The Hashemite Kingdom of Jordan

Ministry of Health

Non-Communicable Diseases Directorate

National Registry of End Stage Renal Disease

( ESRD )

Annual Report 2013

www.moh.gov.jo

Tel: 5678197 Fax: 5656489

Jordan

The Hashemite Kingdom of Jordan

Ministry of Health

Non-Communicable Disease Directorate

National Registry of End Stage Renal Disease

(ESRD)

Annual Report 2013

Prepared by:

Dr. Ayyob As-Sayaideh Dr. Salem Al-Qaisi

His Majesty King Abdullah II

5

List of the team who participated in achieving this ESRD annual report:

Dr Mohammad Salameh El-Lozi

Senior Consultant in Internal Medicine,

Nephrology and Transplantation. MRCP (UK). FRCP (London). FRCP (Glasgow), Private

sector and P.H.H.

Dr Khaled Ali zayed

Nephrologist, MOH.

Dr Elias Turk

Nephrologist, MOH.

Dr Kamal Hassan Arkoub

Specialist in Community Medicine. MOH.

6

Foreword

sixth

2013

7

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 sup-

port of focal points in all dialysis units is highly appreciated.

We would like to thank Mrs. Rasha Kokash for her 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 Nephrology 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 World Health Organization for its support in preparing and pub-

lishing this report.

Dr. Ayyob As-SayaidehDr.Basheer AL-Qaseer

8

Name of HospitalsRoyal Medical Services Hospital Name Site Phone numberKing Hussein Medical center Amman 5804804Queen Alia Military Hospital Amman 5157100Prince Hashem Bin Al Hussein Zarqa’a 3962002Prince Hashem Bin Abudullah Aqaba 2014111Prince Ali Bin Al Hussein Karak 2386370Prince Rashid bin Al Hassan Irbid 7100890Prince Zeid bin Hussein Tafiela 2242982Queen Rania Hospital Amman 5804804

Ministry of Health Hospital Name Site Phone number Al-Basher Hospital Amman 4775111Abu Obaida Hospital Irbid 026570018Hussein Hospital Balqa 053551140Karak Hospital Karak 032386190Ruweished Hospital Mafraq 026292183Maan Hospital Maan 032132222Mafraq Hospital Mafraaq 026231234 Princess Iman Balqa 053584934AL-Zarqa’a Hospital Zarqa 05398332Jamel Altotnge Amman 4020096Yarmouk Hospital Irbid 027585980Princess Raya Irbid 026521666Ghor Safi Hospital Karak 032302436Prince Hamza Hospital Amman 5053826Queen Rania Al-Abdullah Maan 032150636Ramtha Hospital Irbid 027384384Iman Hospital / Ajloun Ajloun 026421914Princess Salma Hospital Madaba 053207104 AL-Dleal Hospital Zarqa 053825145Jerash Hospital Jerash 026351114Maaz bin Jabal Irbid 026587011Princess Basma Teaching Irbid 027275555Nadeem Hospital Madaba 053244008 AL-Shoneh AL-Janobyeh Balqa 053581364Prince Hussein Balqa 5351731Aqleh Hospital Amman 4642441AL-Ahli Hospital Amman 5664164AL-Dleel Hospital Zarqa 053825144 Rom-ALkatholik Hospital Irbid 027257900AL Haya Hospital Amman 4391111Prince Faisal Hospital Zarqa 053740251Al-Qawasmi Hospital Irbid 027243401

9

University Hospitals

Hospital Name Site Phone numberJordan University Hospital Amman 5353666King Abdullah University Irbid 027200600

Private Sector Hospitals

Hospital Name Site Phone Number

Islamic Hospital Amman 5101010

Jordan Hospital Amman 5608080

AL-Qouds Hospital Amman 4387181

Shmeisani Hospital Amman 5607431

Al Khalidi Hospital Amman 4644281

Ibn al-Haytham Hospital Amman 5205555

Arab Medical Center Amman 5921199

AL Mowasah Hospital Amman 4896842

Dr. Ahmed Hamayda Amman 4785555

AL Esteqlal Hospital Amman 5652600

Lozmelah 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

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 053987995Irbid Specialty Hospital Irbid 027103100Bin Al-Nafees Hospital Irbid 027102100Al-Najah Hospital Irbid 027100170Al-Rahbat Al-Wardyeh Irbid 027102011Islamic Irbid Hospital Irbid 027273111 AL-Rasheid Hospital Amman 4777444Islamic Irbid Hospital Irbid 027273111 Dar AL-Salam Hospital Amman 5850008

10

Table of Contents

pageList of Abbreviations 11

List of tables 12

List of Figures 13

Part One: 15

Introduction 16

Geography 17

Population 17

Jordan Renal Registry 25

Methodology 29

Part Two: 31

Dialysis Units in Jordan 31

Part Three: 33

ESRD Patients in Jordan 33

Trend of ESRD patients in Jordan during (2008-2013)

Part Four 50

Incidence of ESRD Patients

Part Five: 57

Pediatric ESRD 57

Part Six: 62

ESRD patients among Non-Jordanians,

Part seven: 64

ESRD Mortality

References 67

11

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

12

List of tables

Table N. Description Page

Table (1) Estimated Population of Jordan 2013 19

Table (2) Population distribution by Governorate and gender, Jordan 2013 20

Table (3) Selected Demographic, Socio-economic and Health Indicators 2013 21

Table (4) Distribution of ESRD according to age groups & gender and Prevalence Rateper million (PPM), 2013

36

Table (5) Distribution of ESRD patients according to marital status and gender 2013 38

