2

3

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.

4

Foreword

It is my great pleasure to present to you the eighth report of the Jordan National End Stage Renal Disease Registry (ESRDR) for the year 2015.We hope that this report will assist health care providers, public health officials, NGOs in their work to prevent and control renal diseases in Jordan. As a Minister of Health, I will assure that Jordan ESRD Registry will receive all the support that the ministry can offer. The annual report of the Jordan Renal Registry explores the trends and characteristics of (ESRD) in Jordan and clarifies many misconceptions, while providing informative and reliable data to help in policy building at a national level. The data presented in this report constitutes an organized and systematic data of ESRD registry, it provides prevalence, incidence and burden of ESRD in Jordan, and it will provide readers with information on the epidemiology of ESRD in Jordan and its distribution by age groups, gender, and governorates. It also assists researchers, renal diseases experts, and 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 benefit. Minister of Health Prof. Dr. Mahmoud Al-sheyyab

6

Name of Hospitals Royal Medical Services Hospital Name Site Phone number King Hussein Medical center Amman 5804804 Prince Hashem Bin Al Hussein Zarqa’a 3962002 Prince Hashem Bin Abudullah Aqaba 2014111 Prince Ali Bin Al Hussein Karak 2386370 Prince Rashid bin Al Hassan Irbid 7100890 Prince Zeid bin Hussein Tafiela 2242982

Queen Rania Hospital Amman 5804804

Ministry of Health Hospital Name Site Phone number Al-Basher Hospital Amman 4775111 Abu Obaida Hospital Irbid 026570018 Hussein Hospital Balqa 053551140 Karak Hospital Karak 032386190 Ruweished Hospital Mafraq 026292183 Maan Hospital Maan 032132222 Mafraq Hospital Mafraaq 026231234 Princess Iman Balqa 053584934 AL-Zarqa’a Hospital Zarqa 05398332 Jamel Altotnge Amman 4020096 Yarmouk Hospital Irbid 027585980 Princess Raya Irbid 026521666 Ghor Safi Hospital Karak 032302436 Prince Hamza Hospital Amman 5053826 Queen Rania Al-Abdullah Maan 032150636 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

Al-Najah Hospital Irbid 027100170

7

University Hospitals Hospital Name Site phone number

Jordan University Hospital Amman 5353666 King 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 Specialty Hospital Amman 5609609 Aljazeera Hospital Amman 5657581 Ibn al-Haytham Hospital Amman 5205555 Arab Medical Center Amman 5921199 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 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-Rahbat Al-Wardyeh Irbid 027102011 Islamic Irbid Hospital Irbid 027273111

8

Table of Contents

page List of Abbreviations 9 List of Tables

List of Figures

Part One: 12

Introduction

Geography

Population

Jordan Renal Registry

Methodology

Part Two: 28

Dialysis Units in Jordan

Part Three: 30 ESRD Patients in Jordan

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

Part Four: 51

Incidence of ESRD Patients

Part Five: 61

Pediatric ESRD

Part Six: 66

ESRD patients among Non-Jordanians, Part seven: 69

ESRD Mortality References 72

9

List of Abbreviations

ESRD End Stage Renal Disease

MOH Ministry of Health

CDC Centers of Disease Control and Prevention

WHO World Health Organization

BRFSS Behavioral Risk Factors Surveillance System

NCD Noncommunicable Disease

PHH Prince Hamza Hospital

DOS Department of Statistics (Jordan)

OR Odds Ratios

BMI Body Mass Index

CI Confidence Interval

PS Private Sector

CKD Chronic Kidney Disease

GFR Glomerular Filtration Rate

RRT Renal Replacement Therapy

RMS Royal Medical Services

PPM Prevalence per Million Populations

ASIR Age Specific Incidence Rate

JCR Jordan Cancer Registry

IMR Infant Mortality Rate

AKI Acute Kidney Injury

SLE Systemic Lupus Erythematosus

10

List of tablesTable N. Description PageTable (1) Estimated Population of Jordan 2015 16Table (2) Population distribution by Governorate and gender, Jordan 2015 17

Table (3) Selected Demographic, Socio-economic and Health Indicators 2015 18Table (4) Distribution of ESRD according to age groups & gender and

