7th annual report 2014 - الصفحة الرئيسية...prince faisal hospital zarqa 053740251...

7th Annual Report 20147th Annual Report 20147th Annual Report 2014

www.moh.gov.jowww.moh.gov.jowww.moh.gov.jo

Tel: 5678197 Fax: 5656489Tel: 5678197 Fax: 5656489Tel: 5678197 Fax: 5656489

Jordan Jordan Jordan

The Hashemite Kingdom of Jordan

Ministry of Health

Non-Communicable Disease Directorate

National Registry of End Stage Renal Disease

(ESRD)

Annual Report 2014

Prepared by:

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

D. Majed Asad

His Majesty King Abdullah II

List of the team who par�cipated in achieving this ESRD annual report:

Dr Mohammad Salameh El-Lozi

Senior Consultant in Internal Medicine,

Nephrology and Transplanta�on. 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.

5

Foreword

It is my great pleasure to present to you the seventh report of the Jordan National End Stage Renal Disease Registry (ESRDR) for the year 2014.We hope that this report will assist health care providers, public health ofcials, 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 claries 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 policymakers 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 benet.

Minister of Health

Dr. Ali Hyasat

6

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. Haitham 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 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 publishing this report.

General Director PHC Director of NCD Directorate

Dr. Basheer Alqaseer Dr. Ayyoub As-Sayaideh

Head of National ESRD Registry

Dr. Salem Al-Qaisi

7

8

Name of Hospitals

Ministry of Health

Hospital Name Site Phone number

Royal Medical Services


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 Taela 2242982

Queen Rania Hospital Amman 5804804

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 Sa Hospital Karak 032302436

Prince Hamza Hospital Amman 5053826

Queen Rania Al-Abdullah Maan 032150636

Ramtha Hospital Irbid 027384384

Iman Hospital / Ajloun Ajloun 026421914

Princess Salma Hospital Madaba 053207104

Jerash Hospital Jerash 026351114

Maaz bin Jabal Irbid 026587011

Princess Basma Teaching Irbid 027275555

Nadeem Hospital Madaba 053244008

AL-Shoneh AL-Janobyeh Balqa 053581364

Prince Hussein Balqa 5351731

Aqleh Hospital Amman 4642441

AL-Ahli Hospital Amman 5664164

AL-Dleel Hospital Zarqa 053825144

Rom-ALkatholik Hospital Irbid 027257900

AL Haya Hospital Amman 4391111

Prince Faisal Hospital Zarqa 053740251

Al-Qawasmi Hospital Irbid 027243401

9



Amman

University Hospitals

Jordan University Hospital 5353666King Abdullah University Hospital Irbid 027200600

Private Sector Hospitals

Islamic Hospital Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

Amman

5101010

Jordan Hospital 5608080

AL-Qouds Hospital 4387181

Shmeisani Hospital 5607431

Specialty Hospital 5609609

Aljazeera Hospital 5657581

Ibn al-Haytham Hospital 5205555

Arab Medical Center 5921199

Dr. Ahmed Hamayda 4785555

AL Esteqlal Hospital 5652600

Lozmelah Hospital 4624345

AL Isra Hospital 5300300

Marka Islamic 4893855

Palestine Hospital 5607071

Philadelphia Hospital 5854801

Tla Al Ali Hospital 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

Almagased 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

Bin Al-Nafees Hospital Irbid 027102100

Al-Najah Hospital Irbid 027100170

Al-Rahbat Al-Wardyeh Irbid 027102011

Islamic Irbid Hospital Irbid 027273111

10

Table of Contents

page

List of Abbreviations

List of tables

List of Figures

Part One:

Introduction

Geography

Population

Jordan Renal Registry

Methodology

Part Two:

Dialysis Units in Jordan

Part Three:

ESRD Patients in Jordan

Trend of ESRD patients in Jordan during (2008-2014)

Part Four:

Incidence of ESRD Patients

Part Five:

Pediatric ESRD

Part Six:

ESRD patients among Non-Jordanians,

Part seven:

ESRD Mortality

References

12

11

13

14

16

17

17

25

29

31

31

33

33

34

54

54

64

64

70

70

73

73

77

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 Ratio

BMI Body Mass Index

CI Condence Interval

PS Private Sector

CKD Chronic Kidney Disease

GFR Glomerular Filtration Rate

RRT

JCR

Renal Replacement Therapy

Jordan Cancer Registry

RMS

IMR


Infant Mortality Rate

PPM

AKI

Prevalence per Million Populations

Acute Kidney Injury

ASIR

SLE

Age Specic Incidence Rate

Systemic Lupus Erythematosus

12

List of tables

Table N. PageDescription

Table (1)

Table (2)

Table (3)

Table (4)

Table (5)

Table (6)

Table (7)

Table (8)

Table (9)

Table (10)

Table (11)

Table (12)

Table (13)

Table (14)

Table (15)

Table (16)

Table (17)

Table (18)

Table (19)

Estimated Population of Jordan 2014

Population distribution by Governorate and gender, Jordan 2014

Selected Demographic, Socio-economic and Health Indicators 2014

Distribution of ESRD according to age groups & gender and Prevalence Rate

per million (PPM), 2014

Distribution of ESRD patients according to marital status and gender 2014

Distribution of ESRD patients by employment status and gender,2014

Distribution of ESRD patients by type of insurance and gender 2014

Distribution of ESRD patients by Governorate and prevalence per million

populations (PPM)

Distribution of primary causes of ESRD for the year 2014

Prevalence of co-morbidity and some risk factors with ESRD

Distribution of ESRD patients by tness for transplantation

Causes of untness for transplantation

Priority level for patient candidate for transplant

Prevalence of Hepatitis B and C in ESRD patients

Distribution and ASIR of ESRD cases by gender and age group Incidence 2014

Primary causes of ESRD for the year 2014 - Incidence

Causes of ESRD in Pediatric patients 2014

Distribution of mortality in ESRD patients by age group and gender

Distribution of ESRD patients among Non-Jordanians according to age

groups and gender, 2014

PageDescriptionFigure N.

