Post on 09-Sep-2019
RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA IN 2017
Halima Resic, MD, PhD - Clinic for haemodialysis, Clinical Center University of Sarajevo Besim Prnjavorac, MD, PhD – Hospital Tesanj
Zahvalnost Kolegama iz centara za dijalizu i transplantaciju na učešću u prikupljanju
podataka za Renalni registar Bosne i Hercegovine
2
Banja Luka, Aleksandar Arezina
Bihac, Mirjana Mujakic
Bijeljina, Ljiljana Lukic
Brcko District, Vera Marincic
Doboj, Gordana Zole
Foca, Marijana Kovacevic
Gradiska, Dejan Daljevic
Gracanica, Nermin Slamnik
East Sarajevo, Olivera Seslija
Konjic, Indira Spanja
Laktasi, Biljana Jakovljevic
Livno, Zdenka Kelava
Mostar, Slavica Coric
Orasje - Odzak, Zelimir Stipancic
Prijedor, Ljubomir Vukovic
Samac, Nenad Petkovic
Sarajevo - Clinic for haemodialisys, Halima Resic
Sarajevo - Clinic for nephrology, Senija Rasic
Sarajevo, Pediatric Clinic, Danka Pokrajac
Sarajevo – Ilidza, Emir Avdic
Tesanj, Besim Prnjavorac
Travnik, Dzemil Hrnjic
Trebinje, Branimir Cihoric
Tuzla, Enisa Mesic
Zenica, Lejla Hantalasevic Becic
Zvornik, Koviljka Bogicevic
Zivinice, Mersiha Cerkezovic
Centers for dialysis and transplantation in Bosnia and Herzegovina
3
Transplantaton
Centers inu BiH
Dialysis centers
with the highest
number of patients
with endemic
nephropathy
1257 patients
(41,5%)
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
4
Epidemiology HBB - Incidence
Incidence in B&H (at day 1) - comparasion Years 2002-2017
Incidence u B&H (at day 1)
Year 2002 Year 2017
N pmp N pmp
Federation B&H 252 * 228 102,7
R. Srpska 120 * 140 114,0
Distrikt Brcko 18 * 14 167,6
Bosnia & Herzegovina 390 101,8 382 108,2
5
* In 2002 there were no official data on the number of inhabitants by entities and Brcko DC.
6
Incidenc patients (at day 1) by age, by entity and Brcko DC, in year 2017
Year 2017 Age group Total
(N) 0-19 20-44 45-64 65-74 ≥75
Federation
B&H 3 (1,3%) 22 (9,6%) 100 (43,9%) 65 (28,5%) 38 (16,7%) 228
R. Srpska 1 (0,7%) 153 (10,7%) 51 (36,4%) 45 (32,1%) 28 (20,0%) 140
Distrikt Brcko 0 (0,0%) 3 (21,4%) 5 (35,7%) 5 (35,7%) 1 (7,1%) 14
Bosnia and
Herzegovina 4 (1,0%) 40 (10,5%) 156 (40,8%) 115 (30,1%) 67 (17,5%) 382
7
Incident patients (per day) in B&H, by age, by entities and Brcko DC in 2017 - graphical
1,3
(3 p
at.
)
9,6
(22 p
at.
)
43,9
(100 p
at.
)
28,5
(65 p
at.
)
16,7
(38 p
at.
)
0,7
(1 p
at.
)
10,7
(15 p
at.
)
36,4
(51 p
at.
)
32,1
(45 p
at.
)
20,0
(28 p
at.
)
0,0
(0 p
at.
)
21,4
(3 p
at.
)
35,7
(5 p
at.
)
35,7
(5 p
at.
)
7,1
(1 p
at.
