Epidemiology of End-Stage Renal Disease and Current Status of Hemodialysis in Yugoslavia

Abstract

Maintenance hemodialysis (HD) in Yugoslavia started in the sixties and followed the dialysis trends in the Western Europe. However, in the last decade the development of renal replacement therapy (RRT) slowed down. In this report the epidemiology of ESRD from 1997–1999 and the survey of the status of HD treatment in Yugoslavia in 1999 are presented. Epidemiological data are obtained by the annual center questionnaires (response rate: 92.6 −94.2%). The survey of HD status is based on a specific questionnaire and covered 2108 patients (65%). At the end of 1999 there were 56 RRT centers in Yugoslavia treating 3939 patients: 3232 (82%) patients by HD, 248 (6.3%) by peritoneal dialysis, and 459 (11.7%) living with transplanted kidney. In a three year period, incidence of ESRD ranged from 108–128 pmp, point prevalence from 435–463 pmp and mortality rate from 20.7–17.9. Numerous refugee patients were treated over the last 10 years. Main causes of ESRD were glomerulonephritis (30%); Balkan nephropathy represented 11% and diabetic nephropathy 7% of all primary renal diseases. Cardiovascular and cerebrovascular diseases were the most common causes of death of RRT patients. Most centers are overcrowded and HD machines are worn out. Mean Kt/V was 1.19±0.08, mean URR% 58.8±7.4. The shortage of drugs prevented adequate management: 83% of HD patients had hemoglobin level less than 100 g/L but only 10.3 −17.8% were treated with rHuEpo; 64.5% of patients had phosphate levels higher than 1.7 mmol/L but only 33.5% used phosphate binders; 47% of patients had hypertension despite the antihypertensive therapy. The prevalence of hepatitis B remained unchanged (about 14%) in HD population during the last three years, but the prevalence of anti-HCV positive patients decreased (31–23%). In conclusion, there is a well developed dialysis service in Yugoslavia but insufficient conditions for adequate treatment.

Ochratoxin A: The Continuing Enigma

“…40,41 Currently, BEN represents 11% of all primary renal diseases diagnosed in the former Yugoslavia (for comparison, diabetic nephropathy represents only 7%). 42 BEN is characterized by progressive tubulointerstitial nephropathy, leading to tubular atrophy, periglomerular fibrosis, and cortical cysts, inevitably progressing to degenerative and necrotic renal epithelia, hyperplastic arteriopathy, and end-stage renal failure. 41,43 The accompanying functional deficits in the early stages of the disease, which begins without an acute episode, include increased urinary concentrations of glucose, proteins, leucine aminopeptidase, and γ -glutamyl transferase, coupled with a decrease in serum cholesterol and protein concentration.…”

Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil

“…The general reduction in HCV seroprevalence points to advances in the management of chronic renal treatment and in the control of HCV transmission (11). Some of these advances were the introduction of recombinant erythropoietin for the treatment of anemia that eliminated the need for regular blood transfusion, the routine anti-HCV screening test implemented at the blood centers preventing the transfusion route of HCV transmission, the modernization of new dialysis equipment, and the requirement of periodic anti-HCV screening of all patients undergoing hemodialysis treatment that permitted the individualization of treatment.…”

Relation between Serum Urea and Mortality of Hemodialysis Patients

“…The target Kt/V was higher than 1.2, but it was not possible to reach it because of economic depression. [13] Analysis of the relation between urea in the baseline period and mortality in patients with Kt/V >1.2 revealed a similar curve as in the whole cohort, while urea in the baseline period was not a significant predictor of mortality in this group of patients. These two data lessen the significance of the first limitation.…”