Table (6) Distribution of ESRD patients by employment status and gender,2013 39

Table (7) Distribution of ESRD patients by type of insurance and gender 2013 40

Table (8)Distribution of ESRD patients by Governorate and prevalence per million populations (PPM)

41

Table (9) Distribution of primary causes of ESRD for the year 2013 42

Table (10) Prevalence of co-morbidity and some risk factors with ESRD 43

Table (11) Distribution of ESRD patients by fitness for transplantation 46

Table (12) Causes of unfitness for transplantation 46

Table (13) Priority level for patient candidate for transplant 48

Table (14) Prevalence of Hepatitis B and C in ESRD patients 49

Table (15) Distribution and ASIR of ESRD cases by gender and age group Incidence 2013 50

Table (16) Primary causes of ESRD for the year 2013 - Incidence 53

Table (17) Causes of ESRD in Pediatric patients 2013 59

Table (18) Distribution of ESRD patients among Non-Jordanians according to age groupsand gender, 2013

66

13

List of Figures

Figure N. Description Page

Figure (1) Map of the Hashemite Kingdom of Jordan 18Figure (2) Population Pyramid – Jordan 2013 19Figure (3) Distribution of dialysis units by health sector, Jordan 2013 31Figure (4) Distribution of Dialysis Machines by Health Sector, 2013 32Figure (5) Number of prevalent ESRD patients in Jordan during (2008-2013) 33Figure (6) International comparison of prevalence rate of Hemodialysis (PPM) 2013 34Figure (7) Distribution of ESRD patients by gender 35Figure (8) ESRD cases according to age groups and gender 37Figure (9) Distribution of ESRD cases less than 19 years and over 60 years 37

Figure (10) Distribution of prevalent ESRD patients by Health sector,2013 39Figure (11) Distribution of ESRD patients according to Blood group 44Figure (12) Distribution of ESRD patients by type of Dialysis 44Figure (13) Distribution of Hemodialysis patients by number of sessions /week 45Figure (14) Causes of unfitness for transplantation 47Figure (15) Distribution of fitness of ESRD patients by Priority level for Transplantation 47Figure (16) Distribution of ESRD patients by availability of a donor 48

Figure (17) Distribution of ESRD cases according to age groups and gender 2013 51

Figure (18) Distribution of ESRD patients by health sector, 2013 52

Figure (19) Distribution of ESRD patients by gender, 2013 52

Figure (20) Distribution of ESRD patients by Nationality 2013 54

Figure (21) Distribution of ESRD patients by type of Dialysis, 2013 54

Figure (22) Distribution of ESRD patients by fitness for transplantation 55

Figure (23) Distribution of fitness of ESRD patients by Priority level for transplantation 2013 55

Figure (24) Distribution of mortality in ESRD patients 2013 56

Figure (25) Distribution of ESRD pediatric patients by gender 57

Figure (26) Distribution of Pediatric patients according to type of Dialysis 58

Figure (27) Distribution of pediatric patients according to age groups and gender 2013 60

Figure (28) Distribution of Pediatric ESRD by fitness for transplantation 60

Figure (29) Distribution of mortality in Pediatric patients 61

Figure (30) Distribution of mortality in ESRD patients 62

Figure (31) Distribution of mortality in ESRD patients according to gender 63

Figure (32) Distribution of mortality in ESRD patients by age group and gender 63

Figure (33) Distribution of ESRD patients by Nationality 64

Figure (34) Distribution of ESRD patients among Non-Jordanians by gender 65

Figure (35) Distribution of ESRD patients among Non-Jordanians according to age groupsand gender 2013

66

15

Part one

Introduction

Geography

Population

Health Status

Jordan Renal Registry

Methodology

16

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 6th annual ESRD report, including prevalence and

the incidence of ESRD in Jordan for the year 2013, 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 hoping this will facilitate their utilization

and comprehension.

17

Geography

Jordan is located in the Middle East, between Latitudes 29-33 north and between Longi-

tudes 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 des-

ert 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 estimated population of Jordan in mid-2013 was 6530000 millions. Including 3366000

males and 3164000 females (male: female ratio 106: 4). (Department of Statistics Jordan,

2013). About 12.7% of the population under the age of 5 years, 37.3% under the age

of 15 years and 59.4% of the population at the age 15-64 years, only 3.3 % of the total

population above the age of 65(Sex Ratio in 2013: 106.4 males for 100 females).Table (1)

and figure (2) show the age distribution of Jordan population, 2012 (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 62.8% of the total population with

population density of (249.7) person per Km2. North region includes (Irbid, Mafraq, Jarash,

Ajloun) which constitute 27.8% of the population with a population density of (55) person

per Km2. South region includes (Karak, Tafila, Ma’an, Aqaba) which constitutes 9.4% of the

population with a population density of 11.7 per Km2

18

Figure (1) Map of the Hashemite Kingdom of Jordan

19

Table (1) Estimated Population of Jordan 2013

Gender age group

Male Female TotalN % N % N %

0-4 427485 12.7 405300 12.8 832785 12.75-9 422095 12.5 400880 12.7 822975 12.6

10-14 401900 11.9 379680 12.0 781580 11.915-19 368915 10.9 347720 11.0 716635 11.020-24 358485 10.7 333170 10.5 691655 10.625-29 307650 9.1 276855 8.7 584505 8.930-34 265915 7.9 245520 7.7 511435 7.835-39 215425 6.4 199015 6.3 414440 6.340-44 155720 4.7 149975 4.7 308850 4.745-49 111750 3.3 106630 3.4 218380 3.350-54 82805 2.5 81320 2.6 164125 2.555-59 71360 2.1 74040 2.3 145400 2.260-64 66645 2.0 59800 1.9 126445 1.9+65 106695 3.2 104095 3.3 210790 3.2Total 3293000 100.0 3164000 100.0 6530000 100.0

