Al-Za'abi, Ruqiya Khamis Abdullah (2018) Oman's treated chronic kidney failure population in ...

276 Pages·2017·5.65 MB·English

Al-Za'abi, Ruqiya Khamis Abdullah (2018) Oman’s treated chronic kidney
failure population in years 1980 to 2015: an epidemiology research.
PhD thesis.

https://theses.gla.ac.uk/9110/

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Enlighten: Theses
https://theses.gla.ac.uk/
[email protected]
Oman’s treated chronic kidney failure population
in years 1980 to 2015: An epidemiology research

By

Ruqiya Khamis Abdullah Al-Za’abi

BSN (USA), MSc (UK)

Submitted in fulfilment of the requirements for the
Degree of Doctor of Philosophy (PhD)

School of Nursing
College of Medical, Veterinary and Life Sciences
© University of Glasgow

© Ruqiya Al-Za’abi
2018
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Abstract
Background and aim: Epidemiological studies on incidence, prevalence, and other
epidemiological variables of Oman’s treated kidney failure population have been limited,
and questionable as to their use of rigorous research methods. The main aim of this study
was to identify the epidemiological variables of treated patients with advanced kidney
disease in Oman, the status of publishing on the studied population, and describing the
dialysis sub-population characteristics in the northern region of Oman.

Methods: First, a secondary data analysis was performed using data from the Oman's renal
replacement therapy (RRT) register (1980-2015). The studied epidemiological variables
included: incidence, prevalence, death figures, causes of death and treatment costs of the
Oman’s treated kidney failure population, especially dialysis sub-population. The
publications on chronic kidney failure population of Oman were explored at this stage.
Secondly, a multi-centre, cross-sectional study (i.e. survey research) was conducted
covering the dialysis sub-population of the northern region of Oman. The basic aim of the
survey was to assist in developing the first description of the main characteristics (e.g.
demography, primary diagnoses, and co-morbidities) of dialysis-treated patients with
advanced kidney disease living the northern region of Oman. A convenience sample (n =
341) of participants were recruited from four renal dialysis centres (RDCs). Those who
met the pre-specified study inclusion criteria were surveyed using a researcher-
administered survey during October and November 2014. SomeFrom December 2014 to
December 2015, there were some additional data was gathered (e.g. death figures) from
December 2014 to December 2015.

Results: The first RRT care that started in Oman was peritoneal dialysis (PD) in April
1980, while the well-structured PD programme started in 1992 and was boosted in 2007. In
1983, the first dialysis center was opened with seven machines for haemodialysis, serving
35 patients. By the end of 2015, the Ministry of Health (MOH) had 18 RDCs serving 1,439
patients on dialysis per annum for Oman’s population. The analysis of the RRT register's
data showed that the mean prevalence for all years (1983-2015) was 724.9 dialysis patients
per year. The mean incidence for the same years was 203.7 kidney failure patients per year.
The mean death rate calculated for all years (1983-2015) was 58 deaths per year. The
recorded causes of death were cardiovascular diseases, and infection. Over the years, it was
described that death due to infections and cardiovascular diseases were increasing among
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the RRT population and particularly within dialysis cohort. The cost of the dialysis
sessions increased dramatically from 2,246,627 OMR (~ 4.5 million GBP) in 1998 to
9,543,572 OMR (~20 million GBP) in 2015, which is a 325% increase. Among the
databases searched, there were 44 articles, which either focused on, or mentioned Oman’s
chronic kidney failure population. Most of these articles focused on kidney transplantation
and were of limited and questionable methodologies.

