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 Table of Contents  
Year : 2021  |  Volume : 5  |  Issue : 4  |  Page : 139-143

Causes of end-stage renal disease among hemodialysis patients in Libya: A multicenter cross-sectional study

1 Department of Genetic Engineering, Biotechnology Research Center, Benghazi, Libya
2 Department of Pediatrics, University of Benghazi, Benghazi, Libya
3 Department of Community and Family Medicine, Tripoli University, Tripoli, Libya
4 Ministry of Health, Tripoli, Libya
5 Department of Genetic Engineering, Biotechnology Research Center; Department of Pathology, University of Benghazi Benghazi, Libya

Date of Submission25-Aug-2020
Date of Acceptance15-Jun-2021
Date of Web Publication28-Feb-2022

Correspondence Address:
Prof. Adam Elzagheid
Department of Genetic Engineering, Biotechnology Research Center, Tripoli
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_75_20

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Background/Aims: Little data are available about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Libya, therefore, we conducted a cross-sectional study to examine the epidemiological factors and frequency of diseases diagnosed in patients with ESRD who are receiving hemodialysis in the major three demographic areas of Libya. Patients and Methods: With a special focus on the three main demographic regions in Libya (East, West, South), in this study, we retrospectively examine and analyze data retrieved from patients who attended 31 hemodialysis centers in 2017. Patients' data were studied for baseline demographic information, gender, age, medical history, physical examination, laboratory results, and comorbidities. Results: More males than females were affected overall, with M:F ratio = 1.6. Approximately, two-thirds of patients resided in the western part of Libya, with a regional distribution of 68.41% in the West, 16.08% in the East, and 15.52% in the South. The majority of cases with ESRD (>60%) were either caused by hypertension (25.36%) or diabetes mellitus (23.75%), or a combination of both (12.93%). On the other hand, genetic diseases caused 8.18% of the cases, whereas glomerular diseases caused 5.98%. Conclusion: The public health legislators and Ministry of Health should focus on tackling the modifiable risk factors of hypertension and diabetes early at a population level to reduce the burden of CKD and the development of ESRD. Early detection of genetic causes is an important health measure through the implementation of screening in high-risk groups and appropriate genetic counseling.

Keywords: Chronic kidney disease, diabetes, end-stage renal disease, glomerulonephritis, hypertension

How to cite this article:
Gusbi E, Abrahem AF, Elfituri A, Eltaib F, Benbubaker WM, Alhudiri IM, Elgriw N, Gusbi M, Rmadan MM, Enattah N, Elzagheid A. Causes of end-stage renal disease among hemodialysis patients in Libya: A multicenter cross-sectional study. Libyan J Med Sci 2021;5:139-43

How to cite this URL:
Gusbi E, Abrahem AF, Elfituri A, Eltaib F, Benbubaker WM, Alhudiri IM, Elgriw N, Gusbi M, Rmadan MM, Enattah N, Elzagheid A. Causes of end-stage renal disease among hemodialysis patients in Libya: A multicenter cross-sectional study. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 30];5:139-43. Available from: https://www.ljmsonline.com/text.asp?2021/5/4/139/338637

  Introduction Top

Chronic kidney disease (CKD) implies various degrees of declined renal function. End-stage renal disease (ESRD) is the final and most severe phase of CKD. It occurs when the kidneys fail to accomplish their vital functions properly. This malfunction inevitably requires patients to depend on hemodialysis or kidney transplantation to survive.[1],[2] As a consequence of the heavy burden of high-cost treatment, suffering, and daily struggles of patients under hemodialysis, this disease has acquired a high-priority health concern which necessitates the further evaluation of patients with CKD and ESRD. CKD along with infectious diseases are considered as leading causes of morbidity and mortality in Africa.[1],[2] Risk factors for CKD such as cardiovascular disease and diabetes mellitus are leading causes of morbidity and mortality in Libya.[3]