Figure (2) Population Pyramid – Jordan 2013

Female Male

85+80-8475-7970-4065-6960-6455-5950-5445-4040-4435-3935-3630-3425-2920-2415-1910-14

5-90-4

420 315 210 105 105 210 315 4200

20

Table (2) Population distribution by Governorate and gender, Jordan, 2013

gender

Governorate

Male Female Total

N % N % N %

Amman 1300000 38.6 1228500 38.8 2528500 38.7

Balqa 227200 6.7 205800 6.6 437500 6.7

Zarqa 503400 15.0 469500 14.8 972900 14.9

Madaba 84100 2.5 79200 2.5 163300 2.5

Central region 2114700 62.8 1987500 62.8 4102200 62.8

Irbid 595300 17.7 567000 17.9 1162300 17.8

Mafraq 159100 4.7 147800 4.7 306900 4.7

Jarash 100800 3.0 95100 3.0 195900 3.0

Ajloun 76400 2.3 73800 2.3 150200 2.3

North Region 931600 27.7 883700 27.9 1815300 27.8

Karak 128900 3.8 125800 4.0 254700 3.9

Aqaba 79200 2.4 63100 2.0 142300 2.2

Maan 65000 1.9 59100 1.9 124100 1.9

Tafeilah 46600 1.4 44800 1.4 91400 1.4

South Region 319700 9.5 292800 9.3 612500 9.4

Total 3366000 100.0 3164000 100.0 6530000 100.0

21

Table (3) Slected Demographic, Socio-economic and Health Indicators 2013

Indicators 2013

Population 2013 6.530.000

Population Density (Person per km2) 73.5

Population Growth Rate 2.2 %

Rate of Natural Increase 2.1%

Population Doubling Time (Year) 31.5

Population Less Than 15 Year of Age 37.3%

Percentage of Population Age 15-64 Years 59.4%

Percentage of Population Age 65+ 3.3

Dependency Ratio 68.2

Percentage of Urban Population 82.6%

Percentage of Rural Population 17.4%

Total Fertility Rate (Women 15-49 Years) 3.5

Urban 3.8

Rural 4.0

Sex Ratio 106.4

Total Households (000) 1,157.2

Crude Marriage Rate (Per 1000 Population) 10.9

Crude Divorce Rate (Per 1000 Population) 2.9

Singulate Mean Age at First Marriage (Year) 28.4

Male 29.4

Female 25.8

Jordanian Married of Total Population 15+ 55.4

Male 54

Female 56.8

Average Household Size (person) 5.4

Population Median Age (year) 20.3

Crude Birth Rate (Per 1000 Population) 27.6

Crude Death Rate (Per 1000 Population) 5.8

Infant Mortality Rate (Per 1000 Live Births) 17.0

Under Five Mortality Rate (Per 1000 Live Births) 28.0

Life Expectancy at Birth (Year) 74.4

Male 72.7

Female 76.7

Unemployment Rate (%) 12.2

Male 10.4

Female 19.9

22

Health Status

Morbidity Data

Jordan 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 preva-

lence 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 16th annual report for the year 2011, JCR registered 6971 cancer cases, of these

4675 (67.1%) were among Jordanians and 2296 (32.9%) were among non-Jordanians.

The crude incidence rate of all cancers among Jordanians was 74.8 per 100,000 populations

(68.1 for males and 81.9 for females).

The male to female ratio was 0.88: 1.

23

Mortality data

It 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 17 deaths per 1,000 live births in 2013. 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

2011, cardiovascular diseases accounted for about 37.6 % of deaths for both sexes. Cancer

was the second leading cause of death accounting for 14.3 % of total deaths, while external

causes of mortality were the third leading cause responsible for 8.6 % of total deaths.

While diseases of Genitourinary system constitute about 2.5% total deaths, 366 patients

(91%) of these deaths were due to renal failure (acute and chronic renal failure) according

to mortality report in 2011 (5).

24

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.

25

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.

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.

26

Status of “Renal Replacement Therapy” in Jordan

Proudly 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 deal-

ing 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.

27

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 (Inter) National 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.

28

National Registry of End Stage Renal Disease:

The National Registry of End Stage Renal Disease was created in May 3 rd, 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.

29

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 sixth national ESRD Registry report. Data were received from all (76) 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 2013 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.

30

Methods 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 estimation of the na-

tional population by Department of Statistics (DOS) 2013.

31

Part Two

Dialysis Units in Jordan

By the end of 2013, there were 76 working Dialysis Units distributed all over the country.

32 units (42%) administered by Ministry of Health (MOH), 8 units (10 %) administered by

Royal Medical Services (RMS), 2 units (3%) administered by university hospitals: one

administered by Jordan University Hospital, one by King Abdullah University Hospital

(KAUH) and 34 units (45%) administered by Private Sector (PS), (Figure 3).

Figure (3) Distribution of dialysis units by health sector, Jordan 2013.

32

Distribution of Dialysis Machines by Health Sector, Jordan 2013

The total number of dialysis machines (895) in all units was distributed as followed: 362

(40%) machines in MOH units, 77(9%) machines in RMS, 34(4%) machines in universities

hospitals and 422 (47%) machines in private sector hospitals, (Figure 4).

Figure (4) Distribution of Dialysis Machines by Health Sector,2012

The focal points in all 76 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.

