Births) 17.0Under Five Mortality Rate (Per 1000 Live B 19.0 Life Expectancy at Birth (Year) 73.5Male 72.8Female 74.2
Unemployment Rate (%) 15.3Male 13.3 Female 24.1
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Health Status
Morbidity DataJordan is witnessing an epidemiologic transition, which is characterized by rapid decline in mortality from infectious diseases coupled with an increase of non-communicable diseases (NCDs). Unhealthy diet, Physical inactivity, obesity and smoking are major determinants of NCDs and represent major risk factors for the development of cardiovascular diseases, cancer and diabetes. According to epidemiologic surveys / Behavioral Risk Factors Surveillance survey (BRFSS) which have been conducted by Ministry of Health over the last few years; 2002, 2004 and 2007 among those aged 18 years and above revealed that determinants and levels of risk factors for NCDs are rising.
The Behavioral Risk Factor Surveillance Survey, 2007 showed the following:- Diabetes represent major health problems; reported to affect more than 16%
of adults, impaired glucose tolerance (IGT) was found in an additional 24%, bringing the total prevalence of glucose tolerance abnormalities to over 40 % for 18 years and above.
- The prevalence rate of hypertension was 25.6 %.- The prevalence rate of hypercholesterolemia was 36 %. - The prevalence rate of HDL-C (low level) was 33.8 %. - The prevalence rate of high LDL-C was 24.2 %. - The prevalence rate of high Triglyceride was 48.8 %. - The prevalence of overweight was 30.5%, (BMI 25-29.9 Kg/m2) and the
prevalence of obesity was 35.9 %,( BMI 30 Kg/m2 and more).- Smoking is a major problem, with more than 49.6% of adult men and 5.7% of
women smoking regularly. The last 18th annual report for the year 2013, JCR registered 8744 cancer cases, of these 5416 (61.9%) were among Jordanians and 3328 (38%) were among non-Jordanians.
The crude incidence rate of all cancers among Jordanians was 82.9 per 100,000 populations (76.2 for males and 90.1 for females). The male to female ratio was 0.9: 1.
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Mortality dataIt provides information on annual death rates of a population. It also provides information on specific diseases in terms of clinical and public health perspectives. Major achievements have been made during the last several decades. The Infant Mortality Rate (IMR) fell from 135 in 1960 to 15 deaths per 1,000 live births in 2015. This impressive decline occurred as a result of focused maternal and child health activities, increased vaccination coverage rates, improvements in education, birth spacing, sanitation and access to safe drinking water and improvement of general conditions.
By law, all deaths must be registered in Jordan. However, registration is not universal and death certification by cause is not completely accurate. According to Jordan Mortality Data in 2014, cardiovascular diseases accounted for about 38.39 % of deaths for both sexes. Cancer was the second leading cause of death accounting for 16.49 % of total deaths, while external causes of mortality were the third leading cause responsible for 9.46 % of total deaths. While diseases of Genitourinary system constitute about 3.5% total deaths, 544 patients (90%)of these deaths were due to renal failure (acute and chronic renal failure) according to mortality report in 2014 is (5).
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When it is right, no one remembers.But when it fails, all have to remember”
It is described as a small- sized, light-weighted, bean- shaped but a smart organ. Some consider it as the secretary of the body as it deals with each inbox and outbox in the body. Its dysfunction may affect the functions of other organs and systems. It may be affected by dysfunctions of other organs and systems. When it fails, whether acutely or chronically, this may manifest as multiple signs and symptoms relating to multiple systems in the body. So the patient of kidney failure is considered as all patients in one. As a consequence, the Nephrologists must also be all physicians in one.
In the past Stewart Cameron said,” for those who have chosen a career in Nephrology there can be no better basic moto than to strive to be a person with some technical skill, a broad spectrum of scientific knowledge, and with those personal characteristics of warmth and humanity that serve to cement the science of medicine to the art of medicine.
Kidneys are the first and so far the only organs whose function can be replaced by a machine. Kidney Failure can be acute, called Acute Kidney Injury (AKI) or chronic, called Chronic Kidney Disease (CKD).
When patients of Chronic Kidney Disease (CKD) have reached stage 4 CKD i.e. Glomerular Filtration Rate (GFR) < 30 ml /min / 1.73 m2, ideally they are under a Nephrologists’ care. Stage 5 CKD i.e. GFR is < 15ml/min /1.73 m2, is called dialysis stage. Renal Replacement Therapy “RRT” means of dialysis and transplantation.
Worldwide, the machine of dialysis had served millions of ESRD patients.
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Jordan Renal Registry
Historical development of Nephrology and dialysis 1840-Pierre Priory defined uremia. 1861-Thomas Graham coined the term dialysis for the first time.1913- John Abel invented first dialysis apparatus, first animal dialysis was done.1928 –George Has –first human dialysis was done.1943-Dr.Willem Kolff introduced Kolff rotating drum dialyzers.1948-Waters and Beall –first successful human dialysis.1950- Introduction of dialysis into clinical practice.
The subsequent successful development of a technique to create an adequate arterio-venous fistula in 1972 permitted the rapid growth of dialysis programs. Equipment has been developed to faster home-care hemodialysis and chronic ambulatory peritoneal dialysis.
Technical advances in hemodialysis followed the use of bicarbonate dialysate, more biocompatible membranes, membranes of higher porosity and ultra filtration.
The numbers of patients reaching to ESRD continue to increase annually, and this situation is leading to challenge to the existing system of RRT.
Causes of ESRD are multiple; the most common ones are diabetes mellitus and hypertension. Unless some form of RRT is available, ESRD is eventually fatal. Mortality in patient with ESRD is high.
However, the cost of RRT represents a great social burden, due to the evolving health care environment, growing elderly population, renewing and innovating healthcare technologies, increasing expectations of the population and the dilemma of economic constraints. There should always be a balance between the three key factors of a health care system: access to healthcare, quality of health care and the cost.
27
In conclusion, ESRD is a growing disease all over the world, it is caused by many etiologies, diagnosed by physicians, and must be cared by the Nephrologists.New awareness programs of the disease must be established, and new strategies toward the burden of it must be started. It needs global collaboration and teamwork schedule.