Emerging studies in the past few years from various countries in Africa, such as Cameroon,[4] Sudan,[5] Ethiopia,[6] South Africa,[7] Libya,[8] and Uganda,[9] have explored the seriousness of the emerging problem. According to their findings that showed almost the same cause of ESRD, we felt compelled to investigate the recent ESRD situation in Libya. Although ESRD service centers in Libya are distributed across the country accompanied by increasing governmental efforts to provide better service to those who need it, recent epidemiological studies were not conducted on a national level to understand the characteristics and prevalence of underlying etiologies contributing to ESRD among patients receiving hemodialysis. It is agreed that kidney transplantation is the main therapy of ESRD. However, there are many obstacles facing organ donation programs worldwide, such as ethical, religious, and moral issues, and factors related to access.[10] In Libya, the organ transplantation programs have been malfunctioning due to constant political instabilities which aggravated the already existing access and availability issues. More efforts and resources need to be directed toward identifying and dealing with CKD causes to protect people at risk from developing ESRD. According to early studies, hypertensive and diabetic patients make up more than one-third of ESRD cases in Africa.[2],[10] This is likely the same situation in Libya, with considerable socioeconomic differences and better health services, a slight difference might be seen. The aim of this study was to determine the epidemiological factors and frequency of diseases diagnosed in patients with ESRD who are receiving hemodialysis in the major three demographic areas of Libya.

  Patients and Methods Top

Study design and participants

This is a cross-sectional study. It is based on data collected in 2017 from 2358 patients with ESRD attending 31 hemodialysis centers across Libya. These hemodialysis centers are regionally distributed as West, East, and South.

Inclusion and exclusion criteria

Most of the ESRD patients were diagnosed based on creatinine, Urea, Albumin/Creatinine ratio before being subjected to hemodialysis. Medical files were reviewed and data about relevant preexisting diagnoses that contributed to the development of ESRD were also collected and analyzed. Hypertension diagnosis was made based on medical history, physical examination, serial blood pressure readings of >140/90 mmHg that were not normalized by lifestyle modification. Diabetes diagnosis was based on medical history, physical examination, measuring of fasting and 2 h postprandial blood glucose level, and hemoglobin A1c level of >6.5%. Glomerular diseases were diagnosed based on medical history, physical examination findings, glomerular filtration rate, proteinuria, hematuria, pyuria, cellular casts, serum complement levels, serum autoantibodies, and renal biopsies. All patients who participated in the study fit inclusion criteria and those patients who did not fit the inclusion criteria were excluded.

Ethical approval

Ethical approval was obtained from Biotechnology Research Center ethical committee (BEC-BTRC 20-2020). The data collection tool was anonymous, and data confidentiality was maintained throughout the study. This research was under monitoring from the ethical committee throughout the study.

Statistical analysis software

Statistical analysis was conducted using the SPSS software, version 23 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics were presented as the frequency with percentages. Chi-square test between categorical variables was used as appropriate. Results were considered to be statistically significant if the two-tailed P < 0.05.

  Results Top

A total of 2358 ESRD patients from the three regions were examined in this study, representing east, south, and west regions. Characteristics of the ESRD population are presented in [Table 1]. They include age, sex, demographic region, and frequency of dialysis sessions. The most affected age groups were between 40 and 59-year, with the total count of 1013 patients, forming 43%. The number of female participants was 902 (38.3%), whereas the number of male participants was 1456 (61.7%).
Table 1: Main characteristics of the study population

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The variation in regional distribution of total ESRD patients in the three regions was 16.1%: (East) 15.5% (South) and 68.4% (West). This demonstrates that two-third of the ESRD patients were residing in the west part of Libya [Table 2]. The gender distributions of ESRD patients in the three regions separately were examined and found as follows female population among ESRD patients was 6.2%, 6.6%, and 25.56% from East, South, and West regions, respectively, and the male population was found to represent 10%, 9% and 43% of ESRD population in East, South and West regions, respectively. It is clear that males were more affected by ESRD in the three regions than females. ESRD gender distributions within the three regions were found to be 37.7% (female) and 62.3% (male) in eastern region, 42.6% (female) and 57.4% (male) in southern region, 37.4% (female) and 62.6% (male) in western region. No regional gender distribution difference than the total distribution was found [Table 2].
Table 2: Distribution of gender of end-stage renal disease patients according to demographic regions