In the multi-centre cross-sectional study, the northern region of Oman was divided into two
subdivisions. The average age of this population was 51.7 ± 15.8 (mean ± SD) with no
statistical evidence of difference between the subdivisions of the northern region of Oman
(P = 0.177). There were more males (n = 187 = 54.8%) than females (n = 154 = 45.2%),
with no significant difference between subdivisions (P = 0.598). It was described that the
divorce frequency was low in this population (n = 22 = 6.4%), with no significant
difference between subdivisions (P = 0.49), but unemployment was high (n = 292 =
85.9%), showing no significant difference between subdivisions (P = 0.537). Nearly half
of this population were illiterate (n = 164 = 48.1%), with more illiterate females (n =
103= 66.9%) compared to males (n = 61= 32.6%), and no significant difference between
subdivisions (P = 0.174). Nearly half of the participants had been on dialysis for five years
at the time of data collection (n = 165 = 48.4%). The most common co-morbidities
reported by these participants were hypertension and diabetes combined (n = 156 =
32.4%). The main reported causes of death shown by the data gathered were cardiovascular
diseases (n = 41 = 41.5%) and infection (n = 10 = 10.2%). More than half of the
participants were hoping to have kidney transplantations as soon as possible (n = 173 =
50.7%).
Conclusion: This study is a comprehensive description of the Oman’s RRT epidemiology.
The data showed a significant increase in the incidence and prevalence of treated chronic
kidney failure in Oman. It showed the increase in the cost of dialysis in Oman for the past
17 years (1998-2015), which is in line with the recent publications from Oman (Al-Alawi
et al., 2017; Al-Ismaili et al., 2016) and is in line with global findings. This research’s
results have contributed to providing a deeper understanding of the Oman’s treated chronic
kidney failure population. It appears that there is a heavy burden borne by the country, the
health sector and the patients on dialysis because of the complex nature of life-long
treatment. Oman’s publications on this health problem were limited. Therefore, it is
necessary to conduct additional research with rigorous methods to obtain a complete
picture of this health problem in Oman.
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Table of Contents
Abstract ............................................................................................................................ 2
List of tables ..................................................................................................................... 8
List of figures...................................................................................................................10
Preface .............................................................................................................................12
Acknowledgement ...........................................................................................................14
Author’s declaration .........................................................................................................15
Abbreviations used in the text ..........................................................................................16
Glossary ...........................................................................................................................18
List of author’s publications and presentations relating to this thesis ................................19
1.1 Introduction .......................................................................................................21
1.2 Overview ...........................................................................................................21
1.3 Kidney failure ....................................................................................................23
1.4 Conclusion .........................................................................................................27
2 Published reports used to obtain data on the epidemiology of RRT ...........................28
2.1 Published reports used to obtain data on the epidemiology of RRT of Oman ......28
2.1.1 Search strategy (initial stage) ...................................................................... 28
2.1.2 The search strategy (intensive stage) ........................................................... 30
2.1.3 The conclusions from the published reports on Oman's RRT up to 2013 ..... 34
2.2 A literature review of the international picture of the epidemiology of people with
RRT 35
2.2.1 Overview .................................................................................................... 35
2.2.2 United States Renal Data System (USRDS) ................................................ 36
2.2.3 United Kingdom Renal Registry (UKRR) ................................................... 38
2.2.4 Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)40
2.2.5 Japan Kidney Disease Registry (J-KDR) ..................................................... 42
2.2.6 Renal data from developing countries and the international scene ............... 43
2.2.7 Appraising the quality of the registries ........................................................ 53
2.1 A literature review of the international state of the quality of life of people with
RRT 54
2.1.1 Economic burden on the health systems ...................................................... 56
2.2 Prevention and screening programmes ...............................................................57
2.3 Conclusion .........................................................................................................59
3 Oman’s background and context...............................................................................61
3.1 Introduction .......................................................................................................61
3.1 Political and administrative status ......................................................................61
3.2 Economic status .................................................................................................64
3.3 Socio-cultural status ...........................................................................................65
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3.4 Technological Status ..........................................................................................69
3.5 Legal status ........................................................................................................71
3.6 Environmental status ..........................................................................................71
3.7 Health sector in Oman........................................................................................73
3.8 Conclusion .........................................................................................................76
4 Methods of study one ...............................................................................................78
4.1 Overview ...........................................................................................................78
4.2 Introduction .......................................................................................................79
4.3 The study’s design .............................................................................................82
4.4 The study settings ..............................................................................................84
4.5 Study population and sample characteristics.......................................................85
4.6 Ethical approval and considerations ...................................................................86
4.7 Data collection procedure...................................................................................88
4.7.1 Statistical analysis ....................................................................................... 89
5 Results of study one .................................................................................................90
5.1 Overview ...........................................................................................................90
5.2 The main developments of Oman’s RRT (1980-2015) .......................................90
5.3 Main statistics about Oman’s RRT population ...................................................94
5.3.1 Prevalence of Oman’s RRT (1983-2015) .................................................... 94
5.3.2 Incidence of RRT treatment (1983-2015) .................................................. 104
