RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA IN YEAR 2011. Halima Resić, MD, PhD - Clinic for Hemodialysis, Clinical Center University of Sarajevo Besim Prnjavorac, MD, PhD - Hospital Tesanj
Thanks We are very grateful to colleagues from the Centers for hemodialysis for participation in data collection for the Renal Registry of Bosnia and Herzegovina Hospital Samac, Nenad Petković Hospital Brcko District, Vera Marincic Hospital Foca, Marijana Kovacevic Hospital Prijedor, Ljubomir Vukovic Center for dialisys KB Zenica, Vedad Gradincic Center for dialisys - Hospital Tesanj, Besim Prnjavorac Center for dialisys KB Mostar, Slavica Ćoric Center for dialisys Konjic, Amira Alajbegovic Dzumhur Center for dialisys Livno, Zdenka Kelava Dijalizni centar Gracanica, Nermin Slamnik Health Center Zivinice, Ismet Kutlovac Eurodialisys center Bihac, Mirjana Mujakic Hemodialysis Doboj, Gordana Zole IDC Banja Luka, Biljana Jakovljevic IDC Bijeljina, Ljiljana Lukic IDC Gradiska, Aleksandar Arezina Hospital Travnik, Faruk Bahtic KCMF East Sarajevo center for dialisys, Olivera Seslija Clinic for dialisys KCU Sarajevo, Halima Resic Clinic for nephrology KCU Sarajevo, Senija Rasic Department for dialisys HC Zvornik, Koviljka Bogicevic Hospital Trebinje, Branimir Cihoric Pediatric Clinic CCU Sarajevo, Danka Pokrajac Center for dialisys Ilidza, Emir Avdic UCC Tuzla, Enisa Mesic County Hospital Orasje-department for dialisys Odzak, Želimir Stipancic 2
Centers for dialysis and transplantation in Bosnia and Herzegovina Konjic 1.224 patient (41,8%) DIJALYSIS CENTERS in B&H Total number of patients in 2011. (by centers in FBiH, RS & Brčko district) Banja Luka 194 Bihac 119 Bijeljina 303 Brcko 74 Doboj 124 Foca 21 Gradiska 38 Gracanica 95 Ilidza 60 East Sarajevo 73 Konjic 22 Laktasi 100 Livno 37 Mostar 185 Odzak 101 Pediatric clinic Sarajevo 3 Prijedor 71 Sarajevo-Clinic for HD 218 Sarajevo-Clinic for nephr. 92 Šamac 93 Tesanj 47 Travnik 123 Trebinje 31 Tuzla 285 Zenica 267 Zvornik 77 Zivinice 72 TOTAL: 2.925 3
Distribution of dialysis patients in B&H at the day 31.12.2011. by age group and sex Age group Male Female 0-19 15 (0,9%) 10 (0,8%) 20-44 288 (17,1%) 172 (13,8%) 45-64 772 (45,9%) 514 (41,4%) 65-74 369 (21,94%) 339 (27,3%) 75+ 238 (143,1%) 208 (16,7%) Median 59,4 year 62,3 year 4
Epidemiology chronic renal failure - prevalence Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 5
Prevalence >90 day 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0 2591 2161 2312 2362 2006 1860 No. of pati ent pmp 729,7 564,9 608,6 651,1 665,2 485,4 2006 2007 2008 2009 2010 2011 Year 6
Age group of prevalence patient (>90 dana) December 31. 2011. 0-19 20-44 45-64 65-74 75+ Males (n) 10 220 631 296 175 Females (n) 9 137 450 277 157 Total (n/%) 19 (0,8%) 459 (15,1%) 1192 (45,8%) 591 (24,3%) 319 (14,0%) 7
Epidemiology chronic renal failure - incidence Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 8
Incidencee in B&H (at day 1) comparation 2002.-2011. Entity Federation BiH R. Srpska DC Brcko Bosnia and Herzegovina Incidencee in B&H (at day 1) Year 2002 Year 2011 N pmp N pmp -* -* 266 -* -* -* 160 -* -* -* 6 -* 420 109,7 432 123,1 -* No data 9
Incidence at day 1 (pmp) 2011 432 123,1 No. of patient pmp 2010 510 145,4 2009 554 157,9 Year 2008 572 163,1 2007 576 164,2 2006 531 151,7 0 75 150 225 300 375 450 525 600 675 750 Note: The increase (or decrease) incidencee was relatively because there are no reliable data on population in Bosnia and Herzegovina 10
Incidence at day 91 (pmp) 2011 392 111,7 2010 471 134,3 Year 2009 2008 490 139,7 362 103,2 2007 2006 346 98,6 324 92,6 No. of patient pmp 0 75 150 225 300 375 450 525 600 Note: The increase (or decrease) incidence was relatively because there are no reliable data on population in Bosnia and Herzegovina 11
Epidemiology CKI Primary renal disease Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 12
Primary renal disease in Year 2011 25% 21,1% 19,6% 20% 17,3% 17,9% 15% 10% 9,1% 8,3% 5% 0% 13 % Diabet. Nph. Pyeloneph. Glomeruloneph. Hipertens. Miscell. Unknown Primary disease