33

Part three

ESRD patients in Jordan

Prevalence of ESRD patients in Jordan (2013)

The total numbers of patients treated and registered in the Jordan Renal Registry by the end of 2013 was ( 4272) patients; of them 4097 were Jordanians (95.9%) and 175 were non Jordanians (4.1%). This part of the report only include Jordanian patients –prevalence 2013The number of Jordanian patients that registered in ESRD and treated in hospitals for the year 2013 was 4097 patients, while the number of new cases of ESRD for the year 2013 was 728 patients , out of them 650 patients (89%) were Jordanians,78 (11%) were nonJordanians.The number of Jordanian ESRD patients for the year 2013 was decreased due to kidney transplant that done where (380) Jordanian patients did kidney transplant in our hospitals in Jordan for the years from (2011-2013), also after excluding the number of deaths for each year from 2008-2013 as shown in the figure below. For this year we improve surveillance system for ESRD patients from 2008-2013 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.

Figure (5) Number of prevalent ESRD patients in Jordan during ((2008-2013)

34

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 2013. The

overall Prevalence Per Million Populations in Jordan in 2013 is (627.4/1,000,000)

compared with other countries.

Figure (6): International comparison of prevalence rate of Hemodialysis (PMP)2013

PMP: per million population

Prevalence of ESRD Patients in Jordan, 2013

The total number of ESRD patients during the year 2013 was 4097 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 2013 according to gender. The

number of patients treated in the Dialysis Units was 4097 patients , out of them 2344

were male patients which accounted (57%) and 1753 were female patients accounted

( 43% ),with male to female ratio 1.3:1.

35

Figure (7) Distribution of ESRD patients by Gender

Distribution of ESRD patients according to age groups and gender, 2013

Table (4) shows the distribution of ESRD patients according to the age groups and gender,

the mean age of patients was (51) years, (51 years for males and 51.5 years for females).

The median age of patients was (53) years, (53 years for males and 54 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

(627.4/1,000,000).

36

Table (4) Distribution of ESRD according to age groups and gender and Prevalence Rate per million (PPM), 2013

gender

Age groupMale Female Total

N % N PPM N PPM %

0-4 9 21.1 7 17.3 16 19.2 0.4

5-9 19 45.0 12 29.9 31 37.7 0.8

10-14 23 57.2 34 89.5 57 72.9 1.4

15-19 59 159.9 36 103.5 95 132.6 2.3

20-24 85 237.1 75 225.1 160 231.3 3.9

25-29 130 422.6 88 317.9 218 373.0 5.3

30-34 127 477.6 104 423.6 231 451.7 5.6

35-39 173 803.1 95 477.4 268 646.7 6.5

40-44 192 1208.5 126 840.1 318 1029.6 7.8

45-49 216 1932.9 154 1444.2 370 1694.3 9.0

50-54 242 2922.5 161 1979.8 403 2455.4 9.8

55-59 258 3615.5 166 2242.0 424 2916.1 10.4

60-64 238 3571.7 189 3160.5 427 3377.0 10.4

65+ 571 5351.7 505 4851.3 1076 5104.6 26.3

Total 2342 695.8 1752 553.7 4094 627.4 100.0

*PMP: Per Million Populations

37

Figure (8) ESRD cases according to age groups and gender-2013

Figure (9) Distribution of ESRD cases by age group-2013

38

Distribution of ESRD patients according to marital status and gender

Table (5) shows that the majority of ESRD patients were married (71.2%), (married males

78.9% and married females 61%), while (19.4%) of the ESRD patients were singles (single

males 18.4% and single males 20.7% ),( 1.8%) of the patients were divorced .

Tables (5) Distribution of ESRD patients according to marital status and gender 2013

gender

MaritalStatus

Male Female Total

N % N % N %

Married 1849 78.9 1070 61.0 2919 71.2

Single 430 18.4 363 20.7 793 19.4

Divorced 38 1.6 272 15.5 310 7.6

Widow 25 1.1 50 2.8 75 1.8

Total 2342 57.2 1755 42.8 4097 100.0

Distribution of ESRD patients according to employment status and gender

Table (6) shows the distribution of the ESRD patients according to their employment status

for both genders. House wife’s accounted (67.7 %) of the females, (4.3%) of the patients

were employed either governmental or non-governmentally and military services, (14.0%)

were retired, and (3.8%) were students, (26.2%) of the patients were unemployed, missing

data about employment was (12.6%).

39

Table (6) Distribution of ESRD patients by employment status and gender, 2013

gender

Job

Male Female Total

N % N % N %

House Wife 0 0.0 1188 67.7 1188 29.0

Unemployed 842 36.0 232 13.2 1074 26.2

Retired 537 22.9 35 2.0 572 14.0

Private 347 14.8 18 1.0 365 8.9

Student 80 3.4 76 4.3 156 3.8

Employed 143 6.1 35 2.0 178 4.3

Military 42 1.8 7 0.4 49 1.2

Missing 351 15.0 164 9.3 515 12.6

Total 2342 57.2 1755 42.8 4097 100.0

Distribution of prevalent ESRD patients by health sector

Out of the all 4097 prevalent ESRD patients 1525 patients (37.2% ) were treated in MOH

Dialysis Units , 839 patients (20.5%) treated in RMS Dialysis Units, 136 patients (3.3%)

treated in university hospital Dialysis Unit, and 1597 patients (39.0%) treated in Private

Sector Dialysis Units,(Figure 10)

Figure (10) Distribution of prevalent ESRD patients by Health Sector, 2012

40

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. (42.9%) of the patients

were insured by Kidney Patients Fund in health insurance directorate in Ministry of health.

Civilian (24.1%), Military (24.0%), Private (1.1%). only (1.4%) were not covered by any type

of insurance. Missing data regarding the insurance type accounts for (1.2) % of the cases.