5.3.3 Death profile for RRT patients (1983-2015) .............................................. 107
5.3.4 Cost of dialysis treatment in Oman ........................................................... 112
5.4 Kidney transplantation in Oman (1980-2013) ................................................... 113
5.5 Publications on Oman’s RRT population ......................................................... 115
6 Discussion of study one .......................................................................................... 116
6.1 The main developments of Oman’s RRT (1980-2015) ..................................... 116
6.2 Main statistics about Oman’s RRT population ................................................. 118
6.3 Kidney transplantation in Oman (1980-2013) ................................................... 126
6.4 Publications on Oman’s RRT population ......................................................... 129
6.5 Conclusion ....................................................................................................... 130
7 Methods of study two ............................................................................................. 133
7.1 Introduction ..................................................................................................... 133
7.2 Study design .................................................................................................... 133
7.3 Study settings................................................................................................... 134
7.4 Study population and sample characteristics..................................................... 135
7.5 Recruitment ..................................................................................................... 142
7.6 The study tool .................................................................................................. 142
7.6.1 Survey development process ..................................................................... 143
7.6.2 Justification of survey selection ................................................................ 147
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7.6.3 Validity of the survey instrument .............................................................. 148
7.7 Data collection process .................................................................................... 151
7.8 Ethical considerations ...................................................................................... 152
7.9 The pilot study ................................................................................................. 153
7.10 Preparing the data for analysis ......................................................................... 155
8 Results of study two ............................................................................................... 161
8.1 Overview ......................................................................................................... 161
8.1.1 Participant demography and characteristics ............................................... 161
8.1.2 Participant distribution across districts ...................................................... 169
8.1.3 Participant perception on the risk factors ................................................... 170
8.1.4 Participant primary diseases and causes .................................................... 172
8.1.5 Participant co-morbidities profile .............................................................. 175
8.1.6 Participant haemodialysis characteristics ................................................... 177
8.1.7 Participant perceptions on the impact of dialysis treatment on their lives .. 180
8.1.8 Participant death figures in 2014 and in 2015 ............................................ 181
8.1.9 Participant plans on kidney transplantation ............................................... 184
9 Discussion of study two.......................................................................................... 187
9.1 Participant demography and characteristics ...................................................... 187
1.9.9 Participant distribution across districts ...................................................... 193
9.1.2 Participant risk factors, causes, primary diseases and co-morbidities ......... 195
9.1.3 Participant haemodialysis characteristics ................................................... 197
9.1.4 Participant perceptions on the impact of dialysis treatment on their lives .. 199
9.1.5 Participant death profile in 2014 and in 2015 ............................................ 201
9.1.6 Participant plans on kidney transplantation ............................................... 202
10 Participant plans on kidney transplantation ............................................................. 203
11 The comprehensive discussion on the significant results ......................................... 206
12 Conclusion ............................................................................................................. 214
12.1 Contribution of the study ................................................................................. 214
12.2 Limitations of the study ................................................................................... 215
12.3 Implications and recommendations for practice, service delivery and policy .... 217
12.4 Recommendations for future research .............................................................. 220
12.5 Summary ......................................................................................................... 223
List of References: ......................................................................................................... 225
Appendices .................................................................................................................... 244
Appendix A – Ethics’ forms ....................................................................................... 244
A-1 (The 1st ethical approval letter from MOH of Oman) ....................................... 244
A-2 (The ethical approval letter from University of Glasgow) ................................ 245
A-3 (The 2nd ethical approval letter from MOH of Oman) ...................................... 246
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A- 4 (The research proposal's part that address obtaining the data from the patient
medical profile) ...................................................................................................... 247
Appendix B – Copy right permissions ........................................................................ 248
B-1 (Copy right permission, Scottish Renal Registry) ............................................. 248
B-2 (USRDS permission) ....................................................................................... 248
B-3 (UKRR permission) ......................................................................................... 249
B-4 (RAND copy right permission) ........................................................................ 250
B-5 (Dr. Omar Abboud e-mail) .............................................................................. 251
Appendix C – (The letter of peritoneal dialysis cost from MOH of Oman) ................. 252
Appendix D - Data collection forms ....................................................................... 253
D-1 (Information sheet given to patients in Arabic) ................................................ 253
D-2 (Information sheet in English) ......................................................................... 254
D-3 (Informed consent given to patients in Arabic) ................................................ 256
D-4 (Informed consent in English) ......................................................................... 257
D-5 (The survey 1st version used in the pilot study) ............................................... 258
D-6 (The revised final survey) ................................................................................ 263
Appendix E – Sample of published and unpublished data gathered during field work . 266
E-1 (MOH annual health report 2005 – renal dialysis) ............................................ 266
E-2 (Published article about chronic renal failure, 1985)......................................... 267
E-3 (Sample of aggregated data provided by the RRT register of Oman) ............... 268
Appendix F - Published articles on Oman's RRT population (1980-2013) .................. 269
Appendix G - Field notes and general observations with discussion ........................... 272
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List of tables

