Update in Nephrology and Hypertension Seminar May 23–24th, 1998, Kiev, Ukraine

Lyubomyr Pyrih, Professor Dr., A. Heidland, Professor Dr. Dr.h.c. and C. Wanner, Professor Dr.

Kiev, Ukraine Würzburg, Germany

John H. Dirks, co-chair of COMGAN (Commission for Global Advancement of Nephrology) had visited Professor L. Pyrih (President of the Ukrainian Nephrological Association and Chief of the Department of Urology and Nephrology, Institute of AMS, Kiev) in Kiev in early 1998. They identified the need to provide updated information on clinical nephrology to Ukrainian physicians. This led to the decision, supported by Professor Vladmir Nikolaev (Section of Artificial Organs of National Academy of Sciences of Ukraine) to organize a 2 day course on nephrology and hypertension. The meeting was arranged by the Kuratorium Gesellschaft für Nephrologie, the Ukrainian Nephrological Association, the Joint Action of Nephrology in Central And Eastern Europe (International Society of Nephrology, European Renal Association and Gesellschaft Nephrologie).

A total of 97 physicians participated at the seminar coming from all regions of the Ukraine, particularly from the Universities/Academies in Kiev, Lviv, Kharkiv and Donetsk. Professor L. Pyrih informed the foreign visitors about the state of nephrology in the Ukraine. Nephrology was established as a clinical discipline in 1965 in Kiev. Currently there are 23 regional nephrological departments with a total of 326 clinical nephrologists. The number of nephrological beds in the Ukraine is currently 3000, i.e. 0.59 beds/10000 of population. Because of the grave economic situation, access to expensive medication such as glucocorticosteroids, cytostatic agents etc, is very limited. Haemodialysis treatment was first performed in Kiev in 1969 as reported by Professor E. Baran (specialist in haemodialysis and transplantation, Public Health Ministry of Ukraine). A major breakthrough occurred in the years of Perestroyka and with the beginning of Ukrainian independence (1988/1993), but further development was halted by the developing economic crisis. There are currently 200 dialysis centres which treat more than 800 patients with end-stage renal failure. Because of limited financial resources many centres provide treatment only to one or two dialysis sessions per week. Most dialysis units don't have access to water purification. Patients on dialysis programmes have no access to treatment with vitamins or recombinant erythropoietin. As the combined result of the above shortcomings 1-year survival is 50–80%. Haemodialysis is primarily viewed as a temporary measure to bridge over the time until kidney transplantation can be performed.

The Ukrainian transplantation programme was started in 1969 in Kiev. In the past, there have been more than 1300 kidney allotransplantations. Currently the rate is 120 transplantations per year in five transplantation centres (in Kiev, Donetsk, Lviv, Zaporizzha and Odessa). The 1-year patient survival rate is 90% and graft survival rate 82% in the Kiev transplantation centre. In 1994, a coordination centre for organ tissue and cell transplantation has been established and an Ukrainian association of transplantation medicine has been founded.

The topics that were discussed at the seminar by the lecturers included molecular genetics of hypertension (F. Luft), antihypertensive treatment (A. Distler), renal actions of diuretics (R. F. Greger), pathogenesis of IgA nephropathy (J. Floege), tubulointerstitial fibrosis (G. B. Wolf), diabetic nephropathy (A. Heidland), secondary hyperparathyroidism (S. G. Massry), lipids and progression of chronic renal disease (C. Wanner), RPGN (K. Kühn), renal replacement therapy in acute renal failure (H. G. Sieberth), recombinant human erythropoietin (J. Bommer), adequacy of haemodialysis (J. Bommer), impact of inflammation on mortality in uraemic patients (C. Wanner), absorptive treatment in nephrology (N. Nikolaev), immunosuppression in transplantation (R. Schindler), CAPD (H. Schilling), dialysis equipment (Podvorny), dialysis membranes (C. Meissner), aminoacid treatment (K. Obremska) and convective therapy (N. G. Nilsson).

The seminar was received with great interest and the lectures presented will be published in Russia in Ukrainian Medical Journals. Despite of, or rather because of, the depressing economic situation it is important that nephrologists in Western Europe continue to maintain their links with Ukrainian nephrology. It would be a serious mistake to write off the Ukraine, as currently emphasized by the Ukrainian president Leonid D. Kutschma in the magazine `Spiegel' (1998) (p 22) `Der Westen schaut weg' (Western Europe looks the other way).



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