| Abstract
| - Background. Until 1990, haemodialysis (HD) in Lithuania was underdeveloped, but after independence, development of HD started. Until 1996, no precise data about HD patients in Lithuania were available. In order to create a registry of HD, we started to collect data about dialysis services and HD patients in 1996. Every collection of data was followed by distribution and discussion of the results within the nephrological community. This study describes the changes of Lithuanian HD between 1996-2002. Methods. Between 1996 till 2002 all HD centres in Lithuania were annually visited and data were collected about all HD patients (response rate of 100%). The evaluation of the results during our observational study was made according to the European Best Practice Guidelines. During annual conferences for nephrologists, the guidelines and data of our HD registry were presented. Results. There was an increase in the number of HD stations (from 25 p.m.p. to 75 p.m.p., P<0.001), in HD patients (from 60 p.m.p. to 237 p.m.p., P<0.001) and in the incidence of new HD patients (from 54.3 p.m.p. to 103 p.m.p., P<0.01). The mean age of HD patients increased from 47.2±16.1 years in 1996 to 56.0±14.9 in 2002 (P<0.001). The main underlying cause of ESRD was chronic glomerulonephritis, but its rate decreased from 54.5% in 1996 to 27.5% in 2002 (P<0.001). The percentage of diabetics increased from 7.1% to 16.4%, P<0.05, and in hypertensive nephropathy from 3.1% to 10.9%, P<0.05. We observed improvement of the quality of HD in Lithuania during these 5 years. The percentage of patients on bicarbonate HD increased from 7.1% in 1996 to 100% in 2002 (P<0.001). The percentage of patients receiving more than 12 h HD/week increased from 30.8% in 1996 to 53.5% in 2002 (P<0.001). The mean Kt/V in 1999 was 0.81±0.53, but it increased in 2002 to 1.22±0.27, P<0.001. In 2002, 84.6% of all HD patients were examined for HBsAg, 82.3% for anti-HCV, 31.2% for anti-HBs and 57.1% for anti-HBc. The percentage of patients receiving phosphate binders increased from 65.2% in 1996 to 84.4% in 1997 and 90.5% in 2002. Serum parathyroid hormone (PTH) levels were measured in 27.3% of HD patients in 1999 but in 85.2% of patients in 2002. The mean haemoglobin (Hb) concentration increased from 92±15.4 g/l to 105±14.7 g/l; the percentage of patients with Hb>100 g/l increased from 27.5% to 64% in 2001. The percentage of HD patients receiving epoetin was 94.6% in 2001 as compared with 78% in 1997. There was a marked increase in the use of intravenous iron (from 7.5% patients in 1997 to 70.8% in 2000). The mean weekly dose of Epo was lower in HD patients receiving intravenous iron than in patients receiving oral iron. Conclusions. Over the period of 1996-2002 the HD services significantly expanded in Lithuania. The introduction of European Best Practice Guidelines and the establishment of a HD registry with feedback of the results stimulated the significant progress in the quality of HD and in the management of the patients.
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