Table 2-1 The main themes and terminologies used to search OVID Embase database ................. 32
Table 2-2 Comparison between major registries’ data and Oman ................................................. 53
Table 3-1 The breakdown of Oman’s population in mid-2014...................................................... 67
Table 5-1 Oman’s RRT population distribution across treatment cohorts on 4th November 2014 .. 95
Table 5-2 Prevalence rates for dialysis treated patients in certain years ........................................ 96
Table 5-3 Prevalence of dialysis treated patients across governorates of Oman for 2010 & 2015 .100
Table 5-4 Prevalence of dialysis treatment in the four RDCs of the northern region of Oman (1998-
2013) .........................................................................................................................................101
Table 5-5 Prevalence of dialysis treatment across the four RDCs per month in 2014 ...................103
Table 5-6 Prevalence of dialysis treatment across the four RDCs per month in 2015 ...................104
Table 5-7 Incidence rate for treated kidney failure patients across certain years ..........................106
Table 5-8 Causes of RRT population death across genders .........................................................111
Table 7-1 Oman’s MOH 2012 statistics for dialysis population across RDCs ..............................135
Table 7-2 The breakdown of Oman's population across regions and districts ...............................137
Table 7-3 Census of Omani males to Omani females across age groups in subdivisions of the
northern region of Oman ............................................................................................................138
Table 7-4 Summary of missing data on SPSS .............................................................................158
Table 8-1 The statistical summary of the age variable across the northern region of Oman ..........162
Table 8-2 Statistical summary of the gender variable across subdivisions and RDCs ...................163
Table 8-3 Statistical summary of the race/ethnicity variable across subdivisions and RDCs ........164
Table 8-4 Statistical summary of the race/ethnicity variable in relation to gender across the northern
region of Oman ..........................................................................................................................165
Table 8-5 Statistical summary of the marital status variable across all subdivisions and RDCs ....165
Table 8-6 Statistical summary of the marital status variable in relation to the gender variable across
the northern region of Oman .......................................................................................................166
Table 8-7 Statistical summary of the educational level and employment status variables across the
northern region of Oman ............................................................................................................167
Table 8-8 Statistical summary of the education variable in relation to gender and age group
variables across the northern region of Oman .............................................................................168
Table 8-9 Statistical summary of residential status across subdivisions and RDCs ......................168
Table 8-10 Statistical summary of the primary diseases variable across all subdivisions and RDCs
..................................................................................................................................................172
Table 8-11 Statistical summary of the primary diseases variable in relation to the gender variable
across the whole sample in the north of Oman ............................................................................174
Table 8-12 Statistical summary of the co-morbidities variable across all subdivisions and RDCs 176
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Table 8-13 Statistical summary of the co-morbidities variable in relation to the gender variable
across the northern region of Oman ............................................................................................176
Table 8-14 Statistical summary of the vascular accesses variable across all subdivisions and RDCs
..................................................................................................................................................178
Table 8-15 Duration of survival on dialysis in years across the whole sample at the time of data
collection ...................................................................................................................................179
Table 8-16 Statistical summary of the reported impact of dialysis treatment on participant lives
across subdivisions and RDCs ....................................................................................................181
Table 8-17 Participant responses regarding their plans for kidney transplantation across the whole
sample compared to gender ........................................................................................................184
Table 8-18 Statistical summary of kidney transplantation plans in relation to the age gender and
groups variables across the northern region of Oman ..................................................................185
Table 8-19 Statistical summary of kidney transplantation plans in relation to education level ......186