Background: The risk factors for chronic kidney disease (CKD) are increasing in the Saudi population. Consequently, the incidence and prevalence of end-stage renal disease (ESRD) have increased substantially in Saudi Arabia over the past three decades. This study was conducted to review pre-ESRD care and investigate the primary causes of ESRD among haemodialysis patients in the western region in Saudi Arabia. Methods: A pilot cross-sectional study was conducted in Al-Noor Kidney Centre and Jeddah Kidney Centre in the western region of Saudi Arabia. Participants were patients with ESRD on regular haemodialysis during 2011. Main outcome measures were pre-ESRD care including: reason of referral to nephrology care, source of referral to nephrology care, duration of pre-ESRD care, and vascular access at the first dialysis; and primary causes of ESRD. Results: Preliminary indicators of pre-ESRD care showed that: endocrine, nutritional and metabolic diseases, and immunity disorders were the principal reason for patient referral in 50.6% (95% CIs, 45.1_56.1) of patients; 50.6% (95% CIs, 45.6_55.6) of the patient referrals arrived from the emergency department; a large proportion of haemodialysis patients were not receiving pre-ESRD nephrology care, 47.6% (95% CIs, 41.7_53.5); the predominant vascular access point for haemodialysis was initially a catheter 88.3% (95% CIs, 84.5_91.3). The dominant causes of ESRD were hypertensive nephropathy, 55.8% (95% CIs, 50.8_60.7) and diabetic nephropathy, 24.6% (95% CIs, 20.4_29.1). Conclusions: Pre-ESRD nephrology care needs to be improved in Saudi Arabia. Potential strategies could involve: regular screening of high risk people, encouraging communication between healthcare practitioners, and education on the need to refer patients with CKD to nephrology care in earlier disease stages; and increasing patients' awareness about their health conditions and potential consequences of their kidney disease.

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