Prevalence Rate per million (PPM), 201534

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

201536

Table (6) Distribution of ESRD patients by employment status and gender,2015 37Table (7) Distribution of ESRD patients by type of insurance and gender 2015 39Table (8) Distribution of ESRD patients by Governorate and prevalence per

million populations (PPM)40

Table (9) Distribution of primary causes of ESRD for the year 2015 41

Table (10) Prevalence of co-morbidity and some risk factors with ESRD 42Table (11) Distribution of ESRD patients by fitness for transplantation 45

Table (12) Causes of unfitness for transplantation 46Table (13) Priority level for patient candidate for transplant 48Table (14) Prevalence of Hepatitis B and C in ESRD patients 50

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

Incidence 201552

Table (16) Primary causes of ESRD for the year 2015 - Incidence 56Table(17) Causes of ESRD in Pediatric patients 2015 63

Table (18) Distribution of mortality in ESRD patients by age group and gender 68

Table (19) Distribution of ESRD patients among Non-Jordanians according to

age groups and gender, 201571

11

List of FiguresFigure N. Description Page

Figure (1) Map of the Hashemite Kingdom of Jordan 15

Figure (2) Population Pyramid – Jordan 2015 16Figure (3) Distribution of dialysis units by health sector, Jordan 2015 28Figure (4) Distribution of Dialysis Machines by Health Sector, 2015 29Figure (5) Number of prevalent ESRD patients in Jordan during (2008-2015) 31Figure (6) International comparison of prevalence rate of Hemodialysis (PPM) 2015 32Figure (7) Distribution of ESRD patients by gender 33Figure (8) ESRD cases according to age groups and gender-2015 35Figure (9) ) Distribution of ESRD cases by age group -2015 35Figure(10) Distribution of prevalent ESRD patients by Health sector,2015 38Figure (11) Distribution of ESRD patients according to Blood group 43

Figure (12) Distribution of ESRD patients by type of Dialysis 44Figure(13) Distribution of Hemodialysis patients by number of sessions /week 45

Figure(14) Causes of unfitness for transplantation 47Figure(15) Distribution of fitness of ESRD patients by Priority level for Transplantation 48

Figure(16) Distribution of ESRD patients by availability of a donor 49

Figure(17) Incidence of ESRD Jordanian by gender & age group-2015 53

Figure(18) Distribution of ESRD patients by health sector, 2015 54

Figure(19) Distribution of ESRD patients by gender, 2015 55

Figure(20) Distribution of ESRD patients by Nationality 2015 57

Figure(21) Distribution of ESRD patients by type of Dialysis, 2015 58

Figure(22) Distribution of ESRD patients by fitness for transplantation 58

Figure(23) Distribution of fitness of ESRD patients by Priority level for transplantation 2015

59

Figure(24) Distribution of mortality in ESRD patients 2015 60

Figures(25) Distribution of ESRD pediatric patients by gender 61

Figure (26) Distribution of Pediatric patients according to type of Dialysis 62

Figure (27) Distribution of pediatric patients according to age groups and gender 2015 64

Figure (28) Distribution of Pediatric ESRD by fitness for transplantation 65

Figure (29) Distribution of mortality in Pediatric patients 65

Figure (30) Distribution of mortality in ESRD patients 66Figure (31) Distribution of mortality in ESRD patients according to gender 67

Figure (32) Distribution of mortality in ESRD patients by age group and gender 67

Figure (33) Distribution of ESRD patients by Nationality 69

Figure (34) Distribution of ESRD patients among Non-Jordanians by gender 70

Figure (35) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2015

70

12

Part one

Introduction

Geography

Population

Health Status

Jordan Renal Registry

Methodology

13

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 8th annual ESRD report, including prevalence and the incidence of ESRD in Jordan for the year 2015, 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.

14

Geography

Jordan is located in the Middle East, between Latitudes 29-33 north and between Longitudes 35-39 east, extending about 500 Kilometers from North to South, it is bounded in the North by Syria, East by Iraq and Saudi Arabia, South also by Saudi Arabia and West by Palestine Authority. The total surface area is 89318 Km2. Out of the total area, 75% is desert along the Eastern part of the country. Mountains height ranged between 1100 – 1854meters above sea level. The Dead Sea area is the lowest area in the world and it is around 416 meter below sea level.The climate of the country as a whole is moderate, there are four seasons. The temperature ranged from 0°C in winter to 38°C in summer. Jordan is divided into three regions (Middle, Northern and Southern) and twelve governorates.

