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.]



Further articles in this publication

Hypertension and nephrology

[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 18th Congress of the Hungarian Society of Hypertension]

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

PROHÁSZKA Zoltán, SZILÁGYI Ágnes, SZABÓ Melinda Zsuzsanna oh., RÉTI Marienn, REUSZ György

[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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[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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[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

Hypertension and nephrology

[Covid-19 and the kidney]

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[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Hypertension and nephrology

[Experience with mycophenolate mofetil containing immunosuppressive regimen in de novo kidney transplant recipients (ORANGE study).]


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