Figure (1)

Figure (2)

Figure (3)

Figure (4)

Figure (5)

Figure (6)

Figure (7)

Figure (8)

Figure (9)

Figure (10)

Figure (11)

Figure (12)

Figure (13)

Figure (14)

Figure (15)

Figure (16)

Figure (17)

Figure (18)

Figure (19)

Figure (20)

Figure (21)

Figure (22)

Figure (23)

Figure (24)

Figure (25)

Figure (26)

Figure (27)

Figure (28)

Figure (29)

Figure (30)

Figure (31)

Figure (32)

Figure (33)

Figure (34)

Figure (35)

List of Figures

13

Map of the Hashemite Kingdom of Jordan

Population Pyramid – Jordan 2014

Distribution of dialysis units by health sector, Jordan 2014

Distribution of Dialysis Machines by Health Sector, 2014

Number of prevalent ESRD patients in Jordan during (2008-2014)

International comparison of prevalence rate of Hemodialysis (PPM) 2014

Distribution of ESRD patients by gender

ESRD cases according to age groups and gender-2014

Distribution of ESRD cases by age group -2014

Distribution of prevalent ESRD patients by Health sector,2014

Distribution of ESRD patients according to Blood group

Distribution of ESRD patients by type of Dialysis

Distribution of Hemodialysis patients by number of sessions /week

Causes of untness for transplantation

Distribution of tness of ESRD patients by Priority level for Transplantation

Distribution of ESRD patients by availability of a donor

Incidence of ESRD Jordanian by gender & age group-2014

Distribution of ESRD patients by health sector, 2014

Distribution of ESRD patients by gender, 2014

Distribution of ESRD patients by Nationality 2014

Distribution of ESRD patients by type of Dialysis, 2014

Distribution of ESRD patients by tness for transplantation

Distribution of tness of ESRD patients by Priority level for transplantation 2014

Distribution of mortality in ESRD patients 2014

Distribution of ESRD pediatric patients by gender

Distribution of Pediatric patients according to type of Dialysis

Distribution of pediatric patients according to age groups and gender 2014

Distribution of Pediatric ESRD by tness for transplantation

Distribution of mortality in Pediatric patients

Distribution of mortality in ESRD patients

Distribution of mortality in ESRD patients according to gender

Distribution of mortality in ESRD patients by age group and gender

Distribution of ESRD patients by Nationality

Distribution of ESRD patients among Non-Jordanians by gender

Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2014

48

14

Part one

Introduction

Geography

Population

Health Status


Methodology

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, gures and statistics for decision makers for the process of planning and

implementing preventive programs for ESRD.

thWith great pleasure we present our 7 annual ESRD report, including

prevalence and the incidence of ESRD in Jordan for the year 2014, reviewing

the ongoing changes in the ESRD Registry, using the data to give direction to

renal-control planning and programs in the elds 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.

16

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 289318 Km . 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 estimated population of Jordan in end-2014 was 6675000 millions.

Including 3441000 males and 3234000 females .

(Department of Statistics Jordan, 2014). About 12.8% of the population under

the age of 5 years, 37.4% under the age of 15 years and 59.3% of the population

at the age 15-64 years, only 3.2 % of the total population above the age of

65(Sex Ratio in 2014: 106.4 males for 100 females).Table (1) and gure (2)

show the age distribution of Jordan population, 2014 (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 2 (249.7) person per Km . North region includes (Irbid, Mafraq, Jarash, Ajloun)

which constitute 27.8% of the population with a population density of (55) 2 person per Km . South region includes (Karak, Tala, Ma'an, Aqaba) which

2constitutes 9.4% of the population with a population density of 11.7 per Km .

17

1

3

5

6

7

8

9

10

11

12

2 4

Figure (1) Map of the Hashemite Kingdom of Jordan

Governorate1- Irbid2- Ajloun3- Jarash4- Mafraq5- Zarqa6- Amman7- Salt8- Madaba9- Karak10- Tala11- Ma’an12- Aqaba

Population density (person/km2)

< 50

50 -100

100 - 200

200 - 400

400 - 600

18

420 420315 315210 210105 1050

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14

5-90-4

Female Male

Figure (2) Population Pyramid – Jordan 2014

Table (1) Estimated Population of Jordan 2014

Male Female Total

Total

Age group

Gender

N % N % N %

5 - 90 - 4

431500

410860

377130

366470

314510

271840

220220

162420

114240

84650

72950

68130

109070

3441000

437010 12.7

12.5

11.9

11

10.7

9.1

7.9

6.4

4.7

3.3

2.5

2.1

2

3.2

100

+6560 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 -1910 -14

414260

409750

388080

355420

340550

282970

153290

108990

83120

75680

61120

106400

3234000

13.1

13

12

11

10

8.7

7.7

6.3

4.7

3.4

2.6

2.3

1.9

3.3

100 100

851270

841250

798940

732550

707020

597480

522790

423640

315710

223230

167770

148630

129250

215470

6675000

3.21.92.22.53.34.76.37.89

10.61112

12.612.8

250950

203420

19

Male Female Total

Total

Gender

N % N % N %

Irbid

Ajloun Jarash

Zarqa Amman

Balqa Madaba

Karak

Tala Ma’an

Aqaba

Governorate

Mafraq

North region

central region

South region

Table (2) Population distribution by Governorate and Gender, Jordan,

2014

20

132900051460086000232200

2161180060850016260010300078200952300131800

81006650047600

3269003441000

38.6152.56.7

62.817.74.73

2.327.73.82.41.91.49.5100

1255600 2584600479900 99450080900 166900215000 447200

2031400 4193200579600 1188100151100 31370097300 20030075300 153500903300 1855600128600 46040064500 14550060400 12690045800 93400

299300 6262003234000 6675000

38.8 38.714.8 14.92.5 2.56.6 6.7

62.8 62.817.9 17.84.7 4.73 3

2.3 2.327.9 27.8

4 3.92 2.2

1.9 1.91.4 1.49.3 9.4100 100

Table (3) Selected Demographic, Socio-economic and Health Indicators 2014

Indicators 2014

Population 2014 6.675.000

Population Density (Person per km2) 75.2

Population Growth Rate 2.2 %

Rate of Natural Increase 2.1%

Population Doubling Time (Year) 31.5

Population Less Than 15 Year of Age 37.4%

Percentage of Population Age 15-64 Years 59.3%

Percentage of Population Age 65+ 3.2

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) 1157

Crude Marriage Rate (Per 1000 Population) 12.2

Crude Divorce Rate (Per 1000 Population) 3.1

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) 28.6

Crude Death Rate (Per 1000 Population) 6.1

Infant Mortality Rate (Per 1000 Live Births) 17.0

Under Five Mortality Rate (Per 1000 Live B 28.0

Life Expectancy at Birth (Year) 74.4

Male 72.7

Female 75.8

12.2 Unemployment Rate (%)

10.4 Male

Female 19.9

21

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 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 %. 2- The prevalence of overweight was 30.5%, (BMI 25-29.9 Kg/m ) and the

2prevalence of obesity was 35.9 %,( BMI 30 Kg/m and more).

- Smoking is a major problem, with more than 49.6% of adult men and 5.7% of

women smoking regularly.

22

The last 17 annual report for the year 2012, JCR registered 7422 cancer cases, th

of these 4983 (67.1%) were among Jordanians and 2439 (32.9%) were among

non-Jordanians.

The crude incidence rate of all cancers among Jordanians was 78 per 100,000

populations (70.8 for males and 85.7 for females).

The male to female ratio was 0.9: 1.

Mortality data

It provides information on annual death rates of a population. It also provides

information on specic 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 2014. 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 certication by cause is not completely accurate.

