Reaserch Open Access Review of pre end-stage renal disease care in the western region in Saudi Arabia Amal A Hassanien 1 *, Azeem Majeed 1 , Hilary Watt 1 and Nawal Basri 2 *Correspondence: a.hassanien09@imperial.ac.uk 1 Department of Primary Care & Public Health, School of Public Health, Imperial College London, UK. 2 Jeddah Kidney Centre, King Fahad General Hospital in Jeddah, Ministry of Health in Saudi Arabia, KSA. Abstract Background: Te risk factors for chronic kidney disease (CKD) are increasing in the Saudi population. Consequently, the incidence and prevalence of end-stage renal disease (ESRD) have increased substantially in Saudi Arabia over the past three decades. Tis study was conducted to review pre-ESRD care and investigate the primary causes of ESRD among haemodialysis patients in the western region in Saudi Arabia. Methods: A pilot cross-sectional study was conducted in Al-Noor Kidney Centre and Jeddah Kidney Centre in the western region of Saudi Arabia. Participants were patients with ESRD on regular haemodialysis during 2011. Main outcome measures were pre-ESRD care including: reason of referral to nephrology care, source of referral to nephrology care, duration of pre-ESRD care, and vascular access at the frst dialysis; and primary causes of ESRD. Results: Preliminary indicators of pre-ESRD care showed that: endocrine, nutritional and metabolic diseases, and immunity disorders were the principal reason for patient referral in 50.6% (95% CIs, 45.1_56.1) of patients; 50.6% (95% CIs, 45.6_55.6) of the patient referrals arrived from the emergency department; a large proportion of haemodialysis patients were not receiving pre-ESRD nephrology care, 47.6% (95% CIs, 41.7_53.5); the predominant vascular access point for haemodialysis was initially a catheter 88.3% (95% CIs, 84.5_91.3). Te dominant causes of ESRD were hypertensive nephropathy, 55.8% (95% CIs, 50.8_60.7) and diabetic nephropathy, 24.6% (95% CIs, 20.4_29.1). Conclusions: Pre-ESRD nephrology care needs to be improved in Saudi Arabia. Potential strategies could involve: regular screening of high risk people, encouraging communication between healthcare practitioners, and education on the need to refer patients with CKD to nephrology care in earlier disease stages; and increasing patients’ awareness about their health conditions and potential consequences of their kidney disease. Keywords: Chronic kidney disease, end-stage renal disease, nephrology care © 2013 Hassanien et al; licensee Herbert Publications Ltd. Tis is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). Tis permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background End-stage renal disease (ESRD) has emerged as an important public health issue worldwide, because of the marked increase in its incidence and prevalence. This increases the need for multidisciplinary management including financial and social support, and medical care. Early referral of patients with chronic kidney disease (CKD) to specialized renal services can help to preserve renal function and delay the progression of renal failure by preventing and managing the modifiable risk factors of CKD and treating secondary complications [1-3]. Many studies have shown that a long duration of pre-ESRD nephrology care, which is the period between the first time the patient has been seen by a nephrologist and the first dialysis [1], has a significant effect on the quality of life and survival rate in patients with ESRD before and after receiving renal replacement therapy (RRT) [2,4,5]. Improved detection of patients with CKD in its early stages can significantly reduce the prevalence of cardiovascular morbidity, and gives an adequate time to prepare patients for RRT; especially those patients who need to create vascular access for dialysis, as maturation of arterio-venous fistula (AVF) takes from 6 to 8 weeks; and helps to improve pre-emptive renal transplantation treatment [1,3]. National Kidney Foundation- Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines recommended that the preparation for RRT should start in CKD stage 4, when the estimated Glomerular Filtration Rate (eGFR) is <30 mls/min/1.73m 2 [1]. This gives time to choose and create a suitable dialysis access point, considered a modifiable risk factor for bacteraemia and mortality [6,7], and avoids the need for temporary vascular access. These interventions have a significant impact in improving the quality of life and reducing the financial demands of renal care. Many reports have shown evidence of increasing prevalence of the most common causes of ESRD in Saudi Arabia such as diabetes [8], and obesity- conditions associated with many chronic diseases [9-11]. Furthermore, the incidence and prevalence of RRT have been increasing substantially in the last three decades [12]. The majority of patients with ESRD are getting their RRT in the form of haemodialysis (around 53.7%), with 5.1% on peritoneal dialysis, and with 41.2% renal graft. Around 70% of RRT is provided by Ministry of Health free of charge [13]. This study was conducted to review pre-ESRD care and to investigate primary causes of ESRD among haemodialysis Journal of Diabetes Research & Clinical Metabolism ISSN 2050-0866