Status of “Renal Replacement Therapy” in JordanProudly speaking, Jordan is one of the first countries in the Middle East that early started programs of dialysis and kidney transplantation. There are many renal dialysis units all over the country, belonging to Ministry of Health, Royal Medical Services, University hospitals and Private Sector. In addition, there are many kidney transplant centers in all sectors dealing with the best medical care.
Jordan has approved to be one of the pioneer countries in Nephrology and its modalities. Jordan achieved many in the field of nephrology like:1968- the first dialysis was done at the Military Hospital “the Main Hospital” in Marka area – Amman.
- The first dialysis machine used in Jordan was”TRAVENOL” machine type.- The first kidney transplantation done in Jordan was on 18/05/1972 at the same main Military Hospital. It was the first to be done in the Middle East.1981- The establishment of renal dialysis unit at Jordan university Hospital. The machine type was REDY “Sorbs system”. It was portable, moving to Khaldi and Islamic Hospitals.
1982- The first renal dialysis Unit was established in private sector, it was at Al-Khaldi Hospital.
1984- The first kidney transplantation was done in private sector at Islamic Hospital, then at Al- Khaldi Hospital.
2009- The first kidney transplantation in Jordanian public hospital was done at Prince Hamza Hospital in October 2009 according to The Jordanian National Program Of Renal Transplantation of the JMOH.
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So dialysis was introduced in Jordan in 1968. Ever since, there has been a continuous expansion of the dialysis centers in terms of the geographic coverage and capacity. The economic prosperity helped building the services all over the country.
Modern hemodialysis machines were installed in the vast majority of units, which allowed for the performance of bicarbonate dialysis, controlled ultra filtration, and sodium profile modeling. Also a wider choice of biocompatible dialyzers has become available during the last few years.
Recently, there has been an emerging concern about the projection of the increasing number of patients on dialysis and the future cost. Therefore, close observation of the development of dialysis has been a demand of the Jordan center for organ transplantation. Preparing annual reports about all the modalities of RRT has become a demand activity.
National ESRD Registry, which is based on center and patient forms, is a useful tool to assess the quality of dialysis services and activities used to improve the adequacy of hemodialysis.
Jordan has had a growing number of persons developing CKD leading to ESRD. It is important to have a national registry in order to define the cause of ESRD, and to be able to perform International comparisons in renal epidemiology.
Such a registry will monitor the causes, incidence, and prevalence of ESRD and any emerging trend.
A national ESRD registry will allow the determination of the burden of disease as well as planning and policy formulation in the health care sector.As the Registry develops, data will become available for patients with ESRD, as is reported here.
Finally, it is a great achievement to establish the National ESRD Registry, a new achievement in renal events in Jordan.
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National Registry of End Stage Renal Disease: The National Registry of End Stage Renal Disease was created in May 3rd, 2007 under the jurisdiction of the Ministry of Health by the order of his Excellency the Minister of Health.
Objectives of the National Registry of End Stage Renal Disease:• Establish a national database system about patients of ESRD.• Determine the burden of that disease, on country basis.• Determine governmental payment on dialysis.• Provide data about patients and their suitability to be transplanted, on a
basis of priority.• Stimulate beginning studies and researches about ESRD.• Improve facilities of diagnosis and treatment for ESRD patients. Moreover,
train dialysis technicians and national registry employees.
Action plan of National Registry of End Stage Renal Disease:* Prepare special form for the notification of ESRD from all hospitals and updated
annually (annex1).* Training workshops for all focal point working in dialysis units about how to fill
this form and how and when to send it to the national registry through either passive or active method of surveillance.
* Good Communication with all dialysis units in the hospitals from all sectors to complete and improve documentation in this form.
* Collection of all data about ESRD patients and all renal dialysis units in Jordan, through filling the prepared forms by dialysis technicians and attending Nephrologists.
* Enter data about those patients and dialysis units into a computerized software program.
* Analysis of the data, reporting the results and then delivering it to specialized people to stratify and build special schedules about the of ESRD.
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Methodology:The National Registry of End Stage Renal Disease was created in 2007 and supported by the Ministry of Health. It is a database-system that collects data and information about almost all patients undergoing Renal Replacement Therapy (RRT), i.e. either dialysis (hemodialysis and peritoneal dialysis) or Kidney transplantation.
This is the eighth national ESRD Registry report. Data were received from all (78) dialysis units in Jordan. It is assumed that those undergoing treatment in these units are represent the number of all ESRD cases , because all cases are treated on the expense of the government and even the patients undergoing home peritoneal dialysis.
Data about ESRD patients who are receiving long term (RRT) during 2016 were collected from all dialysis units in the hospitals and then analyzed using special software statistical analysis( SPSS).
Two questionnaires (forms) used for data collection from hospitals. The first one is for the dialysis units: including number of beds, type of insurance of patient, nationality (Annex1).
The second form is for the patients, this form consist of demographic data, clinical data, source of treating facility, follow up and vital status of the patients and all these data will entered on special software for ESRD patients (Annex2). Patients who are not on Renal Replacement Therapy (RRT) and those who only received urgent dialysis or died shortly afterwards (less than 90 days) were not included in this report.
31
Method of Data Collection:Data was collected from all renal dialysis units in Jordan, through the following methods: two types of data collection methods were applied:1- Passive Data Collection: in this system forms filled by dialysis units technicians
and send to national renal registry - MOH/NCDs Directorate.2- Active Data Collection: In this system the head of Renal Registry Unit visited
the dialysis units and fills the forms on the unit and complete all the variables from medical record of those patients. This to ensure more complete and accurate data
All forms were reviewed at the Renal Registry Unit and filtered and checked for any duplication and also document follow up data if the patient still alive or dead cause of death dates of last dialysis.
Data entered to special software designed for data of renal patients, Data analysis was done by using statistical package for the social sciences SPSS version 17.0.
Incidence and prevalence calculations in this report are based on the the population by Department of Statistics (DOS) 2016.