According to Jordan Mortality Data in 2012, cardiovascular diseases

accounted for about 36.65 % of deaths for both sexes. Cancer was the second

leading cause of death accounting for 16.2 % of total deaths, while external

causes of mortality were the third leading cause responsible for 9.37 % of total

deaths.

While diseases of Genitourinary system constitute about 3.1% total deaths,

544 patients (90%)of these deaths were due to renal failure (acute and chronic

renal failure) according to mortality report in 2012 .

23

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 scientic 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 rst 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 2i.e. Glomerular Filtration Rate (GFR) < 30 ml /min / 1.73 m , ideally they are

2under a Nephrologists' care. Stage 5 CKD i.e. GFR is < 15ml/min /1.73 m , is

called dialysis stage. Renal Replacement Therapy “RRT” means of dialysis

and transplantation.

Worldwide, the machine of dialysis had served millions of ESRD patients.

24


Historical development of Nephrology and dialysis

1840-Pierre Priory dened uremia

1861-Thomas Graham coined the term dialysis for the rst time

1913- John Abel invented rst dialysis apparatus, rst animal dialysis was

done.

1928 –George Has –rst human dialysis was done.

1943-Dr.Willem Kolff introduced Kolff rotating drum dialyzers.

1948-Waters and Beall –rst successful human dialysis.

1950- Introduction of dialysis into clinical practice.

The subsequent successful development of a technique to create an adequate

arterio-venous stula 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

ltration.

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 health care, 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.

25

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 Jordan.

Proudly speaking, Jordan is one of the rst 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 eld of nephrology like:

1968- the rst dialysis was done at the Military Hospital “the Main Hospital” in

Marka area – Amman.

- The rst dialysis machine used in Jordan was”TRAVENOL” machine type.

- The rst kidney transplantation done in Jordan was on 18/05/1972 at the same

main Military Hospital. It was the rst 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 rst renal dialysis Unit was established in private sector, it was at Al-

Khaldi Hospital.

1984- The rst kidney transplantation was done in private sector at Islamic

Hospital, then at Al- Khaldi Hospital.

2009- The rst 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.

26

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

ltration, and sodium prole 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 dene 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.

27

National Registry of End Stage Renal Disease: rdThe National Registry of End Stage Renal Disease was created in May 3 , 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:

basis of priority.

Moreover, train dialysis technicians and national registry employees.

Action plan of National Registry of End Stage Renal Disease:

* Prepare special form for the notication of ESRD from all hospitals and

updated annually (annex1).

* Training workshops for all focal point working in dialysis units about how to

ll 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 lling 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.

28

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

Stimulate beginning studies and researches about ESRD.

Improve facilities of diagnosis and treatment for ESRD patients.

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 seventh national ESRD Registry report. Data were received from all

(75) 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 2014

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 rst

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.

29

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 lled 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 lls 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 ltered 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 national population by Department of Statistics (DOS) 2014.

30

Part Two

Dialysis Units in Jordan

By the end of 2014, there were 75 working Dialysis Units distributed all over

the country. 31 units (41.3%) administered by Ministry of Health (MOH), 7

units (9.3 %) administered by Royal Medical Services (RMS), 2 units (2.7%)

administered by university hospitals: one administered by Jordan University

Hospital, one by King Abdullah University Hospital (KAUH) and 35 units

(46.7%) administered by Private Sector (PS), (Figure 3).

Figure (3) Distribution of dialysis units by health sector, Jordan 2014

Governmental hospitals

(41%)

Miliatray hospitals

(9%)Private hospitals

(47 %)


(3% (

31

Distribution of Dialysis Machines by Health Sector, Jordan 2014.

The total number of dialysis machines (913) in all units was distributed as

followed: 368 (40.3%) machines in MOH units, 79(8.7%) machines in RMS,

34(3.7%) machines in universities hospitals and 432 (47.3%) machines in

private sector hospitals, (Figure 4).

Figure (4) Distribution of Dialysis Machines by Health Sector, 2014

Private Sector

(47 %)

Ministry Of Health(40 %)


9( %)


(4 %)

The focal points in all 75 Dialysis Units lled 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.

32

Part three

ESRD patients in Jordan

Prevalence of ESRD patients in Jordan (2014)

The total numbers of patients treated and registered in the Jordan Renal

Registry by the end of 2014 was (4507) patients; of them 4282 were Jordanians

(95 % ) and 225 were non Jordanians (5% ).

This part of the report only include Jordanian patient –prevalence 2014

The number of Jordanian patients that registered in ESRD and treated in

hospitals for the year 2014 was 4282 patients, while the number of new cases of

ESRD for the year 2014 was 723 patients , out of them 655 patients (91%) were

Jordanians,68 (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

gure below.

For this year we improve surveillance system for ESRD patients from 2008-

2014 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.

33

Figure (5) Number of prevalent ESRD and deaths patients in Jordan

during (2008-2014)

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 2014. The overall Prevalence Per Million Populations in Jordan

in 2014 is (641.5/1,000,000) compared with other countries.

Year

125295 365 488 527 520 372

2666

3059

3464

4177

4767

40974282

0

1000

2000

3000

4000

5000

6000

2008 2009 2010 2011 2012 2013 2014

No of deaths No of cases

No

of

case

s /

de

ath

s

34

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

(PPM) 2014

Prevalence of ESRD Patients in Jordan, 2014

The total number of ESRD patients during the year 2014 was 4282 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 2014 according to

gender. The number of patients treated in the Dialysis Units was 4282 patients ,

out of them 2554 were male patients which accounted (59.6%) and 1728 were

female patients accounted ( 40.4% ),with male to female ratio 1.47:1.

35

499620 641

788 815 855 870 875 875970

8861000

1090 11001200

1850

2250

0

500

1000

1500

2000

2500

Counntry

Pre

vale

nce(p

mp

)

Figure (7) Distribution of ESRD patients by Gender

Male(60 %)

Female(40%)

Distribution of ESRD patients according to age groups and gender, 2014

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

and gender, the mean age of patients was (53) years, (52.5 years for males and

53.5 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 (641.5/1,000,000).