Population

The population of Jordan is 9531712( Jordanians 6613587 millions(3368042 males and 3245545 females), male: female ratio 1: 1.04 according to the true sensus conducted oktobar 2015. (Department of Statistics Jordan,2015). About 11.3% of the population under the age of 5 years, 34.5% under the age of 15 years and 61.3% of the population at the age 15-64years, only 4.2 % of the total population above the age of 65(Sex Ratio in 2015: 1: 1.04)males for females).Table (1) and figure (2) show the age distribution of Jordan population, 2015 (Jordanian Population Pyramid ).Table (2) shows the population distribution of Jordanians by governorates and gender, which is used to calculate incidence rates for different regions. Jordan divided into three regions: each region consists of four governorates. The Central region (Amman, Balqaa, Zarqa, and Madaba) constitutes about 61.0% of the total population with population density of (249.7) person per Km2. North region includes (Irbid, Mafraq, Jarash, Ajloun) which constitute 29.6% of the population with a population density of (55) person per Km2. South region includes (Karak, Tafila, Ma’an, Aqaba) which constitutes 9.5% of the population with a population density of 11.7 per Km2

15

Figure (1) Map of the Hashemite Kingdom of Jordan

16

Table (1) Estimated Population of Jordan 2015

N % N % N %384226 11.4 365838 11.3 750064 11.3415444 12.3 396854 12.2 812298 12.3370433 11.0 349150 10.8 719583 10.9352928 10.5 329725 10.2 682653 10.3337111 10.0 308495 9.5 645606 9.8269783 8.0 253871 7.8 523654 7.9232022 6.9 235171 7.2 467193 7.1213362 6.3 216284 6.7 429646 6.5193765 5.8 196344 6.0 390109 5.9171943 5.1 170162 5.2 342105 5.2130874 3.9 129893 4.0 260767 3.991462 2.7 92254 2.8 183716 2.864700 1.9 63452 2.0 128152 1.9

139989 4.2 138052 4.3 278041 4.23368042 100.0 3245545 100.0 6613587 100.0

65+Total

35-3944-4045-4950-5455-5960-64

30-34

GenderAge group

Male Female Total

0-45--910--1415-1920-2425-29

Figure (2) Population Pyramid – Jordan 2015

17

Table (2) Population distribution by Governorate and Gender, Jordan,2015

N % N % N %1295783 38.5 1259140 38.8 2554923 38.6473195 14.0 450457 13.9 923652 14.079996 2.4 76791 2.4 156787 2.4

201093 6.0 195846 6.0 396939 6.02050067 60.9 1982234 61.1 4032301 61.0672902 20.0 643716 19.8 1316618 19.9160909 4.8 153255 4.7 314164 4.886061 2.6 81690 2.5 167751 2.580047 2.4 77115 2.4 157162 2.4

999919 29.7 955776 29.4 1955695 29.6137318 4.1 135131 4.2 272449 4.169543 2.1 65502 2.0 135045 2.065183 1.9 62806 1.9 127989 1.946012 1.4 44096 1.4 90108 1.4

318056 9.4 307535 9.5 625591 9.53368042 100.0 3245545 100.0 6613587 100.0Total

JarashAjlounNorth Region

South RegionTafielahMaanAqabaKarak

Mafrag

GenderGovernorate

Male Female Total

AmmanZarkaMadabaBalgaCentral RegionIrbid

18

Table (3) Selected Demographic, Socio-economic and Health Indicators 2015

Indicators 2015 Population 2015 6.613.587 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 34.5% Percentage of Population Age 15-64 Years 61% Percentage of Population Age 65+ 4.2 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 1:1.04 Total Households (000) 1,157.2 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 Unemployment Rate (%) 13.0 Male 10.4 Female 19.9

19

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 %.

- 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.

20

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

cases, 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 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 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 certification 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 is (5).

21

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.

22

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.