)
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
0-1
9
20-4
4
45-6
4
65-7
4
75+
0-1
9
20-4
4
45-6
4
65-7
4
75+
0-1
9
20-4
4
45-6
4
65-7
4
75+
FBIH RS Brcko DC
Age group
%
8
Incidence in the last 5 years - graphical
108,2112,1
114,4
120,9
116
105,0
110,0
115,0
120,0
125,0
2013 2014 2015 2016 2017
Godina
Pm
p
9
Incidenc patients (at day 1) - abstract
Of 382 incident patients in 2017 (108,2 pmp), 231 patients vere man (133,4 pmp) and 151 woman (83,9 pmp).
Man make up 60,5% of all incidenc patients at day 1.
Average age of the 382 incidenc patients is 61,8
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
10
Renal failure epidemiology - Prevalence
Distribution of dialysis patients by age and gender at day 31.12.2017
Age group All Males Females
0-19 18 (0,7%) 11 (0,7%) 7 (0,7%)
20-44 453 (17,1%) 288 (18,0%) 165 (15,7%)
45-64 1111 (41,9%) 701 (43,8%) 410 (39,0%)
65-74 644 (24,3%) 374 (23,4%) 270 (25,7%)
75+ 427 (16,1%) 227 (14,2%) 200 (19,0%)
Total : 2653 1601 1052
Mediana 61,0 godina 60,0 godina 63,0 godina 11
12
Prevalent patients age group on the 31.12.2017 - graphical
0,7
%
17
,1%
41
,9%
24
,3%
16
,1%
0-19 20-44 45-64 65-74 75+
Age group
13
Prevalence in the last 5 years - graphical
74
2,6
74
8,5
74
5,4 74
9,9
75
1,3
730,0
735,0
740,0
745,0
750,0
755,0
760,0
765,0
2013 2014 2015 2016 2017
Year
Pm
p
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
14
Epidemiology - Primary renal disease
15
The most common causes of renal failure in prevalence of patients in B&H in 2017
20
,1%
13
,8%
13
,0%
19
,7%
17
,2%
10
,1%
GN PN HT DM Misc. Unkn.
16
Prevalence of primary renal disease in the period 2013-2017 Years
GN;
150,7 pmp
PN;
103,9 pmp
DM;
147,8 pmp
HT
97,4 pmp
PKD;
40,8 pmp
20,0
40,0
60,0
80,0
100,0
120,0
140,0
160,0
2013 2014 2015 2016 2017
Year
Pm
p
17
Diabetic nephropathy in the incidence and prevalence of patients in the period 2006-2017 Years
Incidenc
Pmp=32,6
Prevalenc
Pmp=147,9
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
110,0
120,0
130,0
140,0
150,0
160,0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year
Pm
p
Incidence (pmp) Prevalence (pmp)
Diabetic nephropathy in 2017 (age group of incident patients with DM)
18
N=
19;
16,5
%
N=
41;
35,7
%
N=
0;
0,0
% N=
11;
9,6
%
N=
44;
38,3
%
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
0-19 20-44 45-64 65-74 75+
Age group
%
0
4
8
12
16
20
24
28
32
36
40
44
Patients
num
ber
Diabetic nephropathy in 2017 (age group of prevalent patients with DM)
19
N=
184; 3
5,2
%
N=
74; 1
4,2
%
N=
1; 0
,2%
N=
180; 3
4,5
%
N=
83; 1
5,9
%
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
0-19 20-44 45-64 65-74 75+
Age group
%
0
20
40
60
80
100
120
140
160
180
Patients
num
ber
Diabetic nephropathy in year 2017 Diabetes typ
20
35
80
10
20
30
40
50
60
70
80
Bro
oj paci
jenata
Diabetic nephropathy
INCIDENT PATIENTS (at day 1)
DM - Typ I
DM - Typ II
271
251
100
125
150
175
200
225
250
275
Bro
oj paci
jenata
Diabetic nephropathy
PREVALENT PATIENTS
DM - Typ I
DM - Typ II
21
Balkan endemic nephropathy in year 2017 - Introduction
• Balkan endemic nephropathy is the most endemic renal disease in the north-east of Bosnia.
• Of 205 patients with Balkan nephropathy 89,7% were
older than 65 years of age.