36

Table (4) Distribution of ESRD according to age groups and gender and

Prevalence Rate per million (PPM), 2014

Male Female Total

Total

N N N %

*PPM: Prevalence Per Million Populations

Age group

Gender

PPM

5 - 90 - 4

65+60 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 -1910 -14

PPM PPM

9 7 1624 12 3629 38 6758 31 8974 69 143116 78 194127 99 226164 87 251190 114 304216 136 325259 160 419279 157 436278 179 457731 561 1292

2554 1728 4282

20.6 16.9 18.8 0.455.6 29.3 42.8 0.870.6 79.9 83.9 1.6

153.8 87.2 121.5 2.1201.9 202.6 202.3 3.3368.8 275.6 324.7 4.5467.2 394.5 432.3 5.3744.7 427.7 592.5 5.91169.8 743.7 962.9 7.11890.8 1247.8 1576.8 8.2

1924.9 2497.5 9.83059.72074.5 2933.5 10.23824.52928.7 3535.8 10.74080.45272.6 5996.2 30.26702.1

742.2 534.3 641.5 100.0

37

Figure (8) ESRD cases according to age groups and gender-2014

Figure (9) Distribution of ESRD cases by age group -2014

38

120

887

1547

88

583

1057

208

1470

2604

0

500

1000

1500

2000

2500

3000

0 -19 years 20 - 49 years 50 +

Age-Group

Male Female Total

No

of

ca

ce

s

9 24 2958

74116 127

164190

216259

279 278

731

7 1238 31

6978 99 87

114 136160 157

179

561

0

100

200

300

400

500

600

700

800

Age - Group

male female

No

of

ca

ce

s

5 - 9

0 - 4

65+

60 -

64

55 -

59

50 -

54

45 -

49

40 -

44

35 -

39

30 -

34

25 -

29

20 -

24

15 -1

9

10 -1

4

Distribution of ESRD patients according to marital status and gender

Table (5) shows that the majority of ESRD patients were married (71.5%),

(males 79.2% and females 60.2%), while (17.3%) of the ESRD patients were

singles (males 16.2% and females 1.8%), (1.8%) of the patients were divorced.

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

gender 2014

39

Male Female Total

Total

N % N % N %Marital status

Gender

Married

Single

Widow

Divorced

2023

415

60

56

2554

79.2

16.2

2.3

2.2

100

1040 60.2 71.53063

325 18.8 17.3740

71 4.1 2.4102

292 16.9 1.5348

1728 100 1004282

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 (69.2 %) of the

females, (5.1%) of the patients were employed either governmental or non-

governmentally and military services, (15.0%) were retired, and (3.9%) were

students, (28.0%) of the patients were unemployed, missing data about

employment was (9.1%).

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

gender, 2014

40

Male Female Total

Total

N % N % N %

Gender

0

963

603

394

178 7

0.3 1.3

40 218

48 1.9

6.6 9.1

6 54

277 10.8 114 391

2554 100 1001728 4282

91 3.6

2.3 5.1

76 167

0.0

37.7

23.6

15.4

1196 69.2 27.91196

236 13.7 28.01199

39 2.3 15.0642

21

4.4 3.9

1.2 9.7415

100

Job

House Wife

Unemployed

Retired

Private

Student

Employed

Military

Missing

Distribution of prevalent ESRD patients by health sector

Out of the all 4282 prevalent ESRD patients 1668 patients (39.0% ) were

treated in MOH Dialysis Units , 915 patients (21.4%) treated in RMS Dialysis

Units, 139 patients (3.2%) treated in university hospital Dialysis Unit, and

1560 patients (36.4%) treated in Private Sector Dialysis Units.(Figure 10)

Figure (10) Distribution of prevalent ESRD patients by Health Sector, 2014

Governmental

hospitals

(39 %)

Miliatray hospitals

(21 %)

Private hospital( 37 %)

University hospitals

(3 %)

41

Distribution of ESRD cases according to the type of insurance

Table (7) shows the distribution of ESRD patients according to insurance type.

(99%) of patients were insured by one of the various types of health insurance.

(45.3%) of the patients were insured by Kidney Patients Fund in health

insurance directorate in Ministry of health. Only (0.8%) were not covered by

any type of insurance.

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

42

Male Female Total

Total

N % N % N %

Gender

1183

583

679

45

25 1

100 100

19 34

2554 100 1728 4282

39 2

1 0.8

18 57

46

23

27

2

755 44 45.31938

498 29 25.21081

426 25 25.81105

22

1 1.3

1 1.667

Insurance type

Kidney patients fund

Civillian

Military

Private

University

No insurance

Distribution of ESRD patients by Governorate

The overall prevalence per Million Population in Jordan is (641/1,000,000),

the highest prevalence was found in Madaba governorate (743/1,000,000)

followed by Amman governorate (713/1,000,000) Tafeilah governorate

(706/1,000,000) Zarka governorate (634/1,000,000) and Ajloun governorate

( 625 / 1,000,000 ) Table (8).

Table (8) Distribution of ESRD patients by Governorate and prevalence

per million populations (PPM)

Male Female Total

Rate

Total

N % N % N %

Irbid

Ajloun Jarash

Zarqa Amman

Balqa Madaba

Karak

Tala Ma’an

Aqaba

Governorate

Mafraq

North region

central region

South region

112337567

1521717436816851

63694323243201

2554

44.014.72.66.0

67.217.13.22.72.024.93.71.31.31.77.9100

721 1844 713.5256 631 634.557 124 743.0119 271 606.01153 2870 684.4295 731 615.358 139 443.1

614.155 123625.445 96586.9453 1089602.963 157371.122 54362.514 46706.623 66515.8122 323

1728 4282 641.5

41.7 43.114.8 14.73.3 2.96.9 6.3

66.7 67.017.1 17.13.4 3.23.2 2.92.6 2.226.2 25.43.6 3.71.3 1.30.8 1.11.3 1.57.1 7.5100 100

* PPM: Prevalence per Million Populations

Number of total cases in Jordan as received from renal dialysis units are 4282.

Gender

43

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 (30.8%), followed by

Hypertension (27.9%), Diabetes Mellitus and Hypertension (20.9%),

Glomerulonephritis (10.9%) and then Polycystic kidney disease (2.0%)

congenital causes(2.0 %), Infection (1.6%).

Table (9) Distribution of primary causes of ESRD for the year 2014

44

Male Female Total

Total

N % N % N %

803 517 132031.4 29.9 30.8

702 494 119627.5 28.6 27.9

43 27 701.7 1.6 1.6

548 348 89621.5 20.1 20.9

29 12 411.1 0.7 1.0

263 202 46510.3 11.7 10.9

7 22 290.3 1.3 0.7

49 38 871.9 2.2 2.0

40 23 631.6 1.3 1.5

2554 1728 4282100 100 100

48 39 871.9 2.3 2.0

12 6 280.5 0.3 0.7

Primary Causes

Of ESRD

Diabetes mellitis

Hypertension

DM and Hypertension

Glomerulonephritis

Polycystic kidney

Congenital

Infection

Vesico uretric reux

SLE

Drug

Others

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 (55.0%) of patients were hypertensive, while cardiovascular

diseases were found in (13.8%) of ESRD patients. The prevalence of diabetes

constitutes (34.9 %). The prevalence of smoking in ESRD was (8.3%) and (4.3%)

of the patients had family history of renal diseases, Table (10).