32
Part Two
Dialysis Units in JordanBy the end of 2016, there were 78 working Dialysis Units distributed all over the country. 37 units (47.4%) administered by Ministry of Health (MOH), 8 units (10.3 %) administered by Royal Medical Services (RMS), 2 units (2.6%) administered by university hospitals: one administered by Jordan University Hospital, one by King Abdullah University Hospital (KAUH) and 31 units (39.7%) administered by Private Sector (PS),(Figure 3).
Figure (3) Distribution of dialysis units by health sector, Jordan 2016
33
Distribution of Dialysis Machines by Health Sector, Jordan 2016.The total number of dialysis machines (933) in all units was distributed as followed: 436 (46.7%) machines in MOH units, 84(9.0%) machines in RMS, 34(3.6%) machines in universities hospitals and 379 (40.6%) machines in private sector hospitals, (Figure 4).
Figure (4) Distribution of Dialysis Machines by Health Sector, 2016
The focal points in all 78 Dialysis Units filled the special form of data collection and send it to National ESRD Registry located in the Ministry of Health. (Annex1), data about ESRD patients was received from all hospitals.
34
Part three
ESRD patients in JordanPrevalence of ESRD patients in Jordan (2016)
The total numbers of patients treated and registered in the Jordan Renal Registry by the end of 2016 was 5352 patients; of them 5130 were Jordanians (95.9 % ) and 222 were non Jordanians (4.1% ).
This part of the report only include Jordanian patient –prevalence 2016The number of Jordanian patients that registered in ESRD and treated in hospitals for the year 2016 was 5130 patients, while the number of new cases of ESRD for the year 2016 was 829 patients , out of them 797 patients (96.1%) were Jordanians,32 (3.9%) were non Jordanians).
The number for the last two years decreased for Jordanian due to kidney transplant done for the patients about (380) Jordanian patients did kidney transplant in our hospitals in Jordan for the years from (2011-2014), also after excluding the number of deaths for each year from 2008-2014 as shown in the figure below.
For this year we improve surveillance system for ESRD patients from 2008-2016 from all ESRD units in all governorates we did both active and passive surveillance for vital status for those patients from civil registration data and if the patients were alive or dead.
35
Figure (5) Number of prevalent ESRD and deaths patients in Jordan during (2008-2016)
International comparison of prevalence rate of Hemodialysis ESRD patients
Figure (6) shows the International comparison of prevalence rate of Hemodialysis patients Per Million Population (PMP) in Jordan and other countries in 2016. The overall Prevalence Per Million Populations in Jordan in 2016 is (754.74/1,000,000) compared with other countries.
36
Figure (6): International comparison of prevalence rate of Hemodialysis (PPM) 2016
Prevalence of ESRD Patients in Jordan, 2016 The total number of ESRD patients during the year 2016 was 5130 patients who are receiving hemodialysis or peritoneal dialysis in the hospitals from all sectors.
1. Socio demographic characteristics of ESRD prevalent patients: Figure (7) shows the distribution of ESRD prevalent patients who attended renal dialysis units in all Jordanian hospitals during the year 2016 according to gender. The number of patients treated in the Dialysis Units was 5130 patients , out of them 3076 were male patients which accounted (60.0%) and 2054 were female patients accounted ( 40.0% ),with male to female ratio 1.49:1.
37
Figure (7) Distribution of ESRD patients by Gender
Distribution of ESRD patients according to age groups and gender, 2016
Table (4) shows the distribution of ESRD patients according to the age groups and gender, the mean age of patients was (53) years, (52.8 years for males and 53.4 years for females). The median age of patients was (55) years, (55 years for males and 55.5 years for females). Table (4) also shows the distribution of ESRD cases by prevalence rate per million populations (PPM), the overall prevalence per Million Populations in Jordan was (754.74/1,000,000).
38
Table (4) Distribution of ESRD according to age groups, gender and Prevalence Rate per million (PPM), 2016
*PPM: Prevalence Per Million Populations
Gender
Age-Group
Gender Total
Male PPM Female PPM N PPM
0-4 7 18.62 10 26.59 17 22.05
5-9 23 56.38 18 44.13 41 49.11
10-14 29 80.81 39 108.67 68 91.95
15-19 68 200.64 38 112.12 106 151.09
20-24 87 274.37 79 249.14 166 250.18
25-29 140 536.51 89 341.06 229 425.51
30-34 155 641.23 106 438.52 261 543.58
35-39 191 859.15 101 454.31 292 661.29
40-44 226 1119.83 137 678.84 363 905.40
45-49 268 1532.26 151 863.33 419 1191.72
50-54 342 2561.55 190 1423.08 532 1985.09
55-59 349 3680.50 195 2056.44 544 2881.17
60-64 362 5550.36 238 3649.13 600 4555.57
65 and above 829 5842.22 663 4672.37 1492 5221.33
total 3076 922.06 2054 615.71 5130 754.74
39
Figure (8) ESRD cases according to age groups and gender-2016
Figure (9) Distribution of ESRD cases by gender and age group -2016
40
Distribution of ESRD patients according to marital status and gender
Table (5) shows that the majority of ESRD patients were married (73.5%), (males 80.0% and females 58.7%), while (16.3%) of the ESRD patients were singles (males 13.8% and females 19.2%), (4.9%) of the patients were divorced.
Tables (5) Distribution of ESRD patients according to marital status and gender 2016
Gender
Marital Status
Male Female Total
N % N % N %
Married 2486 80.8 1206 58.7 3773 73.5
Single 425 13.8 395 19.2 834 16.3
Widow 78 2.5 289 14.1 370 7.2
Divorced 87 2.8 164 8.0 254 4.9
Total 3076 100.0 2054 100.0 5130 100.0
Distribution of ESRD patients according to employment status and genderTable (6) shows the distribution of the ESRD patients according to their employment status for both genders. House wife’s accounted (85.0 %) of the females, (4.8%) of the patients were employed either governmental or non-governmentally and military services (1.2), (18.7%) were retired, and (4.9%) were students, (18.7%) of the patients were unemployed, missing data about employment was (8.4%).
