Since its opening in 2015, the nephrology department at Mustapha Pacha hospital has made a point of not being limited to hemodialysis alone. Various consultation, screening, prevention and clinical nephrology activities (hospitalization, development of renal biopsy) were then developed at the University Hospital.
I have been on dialysis for 25 years. This is due to the disease lupus which I was diagnosed with at the age of 18. My health has deteriorated significantly. I have come to the point where I only move around in a wheelchair,” confides Ms. Fatiha, a patient with chronic kidney failure who is undergoing hemodialysis sessions at Mustapha University Hospital. “But over the past few weeks, I have gradually started to regain the use of my legs.
I don’t know if the renewal of the machines had an impact, but what is certain is that I noticed a clear improvement,” she continues. “I think the water station has a lot to do with it too. In fact, when the water is well filtered, we feel it and our dialysis goes very well.
We even manage to fall asleep,” she adds. Ms. Fatiha is not an isolated case. Many patients experience exactly the same effects. Indeed, to perform hemodialysis, it is necessary to treat city water which is loaded with calcium, magnesium, limestone and various particles. You should know that the water that arrives in dialysis services is the same as that which arrives in all homes.
This water must therefore undergo special treatment before reaching the hemodialysis generators. And this is precisely what is being done at the Mustapha hospital water station. “It must still be emphasized that at the Mustapha Pacha University Hospital, only 1% are on chronic hemodialysis,” says Professor Farid Haddoum, head of the nephrology department at the hospital.
The reason: “Thanks to the development of numerous activities in the service, we were able to achieve this result. However, we have not closed the hemodialysis unit. On the contrary, we developed it,” he assures.
Peritoneal dialysis
It was in 2015 that the “nephrology department” of Mustapha hospital opened its doors. Created by an interministerial decree in 2014, Professor Haddoum and his team have worked over the last eight years to impose the complete nephrology label. “You should know that nephrology was introduced to the world as a specialty in 1960 and in Algeria in 1989.
This became a specialty to teach in 1990. And so before 1990, nephrology was limited to hemodialysis,” he says. “We have worked hard to develop different activities within our department so as not to reduce nephrology to hemodialysis which constitutes the failure of nephrology,” he continues.
First of all, “we have developed dialysis techniques, particularly peritoneal dialysis,” says Professor Haddoum. The latter purifies the blood by using the peritoneum, the membrane surrounding the abdomen, intestine and other internal organs, as a filter. “This dialysis is done at home with peritoneal dialysis bags.
The exchanges take place at home and the patient is completely independent,” explains Mr. Haddoum. Assuring that peritoneal dialysis is the one “that we are developing, we advise and favor the most at the Mustapha hospital, for several reasons,” assures Mr. Haddoum.
The first is cost. Indeed, peritoneal dialysis is, according to Professor Haddoum, economical (50% less expensive than hemodialysis). The second reason is that it is done every day at home. And finally, the care is provided at home and the patient is completely independent. “Moreover, for the majority of patients, it is only done at night while they are sleeping,” continues Mr. Haddoum.
Conversely, hemodialysis at the center forces patients to come 3 times a week for 4 hours at each session throughout their life, with an extremely high cost. Finally, thanks to the development of this technique, 80% of patients at Mustapha Pacha hospital are now on peritoneal dialysis. “This offer made it possible to move from routine chronic dialysis to peritoneal dialysis which can be done at home or still at the center, but in small local centers in large private centers,” says Mr. Haddoum.
According to him, Algiers alone has no less than 40 private centers. Moreover, patients wishing to remain on hemodialysis have gradually been accompanied to local centers, whether public (if they are not insured) or private (if they are). “We have renewed the fleet of machines and now they are dedicated to the demand for emergency dialysis,” explains Professor Haddoum.
In other words, the hemodialysis unit is oriented towards the missions of the CHU and the care offer of the latter because it must still meet the needs of specialized services, whether for adults, child in medical or surgical terms. “You should know that Mustapha hospital has around thirty medical and surgical departments (adults and children). If before, the service was full all the time, it can now meet emergency dialysis needs which can reach 10 to 12 per day, in addition to emergencies,” explains Mr. Haddoum.
