Contribution of Macedonian nephrologists to the treatment of the renal patients from Kosovo during the recent crisis

A. Sikole, M. Polenakovic, N. Ivanovski and Lj. Stojkovski

Department of Nephrology, University of Skopje, Republic of Macedonia

Sir,

Reading the special report entitled `International nephrological assistance to Kosovo refugees' by Professor Norbert Lameire, published in Nephrol Dial Transplant 1999; 14: 1845, we felt inspired to report on our contribution to the assistance of the refugees from Kosovo, who needed renal replacement therapy.

During the war in Kosovo, some 250000 refugees were admitted to Macedonia, a number that far surpassed the capacity of a small country with a population of 2 million. Among them, 70 patients from the chronic haemodialysis programme of Kosovo came to be treated in our dialysis facilities. The Department of Nephrology from the University of Skopje co-ordinated the distribution of the patients. They were referred to four dialysis centres. Most of the patients (approximately 50) were sent to Struga, the second largest centre in Macedonia, and the rest were dialysed in Tetovo, Gostivar and Debar.

The Department of Nephrology also cared for some transplanted patients. Our renal transplant unit provided medical assistance and special care to five patients with renal allografts. Two of them were recent transplants (one transplant in Belgrade and the other in Moscow). For all of them we provided regular outpatient monitoring, continued supply of immunosuppressants such as Neoral and Cellcept, as well as hospital treatment when needed.

Our dialysis infrastructure and disposables were exerted to the extreme, and we asked for help from the United Nations High Commission for Refugees (UNHCR), to transfer some of the patients to other countries in Europe. Dr Brent Burkholder of the UNHCR co-ordinated the evacuation. Eight patients with their families were evacuated to Belgium and six patients with their families to The Netherlands. Professor M. Molzahn from the Kuratorium fur Dialyse offered to accept 10–20 patients and their families in Germany. Unfortunately, for reasons unknown to us, this evacuation was never carried out, though we had recruited more than 20 patients for evacuation. We are unaware that patients-refugees admitted in Macedonia went to any other countries.

In addition to this assistance, we received 14 dialysis machines from Fresenius Medical Care (three from Italy, three from the Kuratorium fur Dialyse in Germany and eight from Fresenius, Germany), as well as 960 dialysis filters thanks to special efforts made by Professor J. Vienken, Fresenius Medical Care. Also Baxter Europe, through Americares foundation, sent us CAPD solutions (3600 2 l bags), five Tenkhoff catheters and 288 dialysis filters. Gambro Company donated nearly 15000 2 l CAPD bags, 2400 high-flux dialysis filters with a-v lines and dialysis needles. At present we still have six patients from Kosovo on our dialysis programme. The other patients returned home.

We are grateful to Fresenius, Gambro and Baxter for their support, as well as to the UNHCR and the European Renal Disaster Relief Task Force for their support and assistance. We also wish to acknowledge that The Republic of Macedonia with its modest possibilities and limited resources, undertook a lion's share of the burden in the care for the renal patients from Kosovo during the recent refugee crisis.