41
Table (6) Distribution of ESRD patients by employment status and gender, 2016
Distribution of prevalent ESRD patients by health sector
Out of the all 5130 prevalent ESRD patients 2249 patients (43.8% ) were treated in MOH Dialysis Units , 994 patients (19.4%) treated in RMS Dialysis Units, 143 patients (2.8%) treated in university hospital Dialysis Unit, and 1644 patients (32.0%) treated in Private Sector Dialysis Units.(Figure 10)
Gender
Job
Male Female Total
N % N % N %
House Wife 0 0.0 1745 85.0 1745 34.0
Private 518 16.8 41 2.0 576 11.2
Employed 185 6.0 56 2.7 247 4.8
Student 213 6.9 34 1.7 254 4.9
Unemployed 906 29.5 22 1.1 957 18.7
Military 53 1.7 5 0.2 60 1.2
Retired 906 29.5 26 1.3 961 18.7
Missing 295 9.6 125 6.1 430 8.4
Total 3076 100.0 2054 100.0 5130 100.0
42
Figure (10) Distribution of prevalent ESRD patients by Health Sector, 2016
Distribution of ESRD cases according to the type of insurance
Table (7) shows the distribution of ESRD patients according to insurance type. (97%) of patients were insured by one of the various types of health insurance. (34.7%) of the pa-tients were insured by Kidney Patients Fund in health insurance directorate in Ministry of health. Only (3.04%) were not covered by any type of insurance.
Table (7) Distribution of ESRD patients by type of insurance and gender 2016
Gender
Insurance Type
Male Female Total
N % N % N %
Kidney Patient 1076 34.98 701 34.13 1777 34.64
Civillian 882 28.67 598 29.11 1480 28.85
Military 935 30.40 621 30.23 1556 30.33
University 53 1.72 52 2.53 105 2.05
Private 35 1.14 21 1.02 56 1.09
No Insurance 95 3.09 61 2.97 156 3.04
Total 3076 100.00 2054 100.00 5130 100.00
43
Distribution of ESRD patients by GovernorateThe overall prevalence per Million Population in Jordan is (754.71,000,000/), the highest prevalence was found in Amman governorate (888.91,000,000/) followed by Balgaa governorate (845.81,000,000/) Madaba governorate (837.71,000,000/) Tafeila governorate (831.31,000,000/) Jarash governorate (817.81,000,000/) and Zarka governorate (724.81,000,000/).
Table (8) Distribution of ESRD patients by Governorate and preva-lence per million populations (PPM)
* PPM: Prevalence per Million Populations Number of total cases in Jordan has received from renal dialysis units are 5130
Distribution of ESRD prevalent patients by primary cause
Table (9) shows the main primary causes of ESRD: The most common primary cause is Diabetes Mellitus (30.4%), followed by Hypertension (26.8%), Diabetes Mellitus and Hypertension (24.8%), Glomerulonephritis (7.6%) and then Polycystic kidney disease (2.3%) congenital causes (2.1 %), Infection (1.8%).
N % N % N % Rate
1457 47.4 877 42.7 2334 45.5 888.9
195 6.3 150 7.3 345 6.7 845.8
399 13.0 289 14.1 688 13.4 724.8
75 2.4 60 2.9 135 2.6 837.7
2126 69.1 1376 67.0 3502 68.3 845.1
489 15.9 348 16.9 837 16.3 618.6
79 2.6 60 2.9 139 2.7 430.5
78 2.5 63 3.1 141 2.7 817.8
59 1.9 46 2.2 105 2.0 650.1
705 22.9 517 25.2 1222 23.8 608.0
112 3.6 79 3.8 191 3.7 682.1
46 1.5 31 1.5 77 1.5 831.3
47 1.5 23 1.1 70 1.4 532.2
40 1.3 28 1.4 68 1.3 490.0
245 8.0 161 7.8 406 7.9 631.5
3076 100.0 2054 100.0 5130 100.0 754.7
Balqaa
Governorate GenderTotalMale Female
Amman
Central Region
North Region
South Region
ZarqaMadaba
Irbid
MafraqJarash
Ajloun
Karak
Tafileh
Maan
Aqaba
Total
44
Table (9) Distribution of primary causes of ESRD for the year 2016
Co-morbidity and some risk factors with ESRD
The data showed the presence of other medical conditions coexisting with the ESRD condition itself. The prevalence of co-morbidity in ESRD patients showed that (61.5%) of patients were hypertensive, while cardiovascular diseases were found in (14.7%) of ESRD patients. The prevalence of diabetes constitutes (42.3 %). The prevalence of smoking in ESRD was (9.0%) and (4.4 %) of the patients had family history of renal diseases, Table (10).
%N%N%N
30.4156229.660931.0953
26.8137326.955226.7821
24.8127123.448125.7790
7.63928.31707.2222
2.31162.2452.371
2.11062.3471.959
1.8932.1441.649
0.8431.0210.722
0.7381.4290.39
0.6290.5110.618
2.11072.2452.062
100.05130100.02054100.03076
Hypertention
Both diabetes & hypertension
Glomerulonephritis
TotalFemaleMale
Primary Causes Of ESRD
Diabetes Mellitus
Others
Total
Polycystickidney
Congenital
Infection
Vesico Uretric Reflux
SLE
Drugs
45
Table (10) Prevalence of co-morbidity and some risk factors with ESRD 2016
Distribution of ESRD patients according to Blood Group
Figure (11) shows that approximately one third of the patients 1954 (38.1%) were blood group O and 1413 (27.5%) were blood group A, 822 (16.0%), were blood group B and 521(10.2%) were blood group AB .Data was not available for 420 ESRD patients which constitutes (8.2%), of the ESRD patients.
Figure (11) Distribution of ESRD patients according to Blood group
61.52886
42.31982
34.71626
14.7691
9.0423
6.3295
4.42051.152
6.1286Others
%FrequencyCo-morbidityHypertention
Diabetes Mellitus
Both diabetes & hypertension
Cardiac Disease
Smoking
Urinary Disease
Family HistoryMalignancy
46
Distribution of ESRD patients according to type of Dialysis Figure (12) shows that only 82 patients (2%) were treated by peritoneal dialysis, while 5048 patients (98%) were treated by hemodialysis.