23

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 first countries in the Middle East that

early started programs of dialysis and kidney transplantation. There are

many renal dialysis units all over the country, belonging to Ministry of

Health, Royal Medical Services, University hospitals and Private Sector. In

addition, there are many kidney transplant centers in all sectors dealing with

the best medical care.

Jordan has approved to be one of the pioneer countries in Nephrology and its

modalities. Jordan achieved many in the field of nephrology like:

1968- the first dialysis was done at the Military Hospital “the Main

Hospital” in Marka area – Amman.

- The first dialysis machine used in Jordan was”TRAVENOL” machine

type.

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

same main Military Hospital. It was the first to be done in the Middle East.

1981- The establishment of renal dialysis unit at Jordan university Hospital.

The machine type was REDY “Sorbs system”. It was portable, moving to

Khaldi and Islamic Hospitals.

1982- The first renal dialysis Unit was established in private sector, it was at

Al-Khaldi Hospital.

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

Hospital, then at Al- Khaldi Hospital.

2009- The first kidney transplantation in Jordanian public hospital was done

at Prince Hamza Hospital in October 2009 according to The Jordanian

National Program Of Renal Transplantation of the JMOH.

24

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.

25

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.

26

Methodology:

The National Registry of End Stage Renal Disease was created in 2007 and

supported by the Ministry of Health. It is a database-system that collects data

and information about almost all patients undergoing Renal Replacement

Therapy (RRT), i.e. either dialysis (hemodialysis and peritoneal dialysis) or

Kidney transplantation.

This is the eighth national ESRD Registry report. Data were received from

all (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 2015

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.

27

Method of Data Collection:

Data was collected from all renal dialysis units in Jordan, through the

following methods: two types of data collection methods were applied:

1- Passive Data Collection: in this system forms filled by dialysis units

technicians and send to national renal registry - MOH/NCDs Directorate.

2- Active Data Collection: In this system the head of Renal Registry Unit

visited the dialysis units and fills the forms on the unit and complete all

the variables from medical record of those patients. This to ensure more

complete and accurate data

All forms were reviewed at the Renal Registry Unit and filtered and

checked for any duplication and also document follow up data if the patient

still alive or dead cause of death dates of last dialysis.

Data entered to special software designed for data of renal patients, Data

analysis was done by using statistical package for the social sciences SPSS

version 17.0.

Incidence and prevalence calculations in this report are based on the the

population by Department of Statistics (DOS) 2015.

29

Distribution of Dialysis Machines by Health Sector, Jordan 2015.

The total number of dialysis machines (916) in all units was distributed as

followed: 371 (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, 2015

Private Sector(47%)

Ministry Of Health(40%)

Royal Medical Services

(9%)

University Hospitals

(4%)

The focal points in all 75 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.

30

Part three

ESRD patients in Jordan

Prevalence of ESRD patients in Jordan (2015)

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

Registry by the end of 2015 was (4935) patients; of them 4690 were

Jordanians (95 % ) and 245 were non Jordanians (5% ).

This part of the report only include Jordanian patient –prevalence 2015

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

hospitals for the year 2015 was 4690 patients, while the number of new

cases of ESRD for the year 2015 was 780 patients , out of them 726 patients

(93%) were Jordanians,54 (7%) were non Jordanians).

The number for the last two years decreased for Jordanian due to kidney

transplant done for the patients about (380) Jordanian patients did kidney

transplant in our hospitals in Jordan for the years from (2011-2014), also

after excluding the number of deaths for each year from 2008-2014 as

shown in the figure below.

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

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.

31

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

during (2008-2015)

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 2015. The overall Prevalence Per Million Populations in Jordan

in 2015 is (709.1/1,000,000) compared with other countries.

33

Figure (7) Distribution of ESRD patients by Gender

Male(60%)

Female(40%)

Distribution of ESRD patients according to age groups and gender,

2015 Table (4) shows the distribution of ESRD patients according to the age

groups and gender, the mean age of patients was (53) years, (52.8 years for

males and 53.4 years for females). The median age of patients was (55)

years, (55 years for males and 55.5 years for females).

Table (4) also shows the distribution of ESRD cases by prevalence rate per

million populations (PPM), the overall prevalence per Million Populations in

Jordan was (709.1/1,000,000).