Screening
Other activities have also been developed, since 2016, within the service. “We were able to have, thanks to all the combined efforts of the Ministry of Health, but also of the hospital administration, headed by the general director, Khaled Dahia, an external consultation which is at Télemly and a consultation at inside the Mustapha hospital, but not in the service premises,” assured Mr. Haddoum.
Consultation, screening and prevention activities have also been developed. “Screening, diagnosing and even preventing the disease is an absolute priority in nephrology. This is called pre-hospital medicine. These are outpatient activities that we develop outside the hospital,” explains Mr. Haddoum, assuring in passing that kidney disease is silent, pernicious and insidious.
According to the professor, the patient has no ailments or any symptoms: “It is the biology in the blood, the biology in the urine and an ultrasound of the kidneys which determine whether there is a disease or not. Without that, we miss out.” The kidneys can therefore be destroyed up to 80% without any apparent sign. This is why, according to Mr. Haddoum, it is important to detect kidney disease or to treat the patient at the very beginning of the disease.
Regarding screening, Mr. Haddoum explains that it is impossible to screen everyone: “It is expensive and unprofitable. We tend to go to fish-rich areas. In other words, screen hypertensives, diabetics, heart patients, chronically ill people and all those who take more than two medications per day.
Another new activity developed within the department: so-called clinical nephrology. This involves the hospitalization of patients for high-level explorations. “We introduced a technique called kidney biopsy. It consists of taking small pieces of kidneys which we analyze in the laboratory.
Moreover, the pathological anatomy laboratory at Mustapha Pasha University Hospital now reads kidney biopsies,” he revealed. Other therapies, such as plasmapheresis, have also been developed. This is a method of extracorporeal blood purification that allows harmful macromolecules to be removed from the blood. “There are also the vascular approaches that we have developed,” adds Mr. Haddoum.
Patients from all over the country come to have catheters inserted so they can be hemodialyzed. “We also want to further develop prevention and screening. We consider it important to treat patients to prevent them from going on dialysis because it constitutes the failure of nephrology,” he maintains.
Transplants
Regarding kidney transplants, Mr. Haddoum assures that only 19% of patients are transplanted. “Unfortunately, we don’t do enough transplantation. Only 150 transplants have been carried out since 2016. However, we wanted to do 50 to 60 per year,” he laments.
The reason: there are many ready couples and few operated patients. To this end, he explains: “To carry out kidney transplants, it is necessary to bring together, during the same day and for 4 hours, anesthetists, surgeons, pharmacists, immunologists… And this remains very difficult. Ultimately, it is the transplant surgery that slows down the program.” You should know that there is a whole process before reaching the transplant stage.
There is first a pre-transplant consultation to prepare the couples (donor/recipient). “We also have a medical transplantation unit which did not exist and which we created in 2016. With an entrance hall which is the pre-transplant consultation where patients with renal failure (before dialysis or during dialysis) , come with donors,” confides Mr. Haddoum.
The couples are then selected, with identification of the donor and the recipient, and it is only when everything is medically ready that the couples are offered transplant surgery. “Unfortunately, the limiting factor is transplant surgery because surgical activities compete with the activities of the service, whether in cardiac surgery, general surgery, urology…” he says. On the logistics side, the department head assures us that things are also stuck.
According to him, carrying out a transplant requires two operating theaters available on the same day, two anesthesia-resuscitation teams also available on the same day, two teams of anesthesia nurses and the same for the surgeons. “The immunologist must also do the assessments the day before to ensure that there are no contraindications.
The blood center must prepare everything necessary. The hospital pharmacy as well. Biochemistry, micro-bio, virology…”, he lists. The difficulty therefore lies in all these details. “We operate on our patients at Mustapha Pasha, whenever possible. But couples who are ready will also have surgery elsewhere.
We send them to teams in hospital centers which have more surgical possibilities and fewer couples than us. They do the surgery and they come back,” assures Mr. Haddoum.
Moreover, there is also a hospitalization-transplant unit for recent transplant recipients who have just been operated on and for older transplant recipients who, from time to time, have problems (infectious, metabolic or other). “Ultimately, by developing all these activities, we are trying to direct nephrology towards what is rational,” concludes Mr. Haddoum.