Figure (12) Distribution of ESRD patients by type of Dialysis
Distribution of Hemodialysis patients by number of sessions /week
Figure (13) shows that 3603 patients (71.4%) underwent Hemodialysis thrice a week1284 (25.4%) twice a week, 69 (1.4%) once a week, and 92 (1.8%) four times a week, the average duration of the every session is almost four hours. 5048 patients are in hemodialysis*
47
Figure (13) Distribution of Hemodialysis patients by number of sessions /week
Distribution of ESRD cases according to fitness for transplantation
Table (11) shows that 2167 (42.2%) from both genders were considered candidates for transplantation, and 2139 not candidates for transplantation (41.7%), no available data on 824 (16.1%) of ESRD patients.
Table (11) Distribution of ESRD patients by fitness for transplantation
Gender
Gandidate For Transplant
Male Female Total
N % N % N %
Yes 1359 44.2 808 39.3 2167 42.2
No 1225 39.8 914 44.5 2139 41.7
Unknown 492 16.0 332 16.2 824 16.1
Total 3076 100.0 2054 100.0 5130 100.0
48
Distribution of ESRD cases according to unfitness for transplantation
Table (12) and Figure (14) show that the main causes of unfitness for transplantation were as followed: age 958 patients (44.8%), medical causes 819 patients (38.3%) of all cases, malignancies in 47 patients (2.2%), while unknown causes for the cases were 147 patients (6.9%) of all patients.
Table (12) Causes of unfitness for transplantation
Figure (14) Causes of unfitness for transplantation
Cause Frequency %
Age 958 44.8
Medical cause 819 38.3
Malignancy 47 2.2
Other Causes 168 7.9
Missed 147 6.9
Total 2139 100.0
49
Distribution of fitness of ESRD patients by priority level for transplantation
Figure (15) and Table (13) show the priority level for transplantation for patients who are candidate for transplantation,: that 913 patients (42.1%) were considered of high priority level for transplantation and 697 patients (32.2%) considered of medium and 348 patients (16.1%) of low priority and 209 (9.6%) had no data about their priority level.
Figure (15) Distribution of fitness of ESRD patients by Priority level for Transplantation
Table (13) Priority level for ESRD patient candidate for transplant-2016
Gender
Rriorety Level
Male Female Total
N % N % N %
High 546 40.2 367 45.4 913 42.1
Medium 448 33.0 249 30.8 697 32.2
Low 224 16.5 124 15.3 348 16.1
Unknown 141 10.4 68 8.4 209 9.6
Total 1359 100.0 808 100.0 2167 100.0
50
Distribution of ESRD cases according to availability of a donor
Figure (16) shows that 1535 patients (70.8%) had no available donor, and 536 patients (24.7%) had available donor, 96 patients (4.4%) had no data about available donor, this reflects the burden of ESRD in Jordan.
Figure (16) Distribution of ESRD patients by availability of a donor
Prevalence of Hepatitis B and C in prevalent ESRD patientsTable (14) shows the prevalence of hepatitis B and C in ESRD patients. (1.2 %) of the cases had Hepatitis B and (7.8 %) had Hepatitis C.
Table (14) Prevalence of Hepatitis B and C in ESRD patientsHepatitis CHepatits BType Of Hepatitis
TotalFemaleMaleTotalFemaleMaleGender
%NNN%NNN
7.84021972051.2612239Positive
88.945621777278595.2488319602923Negative
3.216680863.618672114Missed
100.0513020543076100.0513020543076Total
51
Part Four
Incidence of ESRD Patients
The total number of patients who treated in the dialysis units by the end of 2016 were (5130) patients, but the number of new cases for the year 2016 was 829 patients; of them 797 were Jordanians(96.1%) and 32 were non Jordanians (3.9%).
This part of the report only include Jordanian patient – incidence 2016, The number of new cases of ESRD Jordanian patients for the year 2016 was 797 patient.
Incidence of ESRD, 2016
Table (15) and Figure (17) show the distribution of ESRD incident patients in 2016 according to the age group and gender, with a mean age of 53.8 years, and median age of 56 years. Table (14) also shows the distribution of ESRD patients by Age-Specific Incidence Rate per million (ASIR). The overall Incidence per Million Populations in Jordan was (117.3/1,000,000).
52
Table (15) Distribution and ASIR of ESRD cases by gender and age group - Incidence 2016
*ASIR per Million population
N ASIR N ASIR N ASIR %1 0.3 4 1.2 5 6.5 0.6
6 1.7 6 1.8 12 1.8 1.54 1.2 7 2.1 11 1.6 1.47 2.0 6 1.8 13 1.9 1.69 2.6 8 2.4 17 2.5 2.118 5.2 9 2.7 27 4.0 3.420 5.8 10 3.0 30 4.4 3.825 7.2 12 3.6 37 5.4 4.635 10.1 19 5.7 54 7.9 6.845 13.0 20 6.0 65 9.6 8.259 17.0 31 9.3 90 13.2 11.355 15.9 34 10.2 89 13.1 11.265 18.8 45 13.5 110 16.2 13.8
134 38.7 103 30.9 237 34.9 29.7483 139.6 314 94.1 797 117.3 100.0
55-5960-6465+
Total
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-54
Age-Group FemaleMaleTotal
Gender
53
Figure (17) Incidence of ESRD Jordanian by Gender & age group-2016
Distribution of incident ESRD patients by health sector
Figure (18) shows that the new number of patients treated in the Dialysis Units in 2016 were 797 patients; 321 patients (40.3%) treated in MOH Dialysis Units, 228 patients (28.6%) treated in RMS Dialysis Units, 29 patients (3.6%) treated in university hospital Dialysis Unit, and 219 patients (27.5 %) treated in Private Sector Dialysis Units.
Figure (18) Distribution of ESRD patients by health sector, 2016
54
Distribution of ESRD incident patients by gender
In the years 2016, out of the total (797) new cases of ESRD, 483 patients (60.6%) were males and 314 patients (39.4%) were females with male to female ratio1.66:1 Figure (19)
Figure (19) Distribution of ESRD patients by gender, 2016
Distribution of ESRD Incident patients by primary cause
Table (16) shows the main primary causes of ESRD Incident patients: The most common primary cause was Hypertension (30.7%), followed by Diabetes Mellitus (30.4%), Diabetes Mellitus and Hypertension (25.7%), Infection (2.9%) Glomerulonephritis (2.4%) and then congenital causes (2.1 %) Polycystic kidney disease (1.9%), Vesico uretric reflux (0.9%), SLE (0.6%) , Drug (0.4%), and others was (2.0%) of the patient.
