Croatia is not spared from diabetic nephropathy

Svjetlana Cala on behalf of the Croatian Registry for Renal Replacement Therapy

Nephrology and Dialysis Department "Sestre milosrdnice" Clinical Hospital Zagreb Croatia Email: svjetlana.cala{at}bol-svduh.htnet.hr

Sir,

In the article by Rutkowski [1], Croatia was pointed out as having a peculiarly low proportion of patients with diabetes amongst the dialysed patients, and low age of patients on dialysis, in spite of well-developed dialysis treatment. The data on RRT in Croatia were at that time based on the compilation of group reports from dialysis centres. The Croatian Registry for RRT, based on individual patient data, was completed in the year 2001. All dialysis (40) and transplant (two) centres contributed individual data for all treated patients.

According to the 2001 Report of the Croatian Registry for RRT, prevalence of RRT was 657 p.m.p., with an annual increase of 5.7%. Distribution among haemodialysis, CAPD and transplantation treatment modalities was 79, 6 and 15%, respectively. The median age of dialysis patients was 59 years, while 38% of them were >=65 years old. There were 18% of diabetics among the prevalent dialysis patients.

The incidence of RRT in 2001, from the first day of treatment, was 112 p.m.p. Median age of new patients was 62 years, and 43% were >=65 years old. Diabetic nephropathy was the leading cause of renal failure in incident patients, accounting for 29%. In the additional 3% of incident patients diabetes was present as a co-morbid condition.

Participation of patients with diabetes in the dialysis program in Croatia is significant (32% of incident patients and 18% of prevalent patients). Improved quality of the Croatian Registry, achieved by collecting individual patient data, enabled correction of erroneous conclusions derived from group reports. Prevalence of diabetes in dialysis patients had been underestimated by almost half (9.5 instead of 18%), and percentage of dialysis patients aged 65 years or more by a third (25 instead of 38%).

Croatia is affected by general epidemiological trends, exemplified by increasing patients’ age and a growing participation of diabetics in dialysis, in accordance with the attained rate of RRT. Endemic nephropathy (4% of prevalent patients) does not modify substantially the epidemiological situation in Croatia. A positive correlation between dialysis prevalence and the percentage of diabetics among dialysed patients is invariably present, in the registry data from various European regions [2], and in longitudinal epidemiological data from the USA [3] and Australia [4].

Conflict of interest statement. None declared.

References

  1. Rutkowski B. Changing pattern of end-stage renal disease in central and Eastern Europe. Nephrol Dial Transplant 2000; 15: 156–160[Abstract/Free Full Text]
  2. Rychlik I, Ritz E, Halimi S, Locatelli F. Epidemiology of end-stage renal disease in type 2 diabetes. In Ritz E, Rychlik I, eds. Nephropathy in Type 2 Diabetes. Oxford University Press, Oxford, UK
  3. Anonymous. Excerpts from the USRDS 1997 annual data report. II Incidence and prevalence of ESRD. Am J Kidney Dis 1997; 30 [Suppl 1]: S40–S53[Medline]
  4. Disney APS. Some trends in chronic renal replacement therapy in Australia and New Zealand. Nephrol Dial Transplant 1998; 13: 854–859[Abstract]




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