Dr. Adhra Al-Mawali, can you answer?

Please all people of interest are invited to share their knowledge

This is an intersting and important question. I do not think that it has been addressed anywhere in the Middle or Far East. It has possibly been addressed in SA, but I am not aware of any publications. I have been working in the Kurdish region of Iraq for more than 7 years and we have developed a renal biopsy service for the region. The question of chronic kidney disease risk is constantly raised and the public medical sector certainly needs some basic data to anticipate future needs for dialysis and transplantation. I am uncertain about how the estimates would be best collected. Dialysis is pretty much limited to short term intervention and kidney failure patients are mainly provided with interventional transplantation. Some estimate of ESRD could be made by calculating the number of annual transplants of Kurdish residents by the Kurdish population. This will miss patients that die of renal failure with no intervention. The best estimates could probably be obtained using eGFR from a sizable number of outpatients in general practice facilities. We have discussed the possibility of doing such a study but without making any effort to implement it.

Do you have any plans for Oman?

Yet, the health system in Oman is under transformation stage. At this stage we need a systematic research studies to be conducted to provide our health system with the missing but valid data. Research studies can inform our health plans at this challenging time. Up to my knowledge there are promising healt plans in Oman but yet unclear.

Thanks for the invaluable feedback Michael Hughson.

I am going to pass your query around to some of my colleagues. I would like to continue the discussion. We have made some progress in understanding the demograohics of breast cancer in the Kurdish region. The same needs to be done with kidney disease.

Good morning Michael,

Yes I believe the same understaning of demographics of the ESRD is highly important as the world and my country as well spending a considerable part of the budget on the treatment of this epidemic. The demographics will certainly help in the well distribution and management of resources..

Dr Ruqiya

This is a response from one of my colleagues in Sulaimaniyah. He is a senior UK trained nephrologist who has come back to Kurdistan to help develop renal services.

Dear Mike,

Thanks for raising this issue, although i could not find the question but i guess it was regarding the prevalence of CKD in kurdistan. In many countries around the world including UK, only high risk patients get screened for CKD, So it is very difficult to estimate. we know for the fact that majority of CKD stage 1&2 never present to their GP because they don't have any symptoms and in fact majority of CKD stage 3 present because of symptoms of other diseases which has led to CKD. The other point that most CKD stages 1-3 never progress to stage 4 or end stage which make it even more difficult to identify. We have many patient who declined RRT or died even before they reach ESRD and we have many young people in (Ranya) presents for the first time with end stage kidneys which we don't know the cause and is too late to biopsy (worth studying). I am not sure about USA but i can refer to a study published in Am J kidney disease by Coresh J and his colleagues in 2003 which looked at the prevalence of CKD in USA

Any comments?

Dana

Dear Mike,

The feedback from your colleague is really helpful. I will read the study done by Coresh J and provide some feedback later...

A) Unaware of that.

B) Working on similar interest right now in Florida, USA. We are working on the prevention of ESRD in diabetes mellitus (DM). thus far, using the new paradigm of insulin therapy of Mandal Diabetes Research Foundation (MDRF). We are able to show stable renal function with no progression to ESRD in our population with DM. We also have identified that enthusiastic use of ACEI/ARB drugs to treat microalbuminuria/proteinuria results in progression to ESRD. Glycemic control in our patients is not necessarily tight but none receives ACEI/ARB drugs.

this is a sensitive topic in Jordan as well. I just finished conducting a national study that followed the high risk outpatients for chronic kidney disease. we are analyzing the data right now, and it looks like that the results are consistent with the western statistics. we found that around 15% of the sample had already CKD (eGFR

The situation is much similar in Oman. There is a recent systematic review (2012 for Amal Hasanein) about the epidemiology of ESRD in GC (Gulf Countries). It is good one but its major limitation was having no renal registries in the GC countries and the lack of research studies enriching this topic. This again will take us to the point of creating renal registries is became a requirement and not complementary. Similar studies of following high risk patients who are mostly have either DM or HTN are very highly recommended. Also it is good to learn from Dr. Anil Mandal and others experiences.

can I have a copy of Hasanein's study if published, or the full reference citation it will be a great help for us in Jordan to explain the size of the problem.

Yes Dear Amal, The review title is (Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review) and those are the Authors;Amal A. Hassanien,1 Fahdah Al-Shaikh,2 Eszter P. Vamos,3 Ghasem Yadegarfar,4 and Azeem Majeed5. If you but the title in the search engine of Google Scholar you will be able to access it for free..All the best

Sorry Dear Amani I meant.

There is another study done in Liby which I Gues might be helpful. The title is (Epidemiology and aetiology of dialysis-treated end-stage kidney disease in Libya) for

Wiam A Alashek1,3, Christopher W McIntyre1,2,3 and Maarten W Taal2,3*. It is 2012 study also. You can get it with the same search method..if you could not access it. Then send me your email address and I can send it to you as an attachment. This study is free accessed too.

thanks Dear Ruqiya, I really appreciate your kindness :)

Dear Michael Hughson,

The study done by Coresh J and his colleagues in 2003 is really interesting to me but I couldn't access the full article. Also if there is a recent study with the same focus I would like to know more about it/them.

Dr. Nabil Mohsin (AlLawati) in Oman is interested in this topic and has substantial expertise in ESRD as well as in statistical methods for analyzing clinical data which he obtained during his visiting scientist experiences at Harvard and in France.

dear Dr. Edgar Milford, thanks for your input and I am going to contact Dr. Mohsen soon..

Dr Ruquya, it would be great if we work as a team to address this problem in the middle east, first we need a national screening campaign, to assess the size of the problem and to change our institutions policy regarding the high risk patients. it looks like we have a preliminary data, what do you think????

It is a great idea Dr. Amani, but I think we need to build the individual research data system of each country first. I mean for Oman we can not start a national scale study on the level of Middle East until we make the preliminary data for that national study available. the preliminary data we have right now is incomplete. My target now is to investigate what is availabe data and where is the gap so I can make an original adding up research. Now I am planning to communicate with Dr. Mohsen to see what he has done and what I can do further to his work. Also I know there is an (Operational & Management Guidelines for the National Non-communicable Disease Screening Program) is in place since 2010 in Oman. Is it operated and active? The answer is I do not know right now. But if you are interested to know more teh Head o Non-communicable diseases in Oman is called Dr. Ahmed Al-Busaidi. His E-mail is as following: [email protected]. he is very good-cooperative man. all the best

Dear Dr. Edgar Milford,

Can you help me to get any contacts for Dr. Nabil Mohsin (AlLawati) . If you have his email addrss please give it to me and i will be grateful to you.Thanks

Dear Ruqaya,

Kindly I have NO idea. May be look at letretures

Salah

I have No email of Dr Nabil, You could call Royal Hospital and query about his email.

Salah

Dear Mr. Salah,

Yes I have the information I need now because I went to Oman last summer and gathered the necessary data. In fact Dr. Nabil is one of the collaborative team of this project and am really proud about having him. I should say thanks for your consideration.