55
Table (16) Primary causes of ESRD for the year 2016- Incidence
Distribution of ESRD patients by Nationality Figure (20) shows the distribution of ESRD patients according to Nationality, in 2016 there were (32) non-Jordanian patients accounted (3.9%) and 797 Jordanian patients accounted (96.1%).
* SLE - Systemic Lupus erythematosus
%N%N%N
30.724527.18533.1160
30.424232.210129.2141
25.720526.18225.5123
2.9233.8122.311
2.4192.582.311
2.1172.272.110
1.9152.271.78
0.970.621.05
0.651.340.21
0.430.620.21
2.0161.342.512
100.0797100.0314100.0483Total
Causes
Drugs
Congenital
SLE
Others
Diabetes Mellitis
Hypertension only
Glomerulonephritis
Polycystic kidney
Infection
Vesico Uretric Reflux
DM and Hypertension
TotalMale Female
56
Figures (20) Distribution of ESRD patients by Nationality 2016
Distribution of ESRD patients according to type of Dialysis
Figure (21) shows that in 2016, only 24 patients (3.0%) were treated by peritoneal dialysis, while 773 patients (97.0%) were treated by hemodialysis.
Figure (21) Distribution of ESRD patients by type of Dialysis, 2016
57
Distribution of ESRD cases according to fitness for transplantation, 2016.
Figure (22) shows that there were 446 (56.0%) candidates for transplantation, and 351 not candidates for transplantation (44.0%).
Figure (22) Distribution of ESRD patients by fitness for transplantation
Distribution of fitness of ESRD patients by Priority level for transplantation
Figure (23) shows the priority level for transplantation: in 2016 it was found that 186 patients (23.3%) were of high priority level for transplant, 357 patients (44.8%) of medium and 254 patients (31.9%) of low propriety level.
58
Figure (23) Distribution of fitness of ESRD patients by Priority level for Transplantation 2016
Distribution of mortality among ESRD patients
In the year 2016 a total of 54 ESRD patients (6.8 %) died during this year, 18 of them were females and 36 were males of different age group Figure (24).
Figure (24) Distribution of mortality in ESRD patients 2016
59
Part Five:
Pediatric ESRDThe total number of pediatric patients from 0-14 years was 126 patients in 2016.
Figure (25) shows the distribution of Pediatric ESRD who treated in renal dialysis units in all hospitals during the year 2016 according to gender. There were 126 patients, out of them 59 were males (47%) and 67 were female patients accounted (53%).
Figure (25) Distribution of ESRD pediatric patients by Gender
60
Distribution of Pediatric patients according to type of Dialysis
The total number of pediatric patients from 0-14 years was 126 patients. Out of them 105 patients were treated by hemodialysis and 21 on peritoneal dialysis. Figure (26) shows distribution of pediatric patients according to type of dialysis.
Figure (26) Distribution of Pediatric patients according to type of Dialysis
Causes of ESRD in Pediatric patients
Table (17) shows that the primary cause of ESRD in pediatric patients (those below 14 years): the commonest causes of ESRD Vesicouretic reflux (16.7%) Congenital renal anomalies and Neurogenic bladder (15.1%) followed by Glomerulonephritis (14.3%), Hypertension (9.5%), Nephrotic syndrome, Diabetes mellitus (5.6%) Oxalosis and Infection (4.0%) SLE (3.2%), Drug (1.6%) while other causes were not determined in (5.6%) of the pediatric patients.
61
Table (17) Causes of ESRD in Pediatric patients 2016
Pediatric ESRD patients according to age groups and gender, 2016
Figure (27) shows the distribution of pediatric patients according to the age groups and gender in 2016, which indicates that the highest occurrence of the cases was among the age group (10-14) years 68 (54.0 %) for both genders, with a mean age of 9.61 years and median 10.00.
N % N % N %10 16.9 11 16.4 21 16.7
6 10.2 13 19.4 19 15.1
7 11.9 12 17.9 19 15.1
8 13.6 10 14.9 18 14.3
7 11.9 5 7.5 12 9.5
5 8.5 2 3.0 7 5.6
4 6.8 3 4.5 7 5.6
3 5.1 2 3.0 5 4.0
4 6.8 1 1.5 5 4.0
0 0.0 4 6.0 4 3.2
1 1.7 1 1.5 2 1.6
4 6.8 3 4.5 7 5.6
59 100.0 67 100.0 126 100.0
Congenital
Primary Cuase GenderMale Female Total
Vesicouretic reflux
GlomerulonephritisNeurogenic bladder
HypertensionNephrotic syndrom
OxalosisDiabetes mellitus
Infection
DrugSLE
UnknownTotal
Gender
Primary Cuase
62
Figure (27) Distribution of pediatric patients according to age groups and gender 2016
Distribution of Pediatric ESRD according to fitness for transplantationFigure (28) shows that there were 79 (62.7%) candidates fit for transplantation, and 43 not fit for transplantation (34.1%) missed data was 4 (3.2%).
Figure (28) Distribution of Pediatric ESRD by fitness for transplantation
63
Mortality data in Pediatric patients
A total of 11(9.7%) pediatric patients in dialysis renal units died during the year 2016 out of 115 (91.3%) who were at risk. Figure (29)
Figure (29) Distribution of mortality in Pediatric patients
64
Part Six
ESRD MortalityDistribution of mortality among ESRD patients
Figures (30-32) and table (18) show the distribution of deaths for ESRD patients, 380 patients out of 5130 were died during the year 2016. 235 (61.8%) of them were males, and 145 (38.2%) were females. Median age at death was 64 years, (63 years for males and 66 years for females).