34

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

Prevalence Rate per million (PPM), 2015

Total%PPMNPPMNPPMN

0.317.31316.4618.270-40.740.63335.31445.7195-91.383.46094.53372.92710-142.1142.197103.134178.56315-193.3240.1155239.974240.38120-244.4393.4206323.082459.612425-295.1515.8241438.0103594.813830-345.7626.1269430.093824.917635-396.8817.7319611.21201027.019940-448.11107.8379805.11371407.424245-49

10.11810.04721331.91732284.629950-5410.42667.24901875.31733465.931755-5911.44182.55363356.92134992.332360-6430.35107.214204527.36255679.079565+

100.0709.14690579.31880834.32810Total

GenderAge-Group

FemaleMale

*PPM: Prevalence Per Million Populations

35

Figure (8) ESRD cases according to Age groups and gender-2015

7 19 27

63 81124 138

176199

242

299 317 323

795

6 14 33 3474 82 103 93

120 137 173 173

213

625

0

100

200

300

400

500

600

700

800

900

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

No

Of C

ases

Age-Group

Male Female

Figure (9) Distribution of ESRD cases by age group -2015

116

960

1734

2810

87

609

1184

1880

203

1569

2918

4690

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

0-19 20-49 50+ Total

No

Of C

ases

Age-Group

Male Female Total

36

Distribution of ESRD patients according to marital status and gender

Table (5) shows that the majority of ESRD patients were married (72.3%),

(males 79.3% and females 61.8%), while (17.5%) of the ESRD patients were

singles (males 16.5% and females 18.8%), (3.0%) of the patients were

divorced.

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

and gender 2015

N % N % N %

2227 79.3 1162 61.8 3389 72.3

465 16.5 354 18.8 819 17.5

69 2.5 273 14.5 342 7.3

49 1.7 91 4.8 140 3.0

2810 100.0 1880 100.0 4690 100.0

Gender

Mrital Status

Male Female Total

Married

Single

Widow

Divorced

Total

37

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 (66.9 %) of the

females, (6.2%) of the patients were employed either governmental or non-

governmentally and military services (1.0), (15.7%) were retired, and (4.1%)

were students, (30.7%) of the patients were unemployed, missing data about

employment was (7.6%).

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

gender, 2015

N % N % N %

House wife 0 0.0 1257 66.9 1257 26.8

Unemployed 1140 40.6 257 13.7 1438 30.7

Retired 648 23.1 63 3.4 734 15.7

Private 419 14.9 38 2.0 472 10.1

Student 108 3.8 81 4.3 193 4.1

Employed 236 8.4 46 2.4 290 6.2

Military 45 1.6 4 0.2 49 1.0

Missing 214 7.6 134 7.1 356 7.6

Total 2810 100 1880 100 4690 100.0

GenderJob

Male Female Total

39

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.

(45.7%) of the patients were insured by Kidney Patients Fund in health insurance

directorate in Ministry of health. Only (1.1%) were not covered by any type of

insurance.

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

2015

N % N % N %

Kidney patients fund 1255 44.7 888 47.2 2143 45.7

Civillian 709 25.2 506 26.9 1215 25.9

Military 733 26.1 419 22.3 1152 24.6

Private 40 1.4 27 1.4 67 1.4

University 44 1.6 18 1.0 62 1.3

No insurance 29 1.0 22 1.2 51 1.1

Total 2810 100.0 1880 100.0 4690 100.0

Gender

Insurance type

Male Female Total

41

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 (29.8%), followed by

Hypertension (27.5%), Diabetes Mellitus and Hypertension (25.5%),

Glomerulonephritis (7.9%) and then Polycystic kidney disease (2.1%) congenital

causes(1.9 %), Infection (1.5%).