Table (7) Distribution of ESRD patients by type of insurance and gender

gender

Insurance Type

Male Female Total

N % N % N %

Kidney patientsfund 1033 44.1 724 41.3 1757 42.9

Civilian 579 24.7 407 23.2 986 24.1

Military 514 21.9 468 26.7 982 24.0

Private 28 1.2 18 1.0 46 1.1

Universities 28 1.2 13 0.7 41 1.0

Others 101 4.3 77 4.4 178 4.3

No insurance 9 0.4 8 0.5 17 0.4

Missed 50 2.1 40 2.3 90 2.2

Total 2342 57.2 1755 42.8 4097 100.0

41

Distribution of ESRD patients by Governorate

The overall prevalence per Million Population in Jordan is (627.4/1,000,000), the highest

prevalence was found in Madaba governorate (728.7/1,000,000) followed by Amman gov-

ernorate (714.7/1,000,000) Zarka governorate (631.1/1,000,000) and Ajloun governorate (

625.8 / 1,000,000 ) Table (8).

Table (8) Distribution of ESRD patients by Governorate and prevalence per million populations (PPM)

gender

Insurance Type

Male Female Total

N % N % N % Rate

Amman 1051 44.9 756 43.1 1807 44.1 714.7

Zarqa 346 14.8 268 15.3 614 15.0 631.1

Madaba 61 2.6 58 33.3 119 2.9 728.7

Balqa 141 6.0 118 6.7 259 6.3 592.0

Centra Region 1599 68.3 1200 68.4 2799 68.3 682.3

Irbid 405 17.3 267 15.2 672 16.4 578.2

Mafraq 75 3.2 63 3.6 138 3.4 449.7

Jarash 46 2.0 52 3.0 98 2.4 500.3

Ajluon 46 2.0 48 2.7 94 2.3 625.8

North Region 572 24.4 430 24.5 1002 24.5 552.0

Karak 88 3.8 65 3.7 153 3.7 600.7

Aqaba 25 1.1 24 1.4 49 1.2 344.3

Maan 29 1.2 13 0.7 42 1.0 338.4

Tafeile 29 1.2 23 1.3 52 1.3 568.9

South Region 171 7.3 125 7.1 296 7.2 483.3

* PMP: Per Million Populations

Number of total cases in Jordan as received from renal dialysis units are 4097

42

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 (29.3%), followed by Hypertension

(25.1%), Diabetes Mellitus and Hypertension (12.2%), Glomerulonephritis (10.4%) and

then Polycystic kidney disease (2.7%) congenital causes(2.6 %), Infection (2.2%).

Table (9) Distribution of primary causes of ESRD for the year 2013

Primary cause of ESRDMale Female Total

N % N % N %

Diabetes Mellitus 625 26.7 475 27.1 1127 29.3

Hypertension only 635 27.1 395 22.5 1057 25.1

DM and Hypertension 375 16.0 305 17.4 696 12.2

Glomerulonephritis 242 10.3 184 10.5 436 10.4

Polycystic kidney 59 2.5 50 2.8 112 2.7

Congenital 64 2.7 43 2.5 110 2.7

Infection 55 2.3 36 2.1 93 2.3

Vesico uretric reflux 41 1.8 27 1.5 70 1.7

Drug 21 0.9 25 1.4 46 1.1

SLE 11 0.5 26 1.5 37 0.9

Neurogenic bladder 13 0.6 23 1.3 37 0.9

Stone 16 0.7 12 0.7 29 0.7

Alport syndrom 8 0.3 4 0.2 12 0.3

Nephrotic syndrom 7 0.3 5 0.3 12 0.3

FMF 5 0.2 2 0.1 7 0.2

Others 47 2.0 46 2.6 95 2.3

Unknown 118 5.0 97 5.5 220 5.4

Total 2342 100.0 1755 100 4097 100.0

43

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 (60.8%) of

patients were hypertensive, while cardiovascular diseases were found in (14.4%) of ESRD

patients. The prevalence of diabetes constitutes (37.5 %). The prevalence of smoking in

ESRD was (9.6%) and (5 %) of the patients had family history of renal diseases, Table

(10).

Table (10) Prevalence of co-morbidity and some risk factors with ESRD

Comorbidity Frequency %

Hypertension 2492 60.8

Diabetes 1538 37.5

Cardiac disease 592 14.4

Smoking 393 9.6

Urinary tract disease 305 7.4

Familial kidney disease 203 5.0

Malignanacy 41 1.0

Distribution of ESRD patients according to Blood Group

Figure (11) shows that approximately one third of the patients 1260 (31.0%), were blood

group A and 1320 (32.0%) were blood group O, 298 (7.0%), were blood group AB and

634(16.0%) were blood group B . Data was not available for 585 ESRD patients which

constitutes (14.0%), of the ESRD patients.

44

Figure (11) Distribution of ESRD patients according to Blood group

Distribution of ESRD patients according to type of Dialysis

Figure (12) shows that only 69 patients (2%) were treated by peritoneal dialysis, while

4028 patients (98%) were treated by hemodialysis.

Figure (12) Distribution of ESRD patients by type of Dialysis

45

Distribution of Hemodialysis patients by number of sessions /week

Figure (13) shows that 2965 patients (73.7%) underwent Hemodialysis thrice a week, 976

(24.2%) twice a week, 45 (1.1%) once a week, and 42 (1%) four times a week, the aver-

age duration of the every session is almost four hours

Figure (13) Distribution of Hemodialysis patients by number of sessions /week

Distribution of ESRD cases according to fitness for transplantation

Table (11) shows that 1689 (41.2%) from both genders were considered candidates for

transplantation, and 1874 not candidates for transplantation (45.7%) , no available data on

(534) (13%) of ESRD patients.