Figure (30) Distribution of mortality in ESRD patients
65
Figure (31) Distribution of mortality in ESRD patients according to gender
Figure (32) Distribution of mortality in ESRD patients by age group and gender
66
Table (18) Distribution of mortality in ESRD patients by age group and gender
Gender
Age-GroupMale Female Total %
0-4 1 0 1 0.3
5-9 2 1 3 0.8
10-14 2 1 3 0.8
15-19 2 2 4 1.1
20-24 3 2 5 1.3
25-29 2 2 4 1.1
30-34 3 4 7 1.8
35-39 10 5 15 3.9
40-44 8 4 12 3.2
45-49 21 7 28 7.4
50-54 29 18 47 12.4
60-64 26 16 42 11.1
65+ 108 69 177 46.6
Total 235 145 380 100.0
67
Part Seven:
ESRD patients among Non-Jordanians, 2016Distribution of ESRD patients by Nationality
Figure (33) shows the distribution of ESRD patients according to Nationality, The total number of patients among Non-Jordanians was (222) 21 patients out of 245 were died during the year 2015 accounting for (4.1%) of all patients reported to Jordan Renal Registry 2016 , and (4690) patients among Jordanians accounting for (95.9%) of all patients.
Figure (33) Distribution of ESRD patients by Nationality
Distribution of ESRD patients among Non-Jordanians by Gender
Figure (34) shows the distribution of Non-Jordanians ESRD patients who treated in renal dialysis units in all Jordanian hospitals during the year 2016 according to gender, the number of patients treated in the Dialysis Units were 222 patients, there were 137 male patients who accounted (61.7%) and 85 female patients accounted (38.3%).
68
Figure (34) Distribution of ESRD patients among Non-Jordanians by gender
ESRD patients among Non-Jordanians according to age groupsTable (18) Figure (35) shows the distribution of Non-Jordanians patients according to the age groups and gender, which indicates that the highest occurrence of the cases was among the age group (60-69) years for both genders, followed by age-group (50-59) years for both genders .Mean age of the patients was 53 years, while median age of the patients was 56 years (55 years for males and 57 years for females).
69
Table (18) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2016
Figure (35) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2016
Gender
Age-GroupMale Female Total %
0-9 2 0 2 0.9
10-19 7 2 9 4.1
20-29 8 8 16 7.2
30-39 11 10 21 9.5
40-49 23 11 34 15.3
50-59 25 16 41 18.5
60-69 35 24 59 26.6
70+ 26 14 40 18.0
Total 137 85 222 100.0
70
References
1- Annual Report, Jordan, 2016. Department of Statistics (DOS) 2- BRFSS Survey, 2007 Ministry of Health (MOH) Jordan. 3- Cancer incidence in Jordan, MOH, 2014. 4- Global Youth Tobacco Survey, Anti-Smoking Society Association, Jordan,5- Mortality Data in Jordan, 2014, information and mortality section annual
report 2014-Ministry of Health, Jordan.
المملكة األردنية الهاشمية
وزارة الصحة
مديرية األمراض غير السارية
السجل الوطني لمرضى الفشل الكلوي
استمارة معلومات حول وحدات الديلزة الكلوية
1- التاريخ
2- اسم المستشفى
3-العنوان
5- الفرعي4- رقم الهاتف
7- رقم الهاتف6-ضابط االرتباط
8-الطبيب المعالج 9- رقم الهاتفواختصاصه
10-عدد األجهزة موزعة كالتالي
15-المجموع14-معطل13-احتياط12-عزل11-عادي
16-عدد الورديات العاملة
17-عدد المرضى األردنيين موزعين
كالتالي
18- تامين صحي مدني
19-بطاقة غير قادر
20-صندوق مرضى
الكلى22-غير 21-عسكريين
23-المجموعذلك
24-عدد المرضى غير األردنيين
27- المجموع25-الجنسية
26-العدد
28-المجموع الكلي للمرضى في الوحدة
29- مالحظات:
8
المملكة األردنیة الھاشمیةیةمدیریة األمراض غیر السار/وزارة الصحة
/ استمارة المریضلسجل الوطني لمرضى الفشل الكلوياوحدة الدیلزة/ مستشفى ......................................
الرقم المتسلسل
العائلةالجد األب : اسم المریض-2
العمرا :تاریخ المیالد-3 سنة شھریوم
المھنة: -5أنثى . 2. ذكر 1الجنس : -4
أرمل -4مطلق -3أعزب -2متزوج -1الحالة االجتماعیة : -6
الجنسیة : ........................................أذكرغیر أردني -2أردني-1الجنسیة : -7
اخرى ....خاص جامعي صندوق الكلى عسكري حكومي :نوع التأمین الصحي -8
الحي الشارعالعنوان الدائم : المدینة-9
:الخلوي: المنزلالھاتفرقم
10. Blood Group: 1- A 2- B 3- AB 4- O
11. Primary Cause of Renal failure: 1-DM 2- HTN 3-Glomerulonephritis 4. Polycystic Kidney
5-Congenital 6- Infection 7- Drugs induced nephropathy 8- Vesico uretric reflux (VUR)
9-SLE 10- Unknown 11- Others Specify …………………………..
12. Dialysis Type: Per itoneal Hemodialysis If Hemo, sessions per week…………….
13. Date of diagnosis (YEAR ): ................. 14. Starting Date of Dialysis: ….. .../…. /……
14. Place of Dialysis Unit (Hospital):…… ………………………………..15. Past Medical History:1-Uncontrolled BP 5- Malignancy 2-Diabetes Mellitus 6-Familial Renal Diseases 3-Cardiac Diseases 7-Smoking 4-Urinary Tract Diseases 8-Others Specify………………..
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الرقم الوطني-1
المحافظة
7
16. Is the patient candidate for Kidney Transplantation? Yes No
(Confirmed by the attending Nephrologist / Physician) if yes answer the following question :
17. Priority Level :
1- High 2- Medium 3- Low
18. Available related donor 1- Yes 2- No if yes ,what is his relation to the patient :
…………………………………..
19. If not Candidate, Determine Why:………………………………………………………………………
20. Dose the patient do Kidney transplant before 1- Yes 2- No
if Yes When ……………………..
21. Hematology :
Date Hb HCT WBC Platelets
22. Laboratory Test for the patient ?
A-. Virology before starting Dialysis:
Date Hepatitis B Hepatitis C HIV Other test
B-. Virology after starting Dialysis :
Date Hepatitis B Hepatitis C HIV Other test
Name Of Abstractor:………………………………………....