Table (9) Distribution of primary causes of ESRD for the year 2015

%N%N%N

29.8139829.455330.1845

27.5128927.852327.3766

25.5119624.245526.4741

7.93698.41587.5211

2.1971.9362.261

1.9892.1391.850

1.5721.6311.541

0.7320.8150.617

0.7321.3240.38

0.5220.480.514

2.0942.0382.056

100.04690100.01880100.02810Total

Primary Causes Of ESRD

Female

Congenital

Infection

Drugs

Vesico Uretric Reflux

SLE

Polycystickidney

Glomerulonephritis

Male Total

Others

Diabetes Mellitus

Hypertention

Both diabetes & hypertens

42

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 (59.4%) of patients were hypertensive, while cardiovascular diseases were

found in (13.3%) of ESRD patients. The prevalence of diabetes constitutes (40.2

%). The prevalence of smoking in ESRD was (7.8%) and (4.0 %) of the patients

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

Table (10) Prevalence of co-morbidity and some risk factors with ESRD 2015

59.42788

40.21884

33.01548

13.3624

7.8368

6.1285

4.0189

1.151

4.5211

Malignancy

Others

Both diabetes & hypertension

Urinary

Smoking

Family

Cardiac Disease

Co-morbidity Frequency %

Hypertention

Diabetes Mellitus

43

Distribution of ESRD patients according to Blood Group

Figure (11) shows that approximately one third of the patients 1716 (36.6%)

were blood group O and 1396 (29.8%) were blood group A, 724 (15.4%),

were blood group B and 496(10.6%) were blood group AB .Data was not

available for 358 ESRD patients which constitutes (7.6%), of the ESRD

patients.

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

A(30%)

AB(10%)

B(15%)

O(37%)

Missed(8%)

44

Distribution of ESRD patients according to type of Dialysis

Figure (12) shows that only 87 patients (2%) were treated by peritoneal

dialysis, while 4603 patients (98%) were treated by hemodialysis.

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

Hemodialysis(98%)

Peritoneal dialysis

(2%)

Distribution of Hemodialysis patients by number of sessions /week

Figure (13) shows that 3298 patients (71.6%) underwent Hemodialysis thrice a week1162 (25.2%) twice a week, 62 (1.3%) once a week, and 81 (1.8%) four times a week, the average duration of the every session is almost four hours.

100.0 1880 100.0 100.0

1861

2117

46

Distribution of ESRD cases according to unfitness for transplantation

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

transplantation were as followed: age 945 patients (44.6%), medical causes

812 patients (38.4%) of all cases, malignancies in 47 patients (2.2%), while

unknown causes for the cases were 145 patients (6.8%) of all patients.

Table (12) Causes of unfitness for transplantation

Cause Frequency Percent

Age 945 44.6

Medical causes 812 38.4

Malignancy 47 2.2

Other Causes 168 7.9

Missed 145 6.8

Total 2117 100.0

47

Figure (14) Causes of unfitness for transplantation

Age(45%)

Medical causes(38%)

Malignancy(2%)

Other Causes(8%)

Missed(7%)

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 758patients (40.7%)

were considered of high priority level for transplantation and 634 patients

(34.1%) considered of medium and 291 patients (15.6%) of low priority and

178 (9.6%) had no data about their priority level.

Type of Hepatitis

51

Part Four Incidence of ESRD Patients The total number of patients who treated in the dialysis units by the end of

2015 were (4690) patients, but the number of new cases for the year 2015

was 780 patients; of them 726 were Jordanians(93%) and 54 were non

Jordanians (7%).

This part of the report only include Jordanian patient – incidence 2015, The

number of new cases of ESRD Jordanian patients for the year 2015 was 726

patient.

Incidence of ESRD, 2015

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

in 2015 according to the age group and gender, with a mean age of 53.8

years, and median age of 56 years. Table (14) also shows the distribution of

ESRD patients by Age-Specific Incidence Rate per million (ASIR). The

overall Incidence per Million Populations in Jordan was (76.2/1,000,000).

52

Table (15) Distribution and ASIR of ESRD cases by gender and age group - Incidence 2015

%ASIRNASIRNASIRN

0.10.910.001.81

0.63.445.231.71

1.510.9116.1315.48

2.821.12013.4628.114

2.821.12018.7823.112

3.328.92424.3932.615

4.342.23129.51053.021

4.146.13036.91153.919

5.267.73850.71382.125

8.4128.96160.513185.648

12.0248.787184.430304.557

11.6343.384196.023479.061

12.9562.694569.146556.548

30.4628.4221563.898691.5123

100.076.272660.927389.8453

10--14

15-19

20-24

25-29

5--9

60-64

65+

TotalFemaleMale GenderAge-group

0-4

Total

30-34

35-39

40-44

45-49

50-54

55-59

*ASIR per Million population

53

Figure (17) Incidence of ESRD Jordanian by gender & age group-2015

1 18

14 12 1521 19

25

4857 61

48

123

0 3 3 6 8 9 10 11 13 13

3023

46

98

0

20

40

60

80

100

120

140

No

Of C

ases

Age-Group

Male Female

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

ASIR

/ M

illio

n

Age-Group

Female Male

54

Distribution of incident ESRD patients by health sector

Figure (18) shows that the new number of patients treated in the Dialysis Units in 2015

were 726 patients; 261 patients (36.0%) treated in MOH Dialysis Units, 238 patients