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Causes of ESRD at all age groups were investigated. Hypertension was the more frequent cause (25.4%) followed by diabetes mellitus (23.7%), hypertension and diabetes mellitus (12.9%), genetic diseases (8.2%), glomerular disease (6%), obstructive uropathy (4)%, hypertension and obstructive uropathy (0.9%), hypertension and glomerular disease (0.7%), urinary tract infections (0.3%), and unknown causes account for (17.9)%. The distribution of causes of ESRD according to age group and region is shown in [Table 3].
Table 3: Distribution of causes of end-stage renal diseases according to age group and region

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  Discussion Top

Libya is a North African country with a population of about 6.8 million, with the estimated regional resident distribution of about 3.8, 1.8, and 1.2 million in the West, South, and East, respectively. Due to the changes in the Libyan society lifestyle affected by oil production and economic growth, the Libyan population moved in the last 40 years from nomad to urban life. Most of the population resides in large cities with few in the rural areas. According to Jagannathan and Patzer[11] such changes in lifestyle could make a population to be subjected to strong changes in food consumption habits and more stressful lifestyle. With all changes mentioned, one of the big advantages of living an urban life is having more access to medical facilities, therefore detecting renal failure causes became more easier than before, whereas in the past, causes of renal failure could not be recognized in the early stages and consequently leading to the high End Stage-renal disease ESRS-related morbidity and mortality.

In this study, we focused on the causes, age and sex of ESRD patients, their regional distribution and number of dialysis sessions. Our results showed that males were more affected than females forming 61.7% of total ESRD patients with the most affected age group 40–59 years. A combination of both genders in this age group counted for 1013 patients, forming 43% of total ESRD patients. Our finding is in agreement with other studies in African countries where males constitute most of the affected population; in Sudan 63.4%,[5] in Nigeria 67.1%,[12] in Tanzania 74.4%,[10] in Benin 68%,[13] in Congo 59.0%,[14] and in South Africa 60%.[15] It is clear from these studies that ESRD affected the working-age population and thus negatively impacting the economies of these countries and more importantly their populations.[16]

The regional distribution of total ESRD patients in Libya was 16.1% (East) 15.5% (South) and 68.4% (West). Taking into consideration regional Libyan population distribution, affected Libyan populations are significantly differentiated into low prevalence in East, high in South, followed by West. This finding may be accounted to the fact that some of the southern population have no enough access to medical facilities and early detection of ESRD symptoms were not possible thus causing renal failure. In the west part of Libya falsely high percentage of ESRD was seen because of the higher population residing in this area, which is forming approximately two-third of the Libyan population.

Similar to other studies,[5],[17] the first-leading cause of ESRD in our studied population was hypertension with 25.4% of the total ESRD patients, most affected age group is 40–59 years representing 49% of hypertensive ESRD patients. In order for a kidney to function properly and nephrons to filter waste, they required sufficient blood for oxygen and nutrient supplies, which is not the case when blood vessels are damaged because of hypertension, thus leading to kidney failure.

The second leading cause found was diabetes mellitus with 23.7%, most affected age group is >60 years with representing the percentage of 43.6% of ESRD diabetes patients, and this may be attributed to the damage diabetes mellitus causes to the blood capillary, which ultimately leads to renal failure, this was in agreement with findings from previous studies.[10],[18]

Investigating the differences between ESRD causes at the regional level is very beneficial to the health system planners in each region, and the country at large. Starting by the first cause, hypertension, our study showed no significant difference between East 28.5% and South 28.6%, while a slight difference was seen in West 24%. In the case of diabetes mellitus, there was a significant difference, it was lower in the South 13.7% followed by East 21.6% and higher in the West 26.5%, the West cases are almost double the cases in the southern region. This difference might be attributed to the southern population lifestyle with more depending on physical and muscular work which may lead to high burning of glucose.

  Conclusion Top

We found large numbers of ESRD patients have hypertension and diabetes as the etiologic factor that could be prevented by an aggressive approach in controlling hypertension and diabetes mellitus. Identifying the main causes of kidney disease, the establishment of preventive public health programs will help reduce the progress of these cases to ESRD in Libya.


The authors would like to thank the support of the Authority for Research, Science, and Technology also; they would like to thank Biotechnology Research Center.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3]

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