46

Table (11) Distribution of ESRD patients by fitness for transplantation

Candidate fortransplant

Male Female Total

N % N % N %

Yes 1039 44.4 650 37.0 1689 41.2

No 1015 43.3 859 48.9 1874 45.7

Unknown 288 12.3 246 14.0 534 13.0

Total 2342 100.0 1755 100.0 4097 100.0

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: medical diseases 861 patients (45.9%) of all cases, age in 748 patients

(39.9%), malignancies in 36 patients (1.9%), while unknown causes for the cases were

134 patients (7.2%) of all patients.

Table (12) Causes of unfitness for transplantation

Causes Freqyency Percent

Medical causes 861 45.9

Age 748 39.9

Malignancies 36 1.9

Other causes 95 5.1

Missed 134 7.2

Total 1874 100.0

47

Figure (14) Causes of unfitness for transplantation

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 632 patients (37.4%) were considered of high priority

level for transplantation and 536 patients (31.7%) considered of medium and 242 patients

(14.3%) of low priority and 279 (16.5%) had no data about their priority level.

Figure (15) Distribution of fitness of ESRD patients by Priority level for Transplantation

48

Table (13) Priority level for patient candidate for transplant

Priority levelMale Female Total

N % N % N %

High 412 39.7 220 33.8 632 37.4

Medium 325 31.3 211 32.5 536 31.7

Low 147 14.1 95 14.6 242 14.3

Unknown 155 14.9 124 19.1 279 16.5

Total 1039 100.0 650 100.0 1689 100.0

Distribution of ESRD cases according to availability of a donor

Figure (16) shows that 1309 patients (77.5%) had no available donor, and 313 patients

(18.5%) had available donor, 67 patients (4.0%) 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

49

Prevalence of Hepatitis B and C in prevalent ESRD patients

Table (14) shows the prevalence of hepatitis B and C in ESRD patients. (6.4 %) of the

cases had Hepatitis B and (2.5 %) had Hepatitis C.

Table (14) Prevalence of Hepatitis B and C in ESRD patients

Type of Hepatitis Hepatitis B Hepatitis C

Result Male Female Total % Male Female Total %

Positive 128 133 261 6.4 56 47 103 2.5

Negative 1934 1457 3391 82.8 2017 1543 3560 86.9

Missed 280 165 445 10.9 269 165 434 10.6

Total 2342 1755 4097 100.0 2342 1755 4097 100.0

50

Part Four:

Incidence of ESRD Patients

The total number of ESRD who treated in the dialysis units by the end of 2013 were (4272)

patients, but the number of new cases for the year 2013 was 728 (650 Jordanians and 78

non Jordanians).

Incidence of ESRD, 2013

Table (15) and Figure (17) show the distribution of ESRD incident patients in 2013 according

to the age group and gender, with a mean age of 52.7 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 (99.5/1,000,000).

Table (15) Distribution and ASIR of ESRD cases by gender and age group

Incidence 2013

Gender

Age Groub

Male Female Total

N ASIR N ASIR N ASIR %

0-4 6 14.0 3 7.4 9 10.8 1.4

5-9 2 4.7 4 10.0 6 7.3 0.9

10-14 8 19.9 11 29.0 19 24.3 2.9

15-19 11 29.8 2 5.8 13 18.1 2.0

20-24 13 36.3 9 27.0 22 31.8 3.4

25-29 12 39.0 14 50.6 26 44.5 4.030-34 15 56.4 10 40.7 25 48.9 3.8

35-39 24 111.4 8 40.2 32 77.2 4.9

40-44 31 195.1 9 60.0 40 129.5 6.2

45-49 31 277.4 15 140.7 46 210.6 7.1

50-54 38 458.9 17 209.1 55 335.1 8.5

55-59 54 756.7 33 445.7 87 598.3 13.4

60-64 41 615.2 23 384.6 64 506.1 9.8

65+ 124 1162.2 82 787.7 206 977.3 31.7

Overall incidence 410 121.8 240 75.9 650 99.5 100.0

51

*ASIR per Million populations

Figure (17) Incidence of ESRD Jordanian by gender & age group-2013

52

Distribution of incident ESRD patients by health sector

Figure (18) shows that the new number of patients treated in the Dialysis Units in 2013

were 728 patients; 324 patients (44.5% ) treated in MOH Dialysis Units, 188 patients

(25.8% ) treated in RMS Dialysis Units, 12 patients ( 1.6% ) treated in university hospital

Dialysis Unit, and 204 patients (28.0 % ) treated in Private Sector Dialysis Units.

Figure (18) Distribution of ESRD patients by health sector, 2013

Distribution of ESRD incident patients by gender

In the years 2013, out of the total ( 728 ) new cases of ESRD , 464 patients (64%) were

males and 264 patients(36%) were females with male to female ratio 1.3:1 Figure (19).

Figure (19) Distribution of ESRD patients by gender, 2013

53

Distribution of ESRD Incident patients by primary cause

Table (16) shows the main primary causes of ESRD Incident patients: The most com-

mon primary cause was Diabetes Mellitus and Hypertension(combined)(37.1%), followed

by Hypertension (25.5%), Diabetes Mellitus (16.9%), Glomerulonephritis (4.4%) and then

congenital causes(2.8 %), Polycystic kidney disease (2.5%), chronic Pyelonephritis (1.4%),

the primary cause was undetermined in (5.2%) of the patients .