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

45

%

1181 27.6

591 13.8

355 8.3

288

49

6.7

1.1

186

222

4.3

5.2

Co morbidity Frequency

Both diabetes & hypertension

Cardiac disease

Smoking

Urinary tract disease

Familial kidney disease

Cancer

Others

Distribution of ESRD patients according to Blood Group

Figure (11) shows that approximately one third of the patients 1358 (32.0%),

were blood group A and 1521 (35.0%) were blood group O, 325 (8.0%), were

blood group AB and 654(15.0%) were blood group B .Data was not available

for 424 ESRD patients which constitutes (10.0%), of the ESRD patients.

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

A(32%)

AB(8 %)

B(15%)

O(35%)

Missed(10%)

46

Distribution of ESRD patients according to type of Dialysis

Figure (12) shows that only 85 patients (2%) were treated by peritoneal dialysis

while 4197 patients (98%) were treated by hemodialysis.

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

Hemodialysis(98 %)

Peritoneal dialysis

(2 %)

47

48

Distribution of Hemodialysis patients by number of sessions /week

Figure (13) shows that 3025 patients (72.1%) underwent Hemodialysis

thrice a week1058 (25.2%) twice a week, 53 (1.3%) once a week, and 61

(1.5%) four times a week, the average duration of the every session is almost

four hours.

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

/week

twice

( 25 %)

thrice

( 72%)

four �mes

( 2 %)

once

(1 %)

49

Distribution of ESRD cases according to tness for transplantation

Table (11) shows that 1646 (38.4%) from both genders were considered

candidates for transplantation, and 1997 not candidates for transplantation

(46.6%), no available data on (639) (14.9%) of ESRD patients.

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

Distribution of ESRD cases according to untness for transplantation

Table (12) and Figure (14) show that the main causes of untness for

transplantation were as followed: age 892 patients (44.7%), medical causes

768 patients (38.5%) of all cases, malignancies in 41 patients (2.1%), while

unknown causes for the cases were 134 patients (6.7%) of all patients.

Male Female Total

N % N % N %

1018

1193

343

2554

39.9

46.7

13.4

100

628 36.3 38.41646

804 46.5 46.61997

396 17.1 14.9639

1728 100 1004282

Candidate

for transplant

Yes

No

Unknown

Total

50

Table (12) Causes of untness for transplantation

892 44.7

768 38.5

41 2.1

162

1997

8.1

100

134 6.7

Frequency

Causes of untness for tranplantation

Age

Medical causes

Malegnancy

Other causes

Missed

Total

Causes Percent

Figure (14) Causes of untness for transplantation

Medical causes(38 %)

Age(45 %)

malignancy(2 %)

other causes( 8 %)

missed(7 %)

Distribution of tness 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 635 patients (39.7%) were

considered of high priority level for transplantation and 552 patients (33.5%)

considered of medium and 265 patients (16.1%) of low priority and 176

(10.7%) had no data about their priority level.

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

Transplantation

High(40%)

Medium(33%)

Low(16%)

Unknown(11%)

51

52

Male Female Total

N % N % N %

412

341

152

113

1018

40.5

33.5

14.9

11.1

100

241 38.4 39.7653

211 33.6 33.5552

113

63

18.0

10.0

16.1

10.7

265

176

628 100 1001646Total

LevelPriorety

High

Medium

Low

Unknown

Table (13) Priority level for patient candidate for transplant

Distribution of ESRD cases according to availability of a donor

Figure (16) shows that 1285 patients (78.1%) had no available donor, and 302

patients (18.3%) had available donor, 59 patients (3.6%) had no data about

available donor, this reects the burden of ESRD in Jordan.

Figure (16) Distribution of ESRD patients by availability of a donor

Yes(18%)

No(78 %)

Missed(4 %)

Gender

Table (14) shows the prevalence of hepatitis B and C in ESRD patients. (1.2%)

of the cases had Hepatitis B and (9.1 %) had Hepatitis C

Prevalence of Hepatitis B and C in prevalent ESRD patients

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

Male Female Total % Male Female Total %

34

2405

115

2554

18

1645

65

1728

52 1.2

4050 94.6

180 4.2

4282 100

204

2264

86

2554

185

1471

72

1728

389 9.1

3735 87.2

158 3.7

4282 100Total

Type of Hepatitis Hepatitis B HepatitisC

Result

Positive

Negative

Missed

53

Part Four

Incidence of ESRD Patients

The total number of patients who treated in the dialysis units by the end of 2014

were (4282) patients, but the number of new cases for the year 2014 was 723

(655 Jordanians and 68 non Jordanians).

Incidence of ESRD, 2014

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

2014 according to the age group and gender, with a mean age of 54.8 years, and

median age of 58 years. Table (14) also shows the distribution of ESRD

patients by Age-Specic Incidence Rate per million (ASIR). The overall

Incidence per Million Populations in Jordan was (108.3/1,000,000).

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

Incidence 2014

54

*ASIR per Million population

Male Female Total

Total

N N N %Age group

Gender

ASIR ASIR ASIR

5 - 90 - 4

65+60 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 -1910 -14

0 0 05 0 56 4 109 4 13

10 5 1513 13 2618 19 3720 5 2530 14 4445 16 6158 20 7858 25 8347 33 80141 105 246460 263 723

0 0 0 011.6 0.0 5.9 0.114.6 10.3 12.5 0.123.9 11.3 17.7 0.227.3 14.7 21.2 0.241.3 45.9 43.5 0.466.2 75.7 70.8 0.790.8 24.6 59.5 0.6

184.7 91.3 139.4 1.4393.9 146.8 273.3 2.7

240.6 464.9 4.6685.2330.3 558.4 5.6795.1536.9 619.0 6.2689.9986.8 1141.7 11.41292.7

133.7 81.3 108.3 1.1

Figure (17) Incidence of ESRD Jordanian by Gender & age group-2014

55

No

of

Cae

ses

Age - Group

0

20

40

60

80

100

120

140

160

ASI

R/M

ILLI

ON

Age - Group

male female

0

50

100

150

200

250

300

Distribution of incident ESRD patients by health sector

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

2014 were 723 patients; 293 patients (41%) treated in MOH Dialysis Units, 227 patients

(31%) treated in RMS Dialysis Units, 21 patients (3%) treated in university hospital

Dialysis Unit, and 182 patients (25 %) treated in Private Sector Dialysis Units.

Figure (18) Distribution of ESRD patients by health sector, 2014

Private Sector( 25 %)

Ministry Of Health( 41 %)

Royal Medical Services( 31%)


(3 %)

56

Distribution of ESRD incident patients by gender

In the years 2014, out of the total (723) new cases of ESRD, 460 patients

(64%) were males and 263 patients (36%) were females with male to female

ratio1.75:1 Figure (19)

Figure (19) Distribution of ESRD patients by gender, 2014

Male

( 64 %)

Female

(36%)

57

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 Diabetes Mellitus and Hypertension

(32.5%), followed by Diabetes Mellitus (31.7%), Hypertension (25.7%),

Glomerulonephritis (2.1%) and then Vesico uretric reux (1.5%), Polycystic

kidney disease (1.4%), congenital causes(1.2 %), Infection (0.7%), Drug

(0.7%), SLE (0.7%) and others was (1.7%)of the patient.