(32.8%) treated in RMS Dialysis Units, 26 patients (3.6%) treated in university hospital

Dialysis Unit, and 201 patients (27.7 %) treated in Private Sector Dialysis Units.

Figure (18) Distribution of ESRD patients by health sector, 2015

Ministry Of Health(36%)

Private Sector (28%)

Royal Medical Servis(33%)

university hospital

(3%)

55

Distribution of ESRD incident patients by gender

In the years 2015, out of the total (726) new cases of ESRD, 453 patients

(62%) were males and 273patients (38%) were females with male to female

ratio1.66:1 Figure (19)

Figure (19) Distribution of ESRD patients by gender, 2015

Male(62%)

Female(38%)

56

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

(32.2%), followed by Diabetes Mellitus (31.5%), Hypertension (25.8%),

Glomerulonephritis (2.3%) and then Polycystic kidney disease (1.8%),

Infection (1.8%), Drug (1.2%), Vesico uretric reflux (1.2%), congenital

causes(1.0 %), SLE (0.7%) and others was (0.4%)of the patient.

Table (16) Primary causes of ESRD for the year 2015- Incidence

%N%N%N

32.223433.39131.6143

31.522932.28831.1141

25.818723.86526.9122

2.3171.852.612

1.8131.542.09

1.8131.851.88

1.291.131.36

1.291.131.36

1.071.540.73

0.751.540.21

0.430.410.42

100.0726100.0273100.0453Total

Causes

Drugs

Congenital

SLE

Others

Diabetes Mellitis

Hypertension only

Glomerulonnphritis

PolycystIckidney

Infection

Vesico uretric reflux

DM and Hypertension

57

Distribution of ESRD patients by Nationality

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

Nationality, in 2015 there were (54) non-Jordanian patients accounted (7%)

and 726 Jordanian patients accounted (93%).

Figures (20) Distribution of ESRD patients by Nationality 2015

Distribution of ESRD patients according to type of Dialysis

Figure (21) shows that in 2015, only 24 patients (3.3%) were treated by

peritoneal dialysis, while 702 patients (96.7%) were treated by hemodialysis.

Jordanian(93%)

non-Jordanian (7%)

58

Figure (21) Distribution of ESRD patients by type of Dialysis, 2015

Hemodialysis(97%)

Peritoneal Dialysis

(3%)

Distribution of ESRD cases according to fitness for transplantation,2015

Figure (22) shows that there were 458 (63.1%) candidates for transplantation, and 268 not candidates for transplantation (36.9%).

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

No(37%)

Yes(63%)

59

Distribution of fitness of ESRD patients by Priority level for transplantation

Figure (23) shows the priority level for transplantation: in 2015 it was found that

134 patients (18.5%) were of high priority level for transplant, 349 patients (48.1%)

of medium and 243 patients (33.5%) of low propriety level.

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

transplantation 2015

Low(34%)

Medium(48%)

High(18%)

60

Distribution of mortality among ESRD patients

In the year 2015 a total of 41 ESRD patients (5.6 %) died during this year, 12 of them were females and 29 were males of different age group Figure (24).

Figure (24) Distribution of mortality in ESRD patients 2015

Died(6%)

Alive(94%)

61

Part Five:

Pediatric ESRD

The total number of pediatric patients from 0-14 years was 126 patients in

2015.

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

dialysis units in all hospitals during the year 2015 according to sex.

There were 126 patients, out of them 68 were males (54%) and 58 were

female patients accounted (46%).

Figure (25) Distribution of ESRD pediatric patients by Gender

Male(54%)

Female(46%)

\

62

Distribution of Pediatric patients according to type of Dialysis

The total number of pediatric patients from 0-14 years was 126 patients.