• Patients with Balkan nephropathy constitute 7,7% of
the total number of dialysis patients in Bosnia and
Herzegovina.
22
Balkan endemic nephropathy in year 2017 - gaphical
7,7%
(205 patients)
Dialysis population
Balkan nephropathy
Balkan endemic nephropathy 2008 - 2017
23
31.12. godine Number of patients /pmp Males (%) Females (%)
2008* 305/86,9 pmp 49,8% 50,2%
2009 295/84,1 pmp 50,8% 49,2%
2010 301/85,8 pmp 50,5% 49,5%
2011 286/81,5 pmp 52,5% 47,5%
2012 271/77,2 pmp 50,9% 49,1%
2013 251/71,6pmp 50,6% 49,4%
2014 246/70,1 pmp 51,2% 48,8%
2015 234/66,3 pmp 51,3% 48,7%
2016 226/64,0 pmp 52,2% 47,8%
2017 205/58,1 pmp 50,2% 49,8%
* In 2008, the number of patients had its maximum. Since then, that number
has been falling steadily.
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
24
Epidemiology - Treatments modality
Treatments modality prevalent patients in last 5 years
89
,5%
3,3%
7,3%
89
,3%
3,2%
7,6%
88
,8%
2,8%
8,4%
85
,1%
3,1%
11,7%
83
,3%
3,3%
13,3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
%
2013 2014 2015 2016 2017
Year
Transplantation
Peritoneal dialysis
Haemodyalisis
25
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
26
Blood transmitted diseases
27
Blood transmitted diseases – prevalent patients - year 2006-2017
31.12. HbsAg
(N / %)
HCV
(N / %)
HbsAg + HCV
(N / %)
HIV
(N)
MRSA+
(N)
2006 93 / 4,4% 342 / 16,3% 24 / 1,1% 1 1
2007 91 / 4,0% 352 15,5% 24 / 1,0% 1 0
2008 82 / 3,5% 309 13,2% 21 / 0,9% 1 5
2009 90 / 3,8% 308 12,9% 19 / 0,8% 1 5
2010 77 / 3,1% 336 13,5% 23 / 0,9% 1 8
2011 70 / 2,8% 296 11,9% 18 / 0,7% 1 9
2012 64 / 2,5% 273 10,8% 19 / 0,7% 1 6
2013 63 / 2,4% 246 9,3% 18 / 0,7% 1 9
2014 58 / 2,2% 228 / 8,5% 73 / 2,7% 1 6
2015 56 / 2,1% 242 / 9,1% 15 / 0,6% 1 4
2016 54 / 2,0% 173 / 6,5% 11 / 0,4% 1 3
2017 54 / 2,0% 158 / 6,0% 11 / 0,4% 1 3
16,3%
6,0%
5,0
7,0
9,0
11,0
13,0
15,0
17,0
2006 2017
Year
%
Anti HCV+
A significant reduction in % of the hepatitis “C”; From 16,3% in 2006 to 6,5% in 2017
1 patient
HbsAg+;
2,4 %
64 patients
HbsAg+HCV;
0,5 %
14 patients
HCV+;
6,0%
158 patients
Dialysis population
HbsAg +
Anti-HCV +
Anti-HCV+HbsAg
Anti-HIV +
28
Blood transmitted diseases - graphical (at day 31.12.2017)
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
29
Vascular access
Vascular access for haemodialysis – comparasion 2006-2017
30
Year 2006 2017
AV fistula (%) 81,7% 79,4%
Forearm (%) 95,1% 92,5%
Upper arm (%) 4,9% 7,5%
AV graft (%) 1,4% 0,2%
Forearm (%) 42,3% 40,0%
Upper arm (%) 11,5% 0,0%
Thigh (%) 46,2% 60,0%
Catheter temporary (%) 2,9% 8,5%
Subklavia vein (%) 50,0% 29,8%
Jugular vein (%) 48,1% 64,9%
Femoral vein (%) 1,9% 5,3%
Tunneled catheter (%) 3,6% 10,0%
AV Graft
5 pat.;
0,2%Katheter
temporary
188 pat.;
8,5%
Tuneled
katheter
221 pat.;
10,0%
AV Fistula
1756 pat.;
79,4%
31
Vascular access for haemodialysis - grafical (at day 31.12.2017)
Upper arm
1624 patients;
92,5%Forearm
132 patients;
7,5%
32
Vascular access for haemodialysis - AV fistula (at day 31.12.2017)
Thigh;
2 pacijentaForearm;
3 pacijenta