Table (16) Primary causes of ESRD for the year 2014- Incidence

58

Male Female Total

Total

%

136 99 32.5235

151 78 31.7229

7 2 1.29

123 63 25.7186

2 4 0.75

9 6 2.115

2 3 0.75

6 4 1.410

6 6 1.712

448 275 100723

4 7 1.511

2 3 0.75

Causes

DM and Hypertension

Diabetes mellitis

Hypertension only

Glomerulonephritis

Vesico uretric reux

Polycystic kidney

Congenital

Infection

Drug

SLE

Others


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

in 2014 there were (68) non-Jordanian patients accounted (9%) and 655

Jordanian patients accounted (91%).

Figures (20) Distribution of ESRD patients by Nationality 2014

jordanian(91%)

Nonjordanian(9 %)

59

Distribution of ESRD patients according to type of Dialysis

Figure (21) shows that in 2014, only 16 patients (1%) were treated by peritoneal

dialysis, while 707 patients (99%) were treated by hemodialysis.

Figure (21) Distribution of ESRD patients by type of Dialysis, 2014

Hemodialysis(98%)

Peritoneal

Dialysis( 2%)

60

Distribution of ESRD cases according to tness for transplantation,2014.

Figure (22) shows that there were 329 (45.5%) candidates for transplantation,

and 394 not candidates for transplantation (54.4%).

Figure (22) Distribution of ESRD patients by tness for transplantation

Yes

( 46 %)

No

(54%)

61

Distribution of tness of ESRD patients by Priority level for transplantation

Figure (23) shows the priority level for transplantation: in 2014 it was found that

127 patients (38.6%) were of high priority level for transplant, 121 patients (36.8%) of

medium and 81 patients (24.6%) of low propriety level.

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

transplantation 2014

High(38%)

Medium(37%)

Low(25%)

62

Died(5%)

Alive(95%)

Distribution of mortality among ESRD patients

In the year 2014 a total of 36 ESRD patients (5.0 %) died during this year,

12 of them were females and 24 were males of different age group Figure

(24).

Figure (24) Distribution of mortality in ESRD patients 2014

63

Part Five:

Pediatric ESRD

The total number of pediatric patients from 0-14 years was 119 patients in 2014.

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

dialysis units in all hospitals during the year 2014 according to gender.

There were 119 patients, out of them 62 were males (52%) and 57 were female

patients accounted (48%).

Figure (25) Distribution of ESRD pediatric patients by Gender

Male

( 52 %)

Female(48%)

64

Distribution of Pediatric patients according to type of Dialysis

The total number of pediatric patients from 0-14 years was 119 patients. Out of

them 95 patients were treated by hemodialysis and 24 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

Peritoneal dialysis( 20 %)

Heamodialysis( 80 %)

65

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

(15.1%) followed by Glomerulonephritis (14.3%) Vesicouretic reux (14.3%)

Neurogenic bladder (14.3%), Hypertension (10.1%), Nephrotic

syndrome (5.9%) Oxalosis (5.9%) Diabetes mellitus (4.2%) and Infection

(2.5%) while other causes were not determined in (10.1%) of the pediatric

patients. .

Table (17) Causes of ESRD in Pediatric patients 2014

Male Female Total

Total

%

6 12 15.118

7 10 14.317

6 1 5.97

11 6 14.317

3 2 4.25

7 10 14.317

3 2.53

4 3 5.97

0

8

2

4

1.7

10.1

2

12

64 55 100119

8 4 10.112

1 1 1.72

Causes

Infection

Drug

SLE

Congenital

Glomerulonephritis

Vesicouretic reux

Neurogenic bladder

Hypertension

Nephrotic syndrom

Oxalosis

Diabetes mellitus

Unknown

66

67

Pediatric ESRD patients according to age groups and gender, 2014

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

groups and gender in 2014, which indicates that the highest occurrence of

the cases was among the age group (10-14) years 67 (56.3 %) for both

genders, with a mean age of 9.54 years and median 10.00.

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

and gender 2014

Age group

9

24

29

7

12

38

0

5

10

15

20

25

30

35

40

0 - 4 years 5 -9 year 10 -14 year

Male Female

No

of

Cae

ses

Distribution of Pediatric ESRD according to tness for transplantation

Figure (28) shows that there were 75 (63%) candidates t for transplantation,

and 40 not t for transplantation (33.6%) missed data was 4 (3.4%).

Figure (28) Distribution of Pediatric ESRD by tness for

transplantation

Yes(63%)

No(34%)

Missed(3 %)

68

Mortality data in Pediatric patients

A total of 10 (8%) pediatric patients in dialysis renal units died during the

year 2014 out of 109 (92%) who were at risk. Figure (29)

Figure (29) Distribution of mortality in Pediatric patients

69

Alive(92%)

Dead(8%)

Part Six

ESRD Mortality

Distribution of mortality among ESRD patients

Figures (30-32) and table (18) show the distribution of deaths for ESRD

patients, 372 patients out of 4282 were died during the year 2014. 214 (57.5%)

of them were males, and 158 (42.5%) were females. Most of ESRD deaths

occurred in the age group between (70-74) followed (65-69). Median age at

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

Figure (30) Distribution of mortality in ESRD patients

Alive(91%)

Dead(9%)

70

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

Male(58 %)

Female(42%)

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

gender

12 2

12

4

9 8

1817

23 2325

35

27

17

12

1

43

2

8

5 4

8

17 16 1719

26

15

10

0

5

10

15

20

25

30

35

40

Age- group

Male Female

No

of

Cae

ses

71

Table (18) Distribution of mortality in ESRD patients by age group and

gender

Male Female Total

Total

Age group

5 - 90 - 4 0

60 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 -1910 -14

1 11 2 32 1 32 4 61 3 42 2 44 8 129 5 148 4 12

18 8 2617 341716 3923

35 26 61

17 4023

27 15 42

19 4425

17 10 27214 158 372

65 - 6970 - 7475 - 79

80+

72

Part Seven:

ESRD patients among Non-Jordanians, 2014


Figure (33) shows the distribution of ESRD patients according to Nationality,

The total number of patients among Non-Jordanians was (225) 18 patients out

of 225 were died during the year 2014 accounting for (5%) of all patients

reported to Jordan Renal Registry 2014 , and (4282) patients among Jordanians

accounting for (95%) of all patients.

Figure (33) Distribution of ESRD patients by Nationality

Jordanian( 95%)

Non Jordanian( 5%)

73

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 2014

according to gender, the number of patients treated in the Dialysis Units were

225 patients, there were 140 male patients who accounted (62.2%) and 85

female patients accounted (37.8%).

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

gender

74

Male( 62 %)

Female

( 38 %)

ESRD patients among Non-Jordanians according to age groups

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 (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).

