ANNUAL QUESTIONNAIRE

Dialysis and Transplantation in Saudi Arabia Year 2015

Saudi Center for Organ Transplantation

Hospital Name:

HD Unit (Special name):

Name of the Head of the Unit:

Date of Report:

Telephone number:

Ext. number:

Fax no.:

(A) Staff:
1. How many Consultant Nephrologists work in your Unit?
2. How many Nephrology specialists work in your Unit?
3. How many GPs take care of the HD patients in your Unit?
4. How many nurses take care of HD patients in your Unit?
5. Do you have support of: a social worker?

Dietitian?

Yes

(B) Machines/Capacity:
6. How many outlet connections for HD machines in your unit?
How many of them for Hep. B+ve

HCV+ve

7. What are the types of HD machines (number in each category) at your Unit? Total
(a.) Fresenius: Type S
(b.) Gambro: AK90

Type E
AK95

Type H
AK100

Type B

Type C

AK200

(c.) Braun: Dialogue

(d.) Cobe: Century 3
(e.) I NOVA
(f.) INTEGRA
(g.) NIPRO
(h.) CRRT machine
(i.) Others machine not mentioned above (Pls. specify machine type and number)
(j.) Available but unrepairable/ unused machine (Pls. specify machine type and number)
8. Did you receive HD machines from charity donations in year 2015?
9. If yes, how many?
(C) Patients/Quality Care:
10. What is the total number of your active HD patients in your unit by the end of 2015?
11. How many *NEW permanent chronic HD patients did you have in the year 2015?
(* New permanent chronic HD patients more than 3 months on regular dialysis)
12. What is the blood group distribution of your HD patients? (Numbers)
A

AB

Please turn over

Hospital name (contd):

13. What is the age distribution of your HD patients? (Numbers)
< 5 years

5 -9 years

26-45 years

10-15 years

46- 55 years

16-25 years

56-65 years

14. What is the sex distribution of your HD patients

66-75 years

>75 years

(Male/Female)? Female
/

15. What is the nationality distribution of your HD patients (Saudi/Non Saudi)?

Non Saudi
/

16. How many active HD patients have had previous renal transplantation?
17. What are the main causes of renal failure of your HD patients (number of each)?
Diabetes

Hypertension

Congenital malformation

Pregnancy related

Vasculitis

Primary tubulo int. disease

Obstructive uropathy

Pri. glomerular disease

18. How many HD patients are: Anti HCV +ve

Heredofamilial disease
Unknown

HbsAg +ve

Others
HIV +ve

19. How many at present vascular access in your active HD patients?

AVF

Graft

Jugular catheter

Other

20. Percentage of HD patients treated by Erythropoietin (EPO)?

21. Percentage of HD patients with Hematocrit <30%?

22. Percentage of HD patients with albumin < 30 g/dl?

%
23. Percentage of active (HD) patients have pre-dialysis serum phosphorus > 1.9 mmol/l (6 mg/dl)?

24. Percentage of active (HD) patients have pre-dialysis serum calcium < 2.1 mmol/l (8.4 mg/dl)?

25. Percentage of active (HD) patients receive

Vitamin D: Injectable

Oral

Oral %

26. How many HD patients died during year 2015?

27. Percentage of HD patients ready for renal transplantation?
28. How many active HD patients are: Diabetic only

%
Hypertensive only

Both diabetic and hypertensive

29. How many diabetic HD patients received:
Insulin

Oral hypoglycemic agents

Diet only

30. How many diabetic HD patients were diagnosed of having hyperglycemia:

Before starting dialysis

After starting dialysis

31. How many of your patients are working in

Government Sector

Private Sector

(D) Renal Transplantation

32. Do you follow up post renal transplantation patients?

Yes/ No

33. If yes, how many do you have by end of year 2015?

34. How many of your patients received renal transplants outside the KSA in 2015?
If yes, Country:
Type: Living related donor

Living unrelated donor

Cadaver donor

Send the questionnaire back to SCOT within two weeks by mail or fax to:
P.O. Box 27049, Riyadh 11417. Toll Free: 800-1245500, Tel: 01-4451100, Fax: 01 445 3934
E-mail: replyscot@yahoo.com

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