Upper arm;
0 pacijenata
33
Vascular access for haemodialysis - AV graft (at day 31.12.2017)
34
Vascular access for haemodialysis - Catheter temporary; (at day 31.12.2017)
Jugularis vein
122 patients;
64,9% Subklavia vein
56 patients;
29,8%
Femoralis vein
10 patients;
5,3%
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
35
Acute renal failure in 2017
Causes of acute renal failure in year 2017
222
150
77
50
100
150
200
250
Pa
tie
nts
n
um
be
r
Pre-renal Renal Post-renal
36
Outcome of acute renal failure in year 2017
50,1%
32,3%
17,6%
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
50,0
55,0
%
Deaths Cured Continuing chronic dialysis
program
37
Incidence
Prevalence
Primary renal disease
Treatments modality
Blood transmitted diseases
Vascular access
Acute renal failure
Outcome
38
Outcome
39
Mortality rate of patients on dialysis, (included patients at day 1), in period 2003-2017
12,4%
12,3%
12,9%
10,7%
10,1%
11,6%11,2%
10,5%
12,0%
13,3%
11,7%
13,7%
13,5%
10,2%
11,9%
9,0%
10,0%
11,0%
12,0%
13,0%
14,0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year
%
40
The most common causes of death patients in 2017
Gastro-
intest.;
2,1%;
Infection;
7,2%
Unkn.;
10,7%
Cardiac;
45,2%
Vascul.;
19,3%
Cancer;
12,6%
Misc.;
2,1%
Living
unrelated;
13,3%
Cadaveric;
31,1%
Unknown;
1,7%
Living related;
54,0%
41
Patients with functional renal graft at day 31.12.2017 - graphical
42
Patients age group with functional renal graft at day 31.12.2017
2,5
% (
9 p
at.
) 47,2
% (
167 p
at.
)
44,9
% (
159 p
at.
)
4,8
% (
17 p
at.
)
0,6
% (
2 p
at.
)
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
50,0
%
0-19 20-44 45-64 65-74 75+
Age group
43
Patients with functional renal graft at day 31.12.2017; By gender
248
106
0
25
50
75
100
125
150
175
200
225
250
Num
ber
of patients
wid
th funct
ional gra
ft
Male Female
Number of dialysis patients in Bosnia and Herzegovina continues to increase; 2002., when the Renal Registry was established, the number of patients was 1616 and 31.12.2017 2653 an increase of 64,2%.
The incidence of dialysis patients (at day 1) was 108,2 pmp in 2017.
The most common causes of renal failure in Bosnia and Herzegovina are:
Glomerulonephritis Pyelonephritis Diabetes mellitus (types I and II) Balkan endemic nephropathy Hypertension
44
Conclusions
Diabetes mellitus type I and II on 31.12.2017, is present in 522
patients, or 19,7% compared to the total number of prevalent
patients.
Balkan nephropathy on 31. 12. 2017, present in 205 patients, or
7,7% relative to the total number of prevalent patients and has a
decreasing trend.
45
Conclusions (continued)
In the last 5 years we can see a slight reduction or stagnation of
Blood transmitted diseases in dialysis patients, especially when it
comes to hepatitis.
Mortality of patients in 2017 was 12,4% of the total number of
patients in 2017 (3027) and is correlated with the age of patients,
because in 2017 there were a total of 46,7% of patients aged 65
and over year.
46
Conclusions (continued)