Table (18) Distribution of ESRD patients among Non-Jordanians

according to age groups and gender, 2014

75

Male Female Total %

Total

Age group

10 - 190 - 9

60 - 6950 - 5940 - 4930 - 3920 - 29

0.99 1122 20

4.910 188 8.013 2411 10.726 391326 4216

17.3

29 532418.7

25 361123.616.0

140 22585 10070+

Figure (35) Distribution of ESRD patients among Non-Jordanians

according to age groups and gender, 2014

76

2

9 10

13

26 26

29

25

02

8

1113

16

24

11

0

5

10

15

20

25

30

35

0 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 +

Age - group

Male Female

No

of

Cae

ses

References

1- Annual Report, Jordan, 2014. Department of Statistics (DOS)

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

3- Cancer incidence in Jordan, MOH, 2012.

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

Jordan,

5- Mortality Data in Jordan, 2012.

annual report 2012-Ministry of Health, Jordan.

77

المملكة األردنیة الهاشمیة المملكة األردنیة الهاشمیة المملكة األردنیة الهاشمیة

وزارة الصحةوزارة الصحةوزارة الصحةمدیریة األمراض غیر الساریةمدیریة األمراض غیر الساریةمدیریة األمراض غیر الساریة

السجل الوطني لمرضى الفشل الكلويالسجل الوطني لمرضى الفشل الكلويالسجل الوطني لمرضى الفشل الكلوياستمارة معلومات حول وحدات الدیلزة الكلویة استمارة معلومات حول وحدات الدیلزة الكلویة استمارة معلومات حول وحدات الدیلزة الكلویة

1- التاریخ

2- اسم المستشفى

3- العنوان

5- الفرعي4- رقم الهاتف

6- ضابط االرتباط

9- رقم الهاتف 8-الطبیب المعالج واختصاصه

10- عدد األجهزة موزعة

كالتالي

15- المجموع14- معطل 13- احتیاط12- عزل11- عادي

16- عدد الوردیات العاملة

17- عدد المرضى األردنیین

موزعین كالتالي

18- تأمین صحي مدني

19- بطاقة غیر قادر

20- صندوق مرضى الكلى

23- المجموع22- غیر ذلك 21- عسكریین

24- عدد المرضى غیر األردنیین

25- الجنسیة

26- العدد

27- المجموع

28- المجموع الكلى للمرضى في الوحدة

29- مالحظات

7- رقم الهاتف

8

المملكة األردنیة الهاشمیةالمملكة األردنیة الهاشمیة

مدیریة األمراض غیر الساریة/وزارة الصحةمدیریة األمراض غیر الساریة/وزارة الصحة

السجل الوطني لمرضى الفشل الكلوي/ استمارة المریض السجل الوطني لمرضى الفشل الكلوي/ استمارة المریض

وحدة الدیلزة/ مستشفى ...................................... وحدة الدیلزة/ مستشفى ......................................

المملكة األردنیة الهاشمیة

مدیریة األمراض غیر الساریة/وزارة الصحة

السجل الوطني لمرضى الفشل الكلوي/ استمارة المریض

وحدة الدیلزة/ مستشفى ......................................

العائلة الجد األب 2- اسم المریض:

الرقم المتسلسل: 1- الرقم الوطني:

العمر: 3- تاریخ المیالد: سنة شهر یوم

7

5- المهنة: 2- أنثى 1- ذكر 4-الجنس:

1- اعزب 6- الحالة االجتماعیة:

حكومي

2- متزوج

عسكري

3- مطلق

صندوق الكلى

الحي

جامعي

4- أرمل

أذكر الجنسیة : .......................................... 2- غیر أردني 1- أردني 7- الجنسیة:

8- نوع التأمین الصحي:

8- العنوان الدائم: المدینة

9- رقم الهاتف:

أخرى:................ خاص

المحافظة

الشارع

المنزل الخلوي

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 reux (VUR)

9-SLE 10- Unknown 11- Others Specify ………………………

12. Dialysis Type: Peritoneal 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……………….

6

16. Is the patient candidate for Kidney Transplantation? Yes No

(Conrmed 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 :

DateDateDate HbHbHb HCTHCTHCT WBCWBCWBC PlateletsPlateletsPlatelets

22. Laboratory Test for the patient ?

A-. Virology before starting Dialysis:

DateDateDate

DateDateDate

Hepatitis BHepatitis BHepatitis B

Hepatitis BHepatitis BHepatitis B

Hepatitis CHepatitis CHepatitis C

Hepatitis CHepatitis CHepatitis C

HIVHIVHIV

HIVHIVHIV

Other test Other test Other test

Other test Other test Other test

B-. Virology after starting Dialysis :

Name Of Abstractor:………………………………………....

Signature: ……………………………………………………...

Date of Abstract: / /

5

المملكة األردنیة الهاشمیةالمملكة األردنیة الهاشمیةالمملكة األردنیة الهاشمیة

مدیریة األمراض غیر الساریة/وزارة الصحةمدیریة األمراض غیر الساریة/وزارة الصحةمدیریة األمراض غیر الساریة/وزارة الصحة

السجل الوطني لمرضى الفشل الكلويالسجل الوطني لمرضى الفشل الكلويالسجل الوطني لمرضى الفشل الكلوي

نموذج اإلبالغ عن الوفیات نموذج اإلبالغ عن الوفیات نموذج اإلبالغ عن الوفیات

وحدة الدیلزة/ مستشفى ...................................... وحدة الدیلزة/ مستشفى ...................................... وحدة الدیلزة/ مستشفى ......................................

2 - االسم: األول األب الجد العائلة2 2 - االسم: األول األب الجد العائلة- االسم: األول األب الجد العائلة

................... .................. .................. ...................... ................... .................. .................. ...................... ................... .................. .................. ......................

..- الجنس: ذكر...... أنثى.................................- الجنس: ذكر...... أنثى................................. .................... 3.. .................... ..- الجنس: ذكر...... أنثى.................................3 .................... 3

.........- الجنسیة:...............................................................................- الجنسیة:............................................................................... 4......... .........- الجنسیة:...............................................................................4 4

...................................................................................... 5...................................................................................... ......................................................................................- العمر: ..- العمر: ..5 - العمر: ..5

..............- اسم المستشفى (وحدة الدیلزة الكلویة):............................................- اسم المستشفى (وحدة الدیلزة الكلویة):............................................ 6.............. ..............- اسم المستشفى (وحدة الدیلزة الكلویة):............................................6 6

...........................- تاریخ بدایة الدیلزة :...............................................- تاریخ بدایة الدیلزة :............................................... 7........................... ...........................- تاریخ بدایة الدیلزة :...............................................7 7

.......................- تاریخ الوفاة:..........................................................- تاریخ الوفاة:.......................................................... 8....................... .......................- تاریخ الوفاة:..........................................................8 8

9- مكان الوفاة: وحدة الدیلزة الكلویة .... مستشفى....... المنزل......................99- مكان الوفاة: وحدة الدیلزة الكلویة .... مستشفى....... المنزل......................- مكان الوفاة: وحدة الدیلزة الكلویة .... مستشفى....... المنزل......................