Out of them 105 patients were treated by hemodialysis and 21 on peritoneal

dialysis. Figure (26) shows distribution of pediatric patients according to

type of dialysis.

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

Dialysis

Peritoneal Dialysis(17%)

Hemodialysis(83%)

63

Causes of ESRD in Pediatric patients Table (17) shows that the primary cause of ESRD in pediatric patients

(those below 14 years): the commonest causes of ESRD Vesicouretic reflux

(15.9%) Congenital renal anomalies (14.3%) followed by

Glomerulonephritis (14.3%) Neurogenic bladder (13.5%), Hypertension

(10.3%), Nephrotic syndrome (6.3%) Oxalosis (5.6%) Diabetes mellitus

(4.8%) Infection (3.2%) Drug and SLE (2.4%), while other causes were not

determined in (7.1%) of the pediatric patients.

Table (17) Causes of ESRD in Pediatric patients 2015

N % N % N %

11 16.2 9 15.5 20 15.97 10.3 11 19.0 18 14.39 13.2 9 15.5 18 14.37 10.3 10 17.2 17 13.58 11.8 5 8.6 13 10.3

6 8.8 2 3.4 8 6.35 7.4 2 3.4 7 5.64 5.9 2 3.4 6 4.83 4.4 1 1.7 4 3.22 2.9 1 1.7 3 2.40 0.0 3 5.2 3 2.46 8.8 3 5.2 9 7.1

68 100 58 100 126 100.0

InfectionDrugSLEUnknown

Total

Diabetes mellitus

GenderPrimary Cuase

Male Female Total

Vesicouretic refluxCongenitalGlomerulonephritisNeurogenic bladderHypertension

Nephrotic syndromOxalosis

64

Pediatric ESRD patients according to age groups and gender, 2015 Figure (27) shows the distribution of pediatric patients according to the age

groups and gender in 2015, which indicates that the highest occurrence of

the cases was among the age group (10-14) years 69 (54.8 %) for both

genders, with a mean age of 9.61 years and median 10.00.

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

and gender 2015

9

23

36

7

18

33

0

5

10

15

20

25

30

35

40

0-4 5-9 10-14

No

Of C

ases

Age-Group

Male Female

66

Part Six

ESRD Mortality Distribution of mortality among ESRD patients

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

patients, 391 patients out of 4690 were died during the year 2015. 231

(59.1%) of them were males, and 160 (40.9%) were females. Median age at

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

Figure (30) Distribution of mortality in ESRD patients

Died(8%)

Alive(92%)

67

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

Male(59%)

Female(41%)

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

1 2 2 2 3 2 310 8

21 1828 25

106

0 2 1 2 3 28

5 49

1519 17

73

0

20

40

60

80

100

120

No

Of C

ases

Age-Group

Male Female

69

Part Seven:

ESRD patients among Non-Jordanians, 2015

Distribution of ESRD patients by Nationality

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

The total number of patients among Non-Jordanians was (245) 21 patients out

of 245 were died during the year 2015 accounting for (5%) of all patients

reported to Jordan Renal Registry 2015 , and 4690 patients among Jordanians

accounting for (95%) of all patients.

Figure (33) Distribution of ESRD patients by Nationality

Jordanian(95%)

Non jordanian(5%)

70

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 2015

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

245 patients, there were 151 male patients who accounted (61.6%) and 94

female patients accounted (38.4%).

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

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).

Male(62%)

Female(38%)

71

Table (19) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2015

2 0 2 0.8

10 2 12 4.9

11 9 20 8.2

13 11 24 9.8

26 14 40 16.3

28 17 45 18.4

33 26 59 24.1

28 15 43 17.6

151 94 245 100.0

%

70+

Total

10-19

20-29

30-39

40-49

50-59

60-69

0-9

GenderAge- Group Male Female Total

Figure (35) Distribution of ESRD patients among Non-Jordanians according to age groups and gender, 2015

2

10 1113

2628

33

28

02

911

14

17

26

15

0

5

10

15

20

25

30

35

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

No

Of C

ases

Age-Group

Male Female

72

References

1- Annual Report, Jordan, 2015. 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, information and mortality section

annual report 2012-Ministry of Health, Jordan.