Table (16) Primary causes of ESRD for the year 2013 - Incidence

CausesMale Female Total

N % N % No %

Diabetes and hypertension 154 38.0 110 35.9 264 37.1

Hypertension 103 25.4 78 25.5 181 25.5

DM 67 16.5 53 17.3 137 16.9

Glomerulonephritis 15 3.7 16 5.2 31 4.4

Congenital Causes 8 2.0 12 3.9 20 2.8

Polycystic Kidney disease 15 3.7 3 1.0 18 2.5

(Pyelonephritis(chronic 6 1.5 4 1.3 10 1.4

SLE 4 1.0 2 0.7 6 0.8

Drugs induced nephropathy 2 0.5 1 0.3 3 0.4

Neurogenic bladder 2 0.5 4 1.3 6 0.8

VUR 8 2.0 2 0.7 10 1.4

Unknown 18 4.4 19 6.2 37 5.2

Others 3 0.7 2 0.7 5 0.7

Total 464 100.0 264 100.0 728 100.0

Distribution of ESRD patients by Nationality

Figure (20) shows the distribution of ESRD patients according to Nationality, in 2013 there

were (78) non-Jordanian patients accounted (11%) and 650 Jordanian patients accounted

(89%).

54

Figures (20) Distribution of ESRD patients by Nationality 2013

Distribution of ESRD patients according to type of Dialysis

Figure (21) shows that in 2013, only 9 patients (1%) were treated by peritoneal dialysis,

while 719 patients (99%) were treated by hemodialysis.

Figure (21) Distribution of ESRD patients by type of Dialysis, 2013

55

Distribution of ESRD cases according to fitness for transplantation, 2013.

Figure (22) shows that there were 310 (42.6%) candidates for transplantation, and 418 not

candidates for transplantation (57.4%)

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 2013 it was found that 89 patients

(28.7%) were of high priority level for transplant, 78 patients (25.2%) of medium and 143

patients (46.1%) of low propriety level.

Figure (23) Distribution of fitness of ESRD patients by Priority level for

transplantation 2013

56

Distribution of mortality among ESRD patients

In the year 2013 a total of 40 ESRD patients (5.5%) died during this year, 19 of them were

females and 21 were males of different age group Figure (24).

Figure (24) Distribution of mortality in ESRD patients 2013

57

Part Five:

Pediatric ESRD

The total number of pediatric patients from 0-14 years was 104 patients in 2013.

Figure (25) shows the distribution of Pediatric ESRD who treated in renal dialysis units in

all hospitals during the year 2013 according to gender.

There were 104 patients, out of them 51 were males (49%) and 53 were female patients

accounted (51%).

Figure (25) Distribution of ESRD pediatric patients by gender

Distribution of Pediatric patients according to type of Dialysis

The total number of pediatric patients from 0-14 years was 104 patients. Out of them 82

patients were treated by hemodialysis and 22 on peritoneal dialysis. Figure (26) shows

distribution of pediatric patients according to type of dialysis.

58

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 Congenital renal anomalies (17.3%) followed

by Glomerulonephritis (16.3%) Vesicouretic reflux (13.5%) Neurogenic bladder (13.5%),

Hypertension (9.6%) Polycystic kidney (10.3), and Neurogenic bladder (8.0%), Hydrone-

phrosis (6.9), Nephrotic syndrome (6.7%) and Oxalosis (4.8%) while other causes were

not determined in (10.6%) of the pediatric patients.

59

Table (17) Causes of ESRD in Pediatric patients 2013

CausesMale Female Total

N % N % N %

Congenital 6 11.8 12 22.6 18 17.3

Glomerulonephritis 7 13.7 10 18.9 17 16.3

Vesicouretic reflux 10 19.6 4 7.5 14 13.5

Neurogenic bladder 4 7.8 10 18.9 14 13.5

Hypertension 6 11.8 4 7.5 10 9.6

Nephrotic syndrome 4 7.8 3 5.7 7 6.7

Oxalosis 4 7.8 1 1.9 5 4.8

Drug 1 2.0 1 1.9 2 1.9

Infection 2 3.9 0.0 2 1.9

Diabetes mellitus 0 0.0 2 3.8 2 1.9

SLE 0 0.0 2 3.8 2 1.9

Unknown 7 13.7 4 7.5 11 10.6

Total 51 100.0 53 100.0 104 100.0

Pediatric ESRD patients according to age groups and gender, 2013

Figure (27) shows the distribution of pediatric patients according to the age groups and

gender in 2013, which indicates that the highest occurrence of the cases was among the

age group (10-14) years 57 (54.8 %) for both genders, with a mean age of 9.5 years

and median 10.00.

60

Figure (27) Distribution of pediatric patients according to age groups and gender 2013

Distribution of Pediatric ESRD according to fitness for transplantation

Figure (28) shows that there were 65 (62.5%) candidates fit for transplantation, and 35 not

fit for transplantation (33.7%) missed data was 4 (3.8%).

Figure (28) Distribution of Pediatric ESRD by fitness for transplantation

61

Mortality data in Pediatric patients

A total of 10 (9.6%) pediatric patients in dialysis renal units died during the year 2013 out

of 94(90.4%) who were at risk. Figure (29)

Figure (29) Distribution of mortality in Pediatric patients

62

Part Six

ESRD Mortality

Distribution of mortality among ESRD patients

Figures (30-32) show the distribution of deaths for ESRD patients, 504 patients out of

4097 were died during the year 2013. 290 (55.8%) of them were males, and 230 (44.2%)

were females. Most of ESRD deaths occurred in the age group 65 and above. Median age

at death was 64 years, (63 years for males and 66 years for females).

Figure (30) Distribution of mortality in ESRD patients

63

Figure (31) Distribution of mortality in ESRD patients according to gender

Figure (32) Distribution of mortality in ESRD patients by age group and gender

64

Part Seven

ESRD patients among Non-Jordanians, 2013

Distribution of ESRD patients by Nationality

Figure (33) show the distribution of ESRD patients according to Nationality, The total

number of patients among Non-Jordanians was (175) accounting for (4%) of all patients

reported to Jordan Renal Registry 2013 , and (4097) patients among Jordanians ac-

counting for (96%) of all patients.