Balkan endemic nephropathy in Year 2011 Balkan endemic nephropathy is the most endemic renal disease in the north-east of Bosnia. Of 328 patients with Balkan nephropathy 75.1% were older than 65 years. Patients with Balkan nephropathy constitute 11.2% of the total number of dialysis patients. 14
11,2% Balkan endemic nephropathy in Year 2011 Dialisis population Balkan nephropaty 15
Balkan endemic nephropathy per Years 31. december 2004 2005 2006 2007 2008 2009 2010 2011 Number of patient/pmp 248/70 246/70 270/77 285/81 306/87 306/87 291/83 328/94 Males (%) 48,6% 48,4% 44,6% 44,2% 47,4% 50% 51,2% 51,5% Females (%) 51,4% 51,6% 55,4% 55,8% 52,6% 50% 48,8% 48,5% 16
Age group of patients with Balkan endemic nephropathy December 31. 2010 0-19 20-44 45-64 65-74 75+ Males (n/%) 0/ 0,0% 1/ 0,6% 34/ 20,1% 82/ 48,5% 52/ 30,8% Females (n/%) 0/ 0,0% 1/ 0,6% 26/ 16,4% 66/ 41,5% 66/ 41,5% 17
Epidemiology chronic renal failure Treatment modality Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 18
Modality patients treatment 2400 2200 2000 1891 2070 2161 2199 2305 2249 1800 Number of patients 1600 1400 1200 1000 800 600 Haemodialysis Peritoneal dialysis Transplantation 400 200 94 101 110 151 117 164 119 167 96 167 0 2006 2007 2008 2009 2010 2011 Year 19
Blood transmitted diseases Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 20
Blood transmitted diseases in Year 2011 (all patients in 2011. year) HbsAg 0,8% (n=24) 0,0% (n=0) 2,7% (n=80) HCV HbsAg+HCV HIV 12,4% (n=362) 21
Vascular access (all patients in 2011. year) Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 22
Vascular access in Year 2011 13,7% 0,8% AV fistula AV graft Catheter 73,5% 23
Vascular access - AV fistula 2000 1800 1600 2055 1400 No. of patient 1200 1000 800 600 400 200 0 Forearm 95 Upper arm 24
Vascular access - AV graft 18 No. of patients 15 12 9 6 10 10 3 3 0 Forearm Upper arm Thigh 25
Vascular access temporary catheter 105 90 105 No. of patients 75 60 45 59 30 15 0 Subklavia vein Jugular vein Femoral vein 4 26
Vascular access permanent catheter Permanent catheter at the end of 2011.. year had 2352 (8.1%) patient 27
Acute renal failure Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 28
Causes acute renal failure 325 300 275 307 No. of patients 250 225 200 175 150 125 100 241 75 50 82 25 0 Pre-renal Renal Post-renal 29
Outcome acute renal failure No. of patients 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0 289 257 Deaths Cured Continuing chronic dialysis program 88 30
Outcome Prevalence Incidence Primary renal disease Modality of treatment Blood transmitted diseases Vascular access Acute renal failure Outcome 31
Mortality rate of patients on dialysis Percent mortality patients per years 2011 13,6% 2010 12,0% year 2009 2008 16,1% 14,6% 2007 13,9% 0% 2% 4% 6% 8% 10% 12% 14% 16% Percent mortality 32
Causes of mortality of dialysis patients in Year 2011 Causes of mortality Accident Cardiac-Vascular Cancer Unknown/unavailable Infection Gastro-intestinal 1 0,3% 42 10,6% 30 7,6% 33 8,4% 18 4,6% 253 64,1% Liver disease 7 1,8% 0 25 50 75 100 125 150 175 200 225 250 Numerical value and percent 33 33
The total number of patients with functioning kidney graft in B&H (situation on December 31.2011) Total 167 Unknown 3 Cadaveric Unrelated 24 36 Related 104 0 25 50 75 100 125 150 Number of patients w ith functioning kidney graft 34
Conclusions Number of dialysis patients in Bosnia and Herzegovina continues to increase; 2002 nd (when the register is established) the number was 1.531 and December 31.2011 year 2.925, an increase of 91%. incidence of patients on dialysis >90 days also increased, in 2011. amounted to 123,1. The most common causes of renal failure in Bosnia and Herzegovina are: Glomerulonephritis Pyelonefritis Diabetes mellitus (typ I i II) 35
Conclusions (continued) Balkan nephropathy and Hypertension Diabetes mellitus Typ I i II is present in 506 patients in Year 2011, or 17,3% compared to the total number of patients. Balkan endemic nephropaty is present in 328 patients, or 11,2% compared to the total number of patients. Mortality in Year 2011 of 13,6% can be explained by the age of patients on dialysis, as in Year 2011 there were a total of 39,4% of patients aged over 65 years. 36