Kosovo 2002: the epidemiology of renal disease and the impact of 1999 Kosovo war on end-stage renal disease patients

Myftar Barbullushi1, Ymer Elezi2 and Alma Idrizi1

1 Department of Nephrology UHC ‘M. Teresa’ Tirana, Albania 2 Department of Nephrology UH of Pristin Kosovo Email: m.barbullushi{at}yahoo.com

Sir,

Kosovo is situated in the Balkans and shares its borders with Albania, the Federal Republic of Yugoslavia (Serbia, Montenegro) and the Former Yugoslav Republic of Macedonia (FYROM). Profound political and social changes during the last decade in the former Yugoslavia have led to the independence of Kosovo in 1999 and have established it under the protection of the United Nations.

Apart from helpful reports from Lameire [1], Sikole et al. [2] and Barbullushi et al. [3] showing contributions of Macedonian and Albanian nephrologists to the treatment of renal patients from Kosovo during the most recent crisis in the region, little has been published describing health services in Kosovo. Moreover, even less is known about impacts of the 1999 war on end-stage renal disease patients in Kosovo and on the incidence and aetiology of end-stage renal disease.

The incidence of end-stage chronic renal disease in Kosovo has been estimated to be 80 per million per year [4], but the exact incidence could be underestimated due to difficulties in screening the true population of Kosovo as well as poor referral or missed cases by medical practitioners. Before the 1999 war in Kosovo, 300 patients had been under dialytic treatment.

The start of the 1999 Kosovo crisis found the local hospitals unprepared, leading to a situation of increased mortality and morbidity among the dialysis patients. Despite efforts taken to maintain dialysis services through volunteer help from physicians, nurses and technicians, the majority of dialysis patients left the country for safety during the war. Nearly 152 of these patients left for treatment in Albania, FYROM and Montenegro. Only a few patients stayed in Kosovo despite threats of war, and these remained because of inability to undertake long and risky journeys. According to our data, eight dialysed patients died at the Pristina Hospital because of lack of haemodialysis. However, this number is probably an error because some patients may have died during travel abroad. After the war almost all patients returned to Kosovo, and from these, 13 died due to different causes.

The main underlying renal diseases in 298 patients leading to end-stage renal disease and current dialysis, summarized in Table 1Go, are glomerulonephritis, pyelonephritis and benign nephrosclerosis. At present, the haemodialysis centres in Kosovo are working at full capacity. More than 65% of dialysed patients are female, which is in contrast to a male preponderance of renal replacement therapy in western countries, and this is thought to be a consequence of the war [5]. One of the most important problems is paediatric haemodialysis. Only two children are being treated by haemodialysis. The haemodialysis centre at Mitrovica has not yet begun operation and patients there are still being treated at the dialysis centre of Pristina. Successful long-term treatment of chronic renal disease in Kosovo will depend on further transfer of knowledge, training of staff and economic feasibility. Haemodialysis is expensive and has already reached the capacity limits of our centres. We therefore urge the creation of an active continuous ambulatory peritoneal dialysis programme as a complementary strategy to treat end-stage renal disease. Renal replacement therapy remains problematic for the vast majority of Kosovo patients because of its high cost. It is therefore worthwhile to use every possible means to prevent progression to the end stage. The data in the present article also confirm the dramatic effects the war had on haemodialysed patients.


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Table 1.  Renal disease leading to end-stage chronic renal disease in Kosovo

 

References

  1. Lameire N. International nephrological assistance to Kosovo refugees. Nephrol Dial Transplant1999; 14:1845[Free Full Text]
  2. Sikole A, Polenakovik M, Ivanovski N, Stojkovski L. Contribution of Macedonian nephrologists to the treatment of the renal patients from Kosovo during the recent crisis. Nephrol Dial Transplant2000; 15:132–133[Free Full Text]
  3. Barbullushi M, Koroshi A, Tase M. Albanian contribution to the treatment of refugee renal patients from Kosovo. Nephrol Dial Transplant2000; 15:1261[Free Full Text]
  4. The incidence and etiology of end-stage renal disease in Kosovo. Albanian J Sci (in press)
  5. Claus S, Roose JD, Lemaire J, Spatzker S, Veys N, Zeier M. Report on training sessions at the Pristina University Hospital Department of Nephrology and Dialysis Unit, 22–29 July 2000, by the Joint Action Nephrology Eastern Europe of ISN and EDTA/ERA. Nephrol Dial Transplant2001; 16:701–703[Free Full Text]




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