Hypertension and nephrology

[Dialysis in Hungary: 2003-2009]

KULCSÁR Imre, SZEGEDI János, LADÁNYI Erzsébet, TÖRÖK Marietta, TÚRI Sándor, KISS István

OCTOBER 20, 2010

Hypertension and nephrology - 2010;14(05)

[The authors show the data of Hungarian dialysis statistics from 2003 to 2009. The questionnaire-based data collection was made by the Dialysis Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 45.2% over six years (an average of 7.5% per year) and the number of new ones increased by 51.2% (8.5% per year). The increase in number of patients treated with haemodialysis was 39% (6.5% per year) in this period. The increase in the number of patients in the peritoneal dialysis program was extremely high: 80.6% (an average of 13.4% per year). The population incidence of new dialysed patients was 332/1 million in 2003 and 483/1 million in 2009. The population point prevalence at the end of the year was 437/1 million in 2003, but 607/1 million in 2009. The penetrance of peritoneal dialysis was 12.8% in 2009. Differences exist among the regions of Hungary in the number of patients, the penetrance of peritoneal dialysis and the prevalence of renal replacement therapies. Among patients suffering in conditions which lead to end stage renal disease the proportion of patients with diabetic or hypertensive nephropathies is increasing and the proprtion of patients with glomerular or tubulointerstitial damage is decreasing. The number (and rate) of the elderly people is growing continuously year by year. The rate of patients on waiting list for renal transplantation is decreasing (the rate was 20% in 2003, but only 10.7% in 2009). There is also a slow decrease in the number of the annual renal transplantations. The mortality rate of chronically dialysed patients shows a little increase. Five dialysis centres for paediatric patients and 58 for adults have been functioning in Hungary by the end of 2009. In average 106 patients have been treated by each Hungarian dialysis centre in contrast to the optimal of 60 persons. The number of nephrologists increased between 2003 and 2007, but slightly decreased since then. The case is similar regarding nephrological nurses.]



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[Recent developments in the diagnosis and therapy of haemolytic uremic syndrome. Part 1: Diagnosis and initial therapy]

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[In this summary an overview is offered on the recent developments of the investigation and the treatment of hemolytic uremic syndrome. Based on the recent developments in the understanding of the pathogenesis and on the novel diagnostics there is an increasing ability to identify the etiology of specific diagnostic sub-groups of the disease. This molecular etiology-based classification and sub-group diagnosis has substantial influence on the short-term and long-term management of the affected patients. The first part of our review focuses on the steps of first and second line diagnosis and the selection between available therapeutic options, and provides flow-charts for the daily work. The various aspects of the long-term management and disease monitoring in hemolytic uremic syndrome will be reviewed in a second article in the future.]

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[Biosimilar erythropoietins in nephrology - benedictio seu maledictio?]

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[Biological medicines of protein or polypeptide origin produced with biotechnology are far more complex in structure than the low molecular weight chemical ones. In conjunction with chemical drugs generic copies are completely the same, while in the field of biological medicines only similarity can be stated, as identical molecules cannot be produced. Spatial structure, isomers and side chains cause difference and for this reason these are called biosimilar drugs. Immunogenity of biosimilar drugs is very different and the risk of antibody production against them is diverse. Pure red cell aplasia, a rare side effect of erythropoietins is a life-threatening condition so every effort must be done for its prevention. Biosimilar drugs are not to be replaced with each other, and even the reference drugs should not be substituted in order to identify easily the side effects of each drug. Importantly financing should support these clinical principles namely a cheaper drug could be started as a new treatment but a former treatment should not be replaced because of cost sensitivity. It is important to provide the availability of the very expensive biologically active drugs to each patient but it is acceptable that the treatment should be as cost-effective as possible. Similarly to the generic copy program of chemical drugs biosimilar drugs are also important for the clinical practice, however their use needs appropriate regulation and farmacovigilance.]

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[Chronic kidney disease and atherosclerosis]


[Accelerated cardiovascular disease is a frequent complication of chronic kidney disease. Chronic kidney disease promotes hypertension and dyslipidaemia, which in turn can contribute to the progression of renal failure. Diabetic nephropathy is a leading cause of renal failure. Hypertension, dyslipidaemia and diabetes together are the major risk factors of the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease. Promoters of calcification are increased and inhibitors are reduced, which favors vascular calcification, an important cause of vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke and peripheral arterial disease.]

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[Kidney transplantation in Hungary, 2010]


[Hungarian kidney transplantation has been established with three milestone operations. In 1902 Emerich Ullmann showed the technical feasibility of renal transplantation on dogs, and later the living donor transplant of András Németh in 1962 and the program starting operation of Ferenc Perner in 1973 already meant the real possibility for Hungarian patients. More than 5000 kidney transplantations were done since, and the operations are now made at the four university medical schools centers. In 2009 248 renal transplantations were done in our country (Budapest: 148, Szeged: 51, Pécs: 39, Debrecen: 34), from which 24 were living donor and nine combined kidney-pancreas cases. Despite the worsening financing situation in the health care system the numbers of transplantations are stable within a 15 year period, but this means a marked decrease in international comparison. In our country, the ratio of living donation is low, there is no paired donation, incompatible transplantation, the problems of hypersensitive patients are unresolved, and there is no old-for-old program. The solution to all of these problems could be joining to Eurotransplant, which is the definite wish of the transplant society based on the positive Slovenian and Croatian examples.]

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[The patients with sensory system impairment in peritoneal dialysis]


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[The importance of serum albumin level in patients with chronic renal disease on maintenance dialysis]

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