Signature: ……………………………………………………... Date of Abstract: / /
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5
المملكة األردنیة الھاشمیة
وزارة الصحةمدیریة األمراض غیر الساریة
السجل الوطني لمرضى الفشل الكلوينموذج اإلبالغ عن الوفیات
وحدة الدیلزة/ مستشفى ...........................................................-------------------------------------------------------------------------------
الرقم الوطني: -1
العائلة الجد األب االسم: األول -2
.... .................. .................. .....................................
..أنثى................................. ....................الجنس: ذكر......-3
.........الجنسیة:...............................................................................-4
...........................................................العمر: .............................-5
..............لكلویة):............................................ااسم المستشفى (وحدة الدیلزة -6
تاریخ بدایة الدیلزة :..........................................................................-7
.......................تاریخ الوفاة:..........................................................-8
مكان الوفاة: وحدة الدیلزة الكلویة .... مستشفى....... المنزل......................-9
....................................إذا كان غیر ذلك حدد.............. ......
.......السبب المباشر للوفاة:..................................................-سبب الوفاة: -10
.......مالحظات:...........................................................................
....... االسم والتوقیع ........................التاریخ .....................
4
توزيع مرضى الفشل الكلوي حسب التامين الصحي فهو كالتالي:مريض لديهم تامين صحي مدني (%28.85) 1480
مريض لديهم إعفاء من صندوق مرضى الكلى (%34.64) 1777 مريض لديهم تامين عسكري (%30.33) 1556 مريض لديهم تامين جامعات (%2.05) 105
مريض لديهم تأمين خاص (شركات) (%1.09) 56 بدون تأمين وتأمينات أخرى وغير معروف (%2.97) 156
وحدات غسيل الكلى
يوجد في األردن 78 وحدة غسيل كلى موزعة كالتالي: (47.4 %) وحدة لدى مستشفيات القطاع الحكومي 37
(39.7 %) وحدة لدى مستشفيات القطاع الخاص 31 (10.3 %) وحدات لدى مستشفيات الخدمات الطبية الملكية 8
(2.97 %) وحدة لدى المستشفيات الجامعية 2
أجهزة غسيل الكلى: يوجد في األردن 933 جهاز غسيل كلى موزعة كالتالي:
جهاز لدى مستشفيات القطاع الحكومي (% 46.7) 436 جهاز لدى مستشفيات القطاع الخاص (% 40.6) 379
جهاز لدى مستشفيات الخدمات الطبية الملكية (% 9.0) 84 جهاز لدى المستشفيات الجامعية (% 3.6) 34
/754.7) األردن في نسمة مليون لكل الكلوي الفشل مرضى انتشار نسبة يبلغ حيث 1،000،000)، وهو أعلى نسبة في محافظة عمان (888.9 / 1،000،000) يليها محافظة البلقاء (845.8/ 1،000،0) ،محافظة مادبا (837.7/ 1،000،000) و محافظة الطفيلة
.(1،000،000 / 831.3)
3
السجل الوطني لمرضى الفشل الكلوي
لقد جاء تأسيس السجل الوطني لمرضى الفشل الكلوي في المملكة األردنية الهاشمية بقرار من معالي وزير الصحة بتاريخ 2007/5/3 , وقد صدر أول تقرير سنوي للفشل الكلوي
عام 2008.
ويهدف السجل الوطني لمرضى الفشل الكلوي إلى توفير قاعدة بيانات ديموغرافية وعلمية حول حجم مشكلة الفشل الكلوي في المملكة من حيث أعداد المرضى والتوزيع الجغرافي، والتوزيع حسب الفئات العمرية والجنس، باإلضافة إلى متوسط عدد مرات الغسيل، مما يساعد على تحديد حجم اإلنفاق الحكومي على عمليات غسيل الكلى وكلفة العالج باألدوية، وأهمية إيجاد البدائل وكلفتها. كما توفر قاعدة البيانات معلومات مرجعية ، تبين أهلية هؤالء المرضى والمصداقية الوصول بسهولة المعلوماتية القاعدة هذه تتسم بحيث الكلى زراعة لغايات عملية يسهل مما الكلى لزراعة يحتاجون اللذين المرضى أولويات وترتيب والموثوقية، الوصول للحاالت المتبرعة بالكلى من المتوفين دماغيا. كما سيقوم السجل بتعميم المعلومات
التي سيتم جمعها على شركاء وطنيين لالستفادة منها وخاصة للدفاع المدني.
بلغ العدد اإلجمالي لمرضى الفشل الكلوي األردنيين 5130 مريض حتى نهاية عام 2016، منهم 3076 من الذكور بنسبة (60%) و2054 من اإلناث بنسبة (40%) ، باإلضافة إلى 222 غير أردني من مختلف الجنسيات, ويعد مرض السكري والضغط من األسباب الرئيسية
للفشل الكلوي حيث يشكل مرض السكري نسبة (30.4%) والضغط نسبة (%26.8).ويسجل ما بين 750إلى 800 حاالت جديدة لألردنيين سنويا تقريبا، حيث يتم جمع الحاالت
من جميع وحدات الديلزة الكلوية في األردن عن طريق الرصد النشط والذاتي .وقد سجل 797 حالة جديدة لألردنيين في عام 2016, منها 743 حالة أحياء
عدد مرضى الفشل الكلوي حسب القطاعات الصحية
مريض لدى مستشفيات القطاع الحكومي (%43.8) 2249 مريض لدى مستشفيات القطاع الخاص (%32.0) 1644
مريض لدى مستشفيات الخدمات الطبية الملكية (%19.4) 994 مريض لدى المستشفيات الجامعي (%2.8) 143
المملكة األردنية الهاشـميةوزارة الصحة
مديرية األمراض غير السارية
السجل الوطني لمرضى الفشل الكلوي
وبائية الفشل الكلوي في األردن لعام2016
إعداد الدكتور سالم القيسي الدكتور ماجد اسعد
المملكة االردنية الهاشـميةوزارة الصحة
مديرية األمراض غير السارية
السجل الوطني لمرضى الفشل الكلوي
وبائية الفشل الكلوي في األردن لعام2016
التقرير السنوي التاسع
