Pan Arab Conference

‫بسم هللا الرحمن الرحيم‬
‫المعهد الطبي القومي بدمنهور‬

AKI in Hospitalized Patients during
Muslim pilgrimage (Hajj: 1432)
By
Dr. Walid Hemida Elrewihby
Nephrology Consultant
Damanhour Medical National Institute
• Hajj (a pilgrimage to Mecca in Saudi Arabia) is a
principal religious obligation for any able adult
Muslim who can afford to do so
• According to Central Department of Statistics and
Information, the total number of pilgrims for
1432 (2011) was 2,927,717
• 1, 829,195 arrived from outside the Kingdom and
the rest came from within the kingdom
• These figures are unparalleled to any other
universal mass congregation
• Most studies on Hajj pilgrims have focused
on heat related, and infectious diseases
• No available studies focusing on the

occurrence of AKI in this group of patients
• Also, there is no statistics about AKI effect on

the outcome during their hospitalization
• We aimed in our study to evaluate the
prevalence of AKI, etiology and associated
risk factors among hospitalized patients
during the Hajj time
• Also to do comparative analysis for the use of

slow continuous therapy versus conventional
HD therapy on the patient outcome
• This was a retrospective observational study
• Done between Islamic lunar dates first of Dul-
Qeda to 29th of Dul-Hejja 1432
• King Abdul Aziz Hospital, a 250-bed tertiary care
hospital, in Makkah, KSA
• One of the four main tertiary care hospitals in
Makkah City that serve pilgrims during Hajj
seasons
• A total of 851 pilgrims were admitted to hospital
• 87(10.2%) patients developed AKI
• The mean age (±SD) was 60.26 (±9.28) years with a
male predominance: men constituted 65 (74.7%) and
females 22 (25.3%)
• About 55.2% of patients were admitted to the medical
ward, 29.9% to the ICU and the remaining 14.9% to
the surgical ward
Characteristics of patients
No. of patients (%)
Age, years mean (±SD) 60.26 (±9.28)
Male 65 (74.7%)
Female 22 (25.3%)
Type of ward admission:
Medical 48 (55.2)
Surgical 13 (14.9)
Intensive care unit 26 (29.9)
Need and type of HD required:
No need for haemodialysis 66 (75.9)
Conventional haemodialysis 14 (16.1)
Continuous renal replacement therapy 7 (8)

Primary cause of admission
No. of patients (%)
Pneumonia 28 (32.2)
Renal disease 13 (14.9)
Skin Infection 9 (10.3)
Diabetes complications 8 (9.2)
Cerebrovascular strokes 8 (9.2)
Cardiovascular disorders 8 (9.2)
Gastroenteritis 5 (5.7)
Anemia 2 (2.3)
Liver disease 2 (2.3)
Traumatic Fractures 2 (2.3)
Acute abdomen 2 (2.3)
Co-morbid diseases:
Co-morbidity
No. of patients (%)
Hypertension
61 (70.1)
Diabetes Mellitus
53 (60.9)
Chronic obstructive pulmonary disease

29 (33.3)
Chronic kidney disease

28 (32.1)
Ischemic heart disease

5 (5.7)
Congestive heart failure

5 (5.7)
Chronic liver disease

3 (3.4)
Old Cerebrovascular accidents 3 (3.4)

The need and type of haemodialysis required:
No. of patients (%)
No need of haemodialysis 66 (75.9%)
Conventional haemodialysis 14 (16.1%)
Continuous Renal Replacement Therapy 7 (8%)

Outcomes on discharge of all patients according to
:the need for RRT during admission
Need for RRT (n = 21) No need for RRT (n=66)
Renal function improved 11 (52.4%) 41 (62.1%)
RRT dependant 4 (19%) 0 (0%)
CKD without RRT 0 (0%) 5 (7.6%)
Death 6 (28.6%) 20 (30.3%)

• This study is, to our knowledge, the first study
evaluating the incidence of AKI in Hajj pilgrims
• The incidence of AKI accounted for about one
tenth of all admitted Hajj patients
• The age of patients were similar to previous
studies in Hajj pilgrims
• We did not find increase in mortality during
hospitalization among patients with past
history of diabetes and hypertension diseases
• Infection was the main cause of admission for
patients who developed AKI
• Pneumonia (32.2%) was the most common
cause of admission followed by renal diseases
(14.9%) and skin infections (10.3%)
• We found no significant differences in
mortality, rate of recovery of kidney function,
or duration of RRT between the group of
patient who received conventional HD and the
other group received continuous RRT
In summary
• Infection was the main cause of admission for
patients who developed AKI
• The type of RRT used had no different effect on
the outcome at time of discharge
• Adequate fluid resuscitation in emergency
rooms can help in reducing the high incidence
of AKI at the Hajj time
• We hope that this data will help the health
care planners, administrators, and officials to
improve health care services to pilgrims in Hajj
• Also prospective studies are needed in the
future on AKI between pilgrims during Hajj
Thank you

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‫بسم هللا الرحمن الرحيم‬

‫المعهد الطبي القومي بدمنهور‬

• No available studies focusing on the

• Also, there is no statistics about AKI effect on

• Also to do comparative analysis for the use of

Type of ward admission:

Intensive care unit 26 (29.9)

Need and type of HD required:

No need for haemodialysis 66 (75.9)

Conventional haemodialysis 14 (16.1)

Continuous renal replacement therapy 7 (8)

Chronic obstructive pulmonary disease

Chronic kidney disease

Ischemic heart disease

Congestive heart failure

Chronic liver disease

Old Cerebrovascular accidents 3 (3.4)

No. of patients (%)

No need of haemodialysis 66 (75.9%)

Conventional haemodialysis 14 (16.1%)

Continuous Renal Replacement Therapy 7 (8%)

Need for RRT (n = 21) No need for RRT (n=66)

Renal function improved 11 (52.4%) 41 (62.1%)

RRT dependant 4 (19%) 0 (0%)

CKD without RRT 0 (0%) 5 (7.6%)

Death 6 (28.6%) 20 (30.3%)

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