......................... إذا كان غیر ذلك حدد.............. ................................................................... إذا كان غیر ذلك حدد.............. ................. إذا كان غیر ذلك حدد.............. .................

.......- سبب الوفاة: - السبب المباشر للوفاة:..................................................- سبب الوفاة: - السبب المباشر للوفاة:.................................................. 10....... .......- سبب الوفاة: - السبب المباشر للوفاة:..................................................10 10

.......مالحظات:.........................................................................................مالحظات:...........................................................................مالحظات:...........................................................................

....التاریخ ........................ االسم والتوقیع ................................التاریخ ........................ االسم والتوقیع ........................التاریخ ........................ االسم والتوقیع ........................

1- الرقم الوطني:

وحدات غسیل الكلى:

یوجد في األردن ٧٥ وحدة غسیل كلى موزعة كالتالي:

٣٥ (٤٦٫٧ % ) وحدة لدى مستشفیات القطاع الخاص

٣١ (٤١٫٣ % ) وحدة لدى مستشفیات القطاع الحكومي

٧ (٩٫٣ % ) وحدة لدى مستشفیات الخدمات الطبیة الملكیة

٢ ( ٢٫٧ % ) وحدة لدى المستشفیات الجامعیة

أجهزة غسیل الكلى:

یوجد في األردن ٩١٣ جهاز غسیل كلى موزعة كالتالي:

٤٣٢ (٤٧٫٣ %) جهاز لدى مستشفیات القطاع الخاص

٣٦٨ (٤٠٫٣ %) جهاز لدى مستشفیات القطاع الحكومي

٧٩ (٨٫٧ %) جهاز لدى مستشفیات الخدمات الطبیة الملكیة

٣٤ (٣٫٧ %) جهاز لدى المستشفیات الجامعیة

حیث یبلغ نسبة انتشار مرضى الفشل الكلوي لكل ملیون نسمة في األردن (٦٤١٫٥/ ١،٠٠٠،٠٠٠)، وهو

أعلى نسبة في محافظة مادبا (٧٤٣٫٠ / ١،٠٠٠،٠٠٠) یلیها محافظة عمان (٧١٣٫٥/ ١،٠٠٠،٠) ،محافظة

الطفیلة (٧٠٦٫٦/ ١،٠٠٠،٠٠٠) و محافظة الزرقاء (٦٣٤٫٥ / ١،٠٠٠،٠٠٠).

4

السجل الوطني لمرضى الفشل الكلوي

لقد جاء تأسیس السجل الوطني لمرضى الفشل الكلوي في المملكة األردنیة الهاشمیة بقرار من معالي وزیر

الصحة بتاریخ ٢٠٠٧/٢/٣ , وقد صدر أول تقریر سنوي للفشل الكلوي عام ٢٠٠٨.

ویهدف السجل الوطني لمرضى الفشل الكلوي إلى توفیر قاعدة بیانات دیموغرافیة وعلمیة حول حجم مشكلة

الفشل الكلوي في المملكة من حیث أعداد المرضى والتوزیع الجغرافي، والتوزیع حسب الفئات العمریة

والجنس، باإلضافة إلى متوسط عدد مرات الغسیل، مما یساعد على تحدید حجم اإلنفاق الحكومي على عملیات

غسیل الكلى وكلفة العالج باألدویة، وأهمیة إیجاد البدائل وكلفتها. كما توفر قاعدة البیانات معلومات مرجعیة

تبین أهلیة هؤالء المرضى لغایات زراعة الكلى بحیث تتسم هذه القاعدة المعلوماتیة بسهولة الوصول

والمصداقیة والموثوقیة، وترتیب أولویات المرضى الذین یحتاجون لزراعة الكلى مما یسهل عملیة الوصول

للحاالت المتبرعة بالكلى من المتوفین دماغیا. كما سیقوم السجل بتعمیم المعلومات التي سیتم جمعها على

شركاء وطنیین لالستفادة منها وخاصة للدفاع المدني.

بلغ العدد اإلجمالي لمرضى الفشل الكلوي األردنیین ٤٢٨٢ مریض حتى نهایة عام ٢٠١٤، منهم ٢٥٥٤

باإلضافة إلى ٢٢٥ غیر أردني من مختلف من الذكور بنسبة (٦٠٪) و١٧٢٨ من اإلناث بنسبة (٤٠٪ ),

الجنسیات, ویعد مرض السكري والضغط من األسباب الرئیسیة للفشل الكلوي حیث یشكل مرض السكري

نسبة (٣٠٫٨٪) والضغط نسبة (٢٧٫٩٪) .

ویسجل ما بین ٧٠٠ إلى ٧٥٠ حاالت جدیدة لألردنیین سنویا ، حیث یتم جمع الحاالت من جمیع وحدات

الدیلزة الكلویة في األردن عن طریق الرصد النشط والذاتي .

وقد سجل ٧٢٣ حالة جدیدة لألردنیین في عام ٢٠١٤, منها ٦٨٧ حالة أحیاء

عدد مرضى الفشل الكلوي حسب القطاعات الصحیة

١٥٦٠ ( ٣٦٫٤ % ) مریض لدى مستشفیات القطاع الخاص

١٦٦٨ ( ٣٩٫٠ % ) مریض لدى مستشفیات القطاع الحكومي

٩١٥ (٢١٫٤ % ) مریض لدى مستشفیات الخدمات الطبیة الملكیة

١٣٩ ( ٣٫٢ % ) مریض لدى المستشفیات الجامعي

3

توزیع مرضى الفشل الكلوي حسب التامین الصحي فهو كالتالي:

١٠٨١ ( ٢٥٫٢ % ) مریض لدیهم تامین صحي مدني

١٩٣٨ (٤٥٫٣ % ) مریض لدیهم إعفاء من صندوق مرضى الكلى

١١٠٥ ( ٢٥٫٨ % ) مریض لدیهم تامین عسكري

٥٧ (١٫٣ % ) مریض لدیهم تامین جامعات

٦٧ ( ١٫٦ % ) مریض لدیهم تأمین خاص (شركات)

٣٤ ( ٠٫٨ % ) بدون تأمین وتأمینات أخرى وغیر معروف

وبائیة الفشل الكلوي في األردن لعام

٢٠١٤

إعداد:

الدكتور أیوب السیایدة الدكتور سالم القیسي

المملكة األردنیة الهاشـمیةوزارة الصحة

مدیریة األمراض غیر الساریة

السجل الوطني لمرضى الفشل الكلوي

د. ماجد أسعد

7th annual report 2014 - الصفحة الرئيسية...prince faisal hospital zarqa 053740251...

Documents