Figure (33) Distribution of ESRD patients by Nationality

65

Distribution of ESRD patients among Non-Jordanians by Gender

Figures (34) shows the distribution of Non-Jordanians ESRD patients who treated in

renal dialysis units in all Jordanian hospitals during the year 2013 according to gender

, the number of patients treated in the Dialysis Units were 175 patients , there were 110

male patients who accounted (63%) and 65 female patients accounted ( 37% ),with

male to female ratio 1.3:1.

Figure (34) Distribution of ESRD patients among Non-Jordanians by gender

ESRD patients among Non-Jordanians according to age groups, 2013

Table (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 (40-49) 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).

66

Table (18) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2013

gender

Insurance Type

Male Female Total %

0-9 1 0 1 0.7

10-19 5 1 6 1.7

20-29 10 5 15 8.8

30-39 14 9 23 13.4

40-49 21 11 32 18.5

50-59 22 9 31 18.1

60-69 32 13 45 26

70+ 14 8 22 12.8

Total 119 56 175 100

Figure (35) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2013

67

References

1- Annual Report, Jordan, 2013. Department of Statistics (DOS)

2- BRFSS Survey, 2007 Ministry of Health (MOH) Jordan.

3- Cancer incidence in Jordan, MOH, 2011.

4- Global Youth Tobacco Survey, Anti-Smoking Society Association,

Jordan,

5- Mortality Data in Jordan, 2011, information and mortality section annual report

2011-Ministry of Health, Jordan.

7

6

5

4

3

وحدات غسيل الكلى:

يوجد في األردن 76 وحدة غسيل كلى موزعة كالتالي: 34 )45 % ( وحدة لدى مستشفيات القطاع الخاص

32 ) 42% ( وحدة لدى مستشفيات القطاع الحكومي 8 ) 10% ( وحدات لدى مستشفيات الخدمات الطبية الملكية

2 ) 3 % ( وحدة لدى المستشفيات الجامعية أجهزة غسيل الكلى:

يوجد في األردن 895 جهاز غسيل كلى موزعة كالتالي: 422 )47%( جهاز لدى مستشفيات القطاع الخاص

362 )40%( جهاز لدى مستشفيات القطاع الحكومي 77 )9%( جهاز لدى مستشفيات الخدمات الطبية الملكية

34 )4%( جهاز لدى المستشفيات الجامعية

1،000،000(، وهو الكلوي لكل مليون نسمة في األردن )627.4/ الفشل انتشار مرضى يبلغ نسبة حيث أعلى نسبة في محافظة مادبا )728.7/ 1،000،000( يليها محافظة عمان )714.7/ 1،000،0( ،محافظة

الزرقاء )631.1/ 1،000،000( و محافظة عجلون )625.8 / 1،000،000(

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، الحكومي على عمليات غسيل اإلنفاق الغسيل، مما يساعد على تحديد حجم إلى متوسط عدد مرات باإلضافة الكلى وكلفة العالج باألدوية، وأهمية إيجاد البدائل وكلفتها. كما توفر قاعدة البيانات معلومات مرجعية ، تبين أهلية هؤالء المرضى لغايات زراعة الكلى بحيث تتسم هذه القاعدة المعلوماتية بسهولة الوصول والمصداقية للحاالت الوصول عملية يسهل مما الكلى لزراعة يحتاجون اللذين المرضى أولويات وترتيب والموثوقية، على شركاء جمعها سيتم التي المعلومات بتعميم السجل سيقوم كما دماغيا. المتوفين من بالكلى المتبرعة

وطنيين لالستفادة منها وخاصة للدفاع المدني.بلغ العدد اإلجمالي لمرضى الفشل الكلوي األردنيين 4097 مريض حتى نهاية عام 2013، منهم 2344 من الذكور بنسبة)57%( و1735 من اإلناث بنسبة )43% ( , ويعد مرض السكري والضغط من األسباب الرئيسية

للفشل الكلوي حيث يشكل مرض السكري نسبة )29.3%( والضغط نسبة )%25.1( .

وقد سجل 650 حاالت جديدة لالردنين في عام 2013 , منها 506 حالة أحياء.

أما عدد الحاالت األردنيين الذين يتلقون العالج في جميع وحدات الديلزة في األردن 3593 وذلك حتى نهاية عام 2013 باإلضافة إلى 175 غير أردني من مختلف الجنسيات.

عدد مرضى الفشل الكلوي حسب القطاعات الصحية 1597 ) 39% ( مريض لدى مستشفيات القطاع الخاص

1525 ) 37.2 % ( مريض لدى مستشفيات القطاع الحكومي 839 )20.5 % ( مريض لدى مستشفيات الخدمات الطبية الملكية

136 ) 3.3 % ( مريض لدى المستشفيات الجامعي

توزيع مرضى الفشل الكلوي حسب التامين الصحي فهو كالتالي: 986 ) 24.1 % ( مريض لديهم تامين صحي مدني

1757 ) 42.9% ( مريض لديهم إعفاء من صندوق مرضى الكلى 982 ) 24 % ( مريض لديهم تامين عسكري

41 ) 1% ( مريض لديهم تامين جامعات 46 ) 1.1%( مريض لديهم تأمين خاص )شركات(

178 )4.3 %( بدون تأمين وتأمينات أخرى وغير معروف

المملكة األردنية الهاشـمية

وزارة الصحة

مديرية األمراض غير السارية

السجل الوطني لمرضى الفشل الكلوي

وبائية الفشل الكلوي فى األردن لعام

2013

إعداد

الدكتور ايوب السيايدة الدكتور سالم القيسي