[The prevalence of Fabry's disease among male patients on hemodialysis in Lithuania (a screening study)]. / Fabry ligos paplitimas tarp hemodializuojamu ligoniu (vyru) Lietuvoje (atrankinis tyrimas).

UNLABELLED: Fabry's disease is an X-linked inborn error of glycosphingolipid metabolism caused by a deficiency of the lysosomal hydrolase alpha-galactosidase A. Due to deficiency of this enzyme activity, a progressive lysosomal accumulation of glycosphingolipids, in particular globotriaosylceramide, takes place within endothelial cells and cells of the vascular and nervous systems, myocardial cells, endothelial, and mesangial and epithelial cells of the kidney, eventually leading to organ dysfunction. The degree of renal involvement generally correlates with the progression of glycosphingolipid accumulation and may lead to renal insufficiency and failure. Renal dysfunction can progress to end-stage renal failure, which usually occurs in the third to fifth decade of life. The prevalence of this disease among males on chronic hemodialysis is different in various countries. Screening for alpha-galactosidase A deficiency by blood spot tests was performed among 536 male dialysis patients in all 42 hemodialysis centers in Lithuania in the period of April-June, 2005. All tests, showed normal galactosidase A enzymatic activity. CONCLUSION: No patient with suspicion of Fabry's disease was found by this screening method.

[Parallels in development of hemodialysis service and kidney transplantations in Lithuania during 1996-2005]. / Hemodializes tarnybos ir inkstu transplantacijos raidos paraleles Lietuvoje (1996-2005).

The aim of our study was to evaluate the changes in hemodialysis service, main demographic characteristics of hemodialysis patients in Lithuania during 1996-2005, and their correlation with the number of recipients on the kidney waiting list. During the study period, we annually visited all hemodialysis centers in Lithuania and collected data about all hemodialysis patients. There was a sharp increase in the number of hemodialysis centers (from 17 to 43), hemodialysis stations (from 25 to 100 per million population, P<0.001), hemodialysis patients (from 60 to 312 per million population, P<0.001), and new hemodialysis patients (from 54.3 to 95 per million population, P<0.01). The mean age of hemodialysis patients increased from 47.2+/-16.1 years in 1996 to 58.8+/-15.6 years in 2005 (P<0.001). Hemodialysis population became older. The percentage of patients aged more than 60 years increased from 22.8% to 53.2% (P<0.001) and aged more than 70 years from 5.4% to 24.4% (P<0.001). The frequency of chronic glomerulonephritis as underlying disease of end-stage renal disease decreased from 54.5% in 1996 to 21.1% in 2005 (P<0.001). There was an increase in the percentage of patients in whom end-stage renal disease was caused by diabetic (from 7.1% to 19.2%, P<0.01) and hypertensive nephropathies (from 3.1% to 13.9%, P<0.05) and chronic pyelonephritis (from 11.2% to 17.9%, P<0.01). The percentage of recipients on the kidney waiting list decreased from 71.4% in 1996 to 21.1% in 2005. In summary, during the last 9 years, hemodialysis service in Lithuania significantly expanded. The number of hemodialysis patients was continuously rising with predominance of diabetic, hypertensive, and elderly patients. Diabetic nephropathy, chronic glomerulonephritis, and pyelonephritis were the main underlying diseases of end-stage renal disease in hemodialysis patients in 2005. The percentage of recipients on the kidney waiting list decreased probably because of the rise in the number of elderly patients and patients with diabetes mellitus in Lithuanian hemodialysis population.

[Development of hemodialysis service in Lithuania during (1996-2003)]. / Hemodializes paslaugu raida Lietuvoje (1996-2003).

The aim of our study was to evaluate the changes of hemodialysis (HD) service and main demographic characteristics of HD patients in Lithuania during seven years period. From 1996 to 2003 we visited annually all HD centers in Lithuania and collected data about all HD patients. There was a sharp increase in the number of HD centers (from 17 to 37), HD stations (from 25 p. m. p. (per million population) to 87 p.m.p.; p<0.001), HD patients (from 60 p.m.p. to 264 p.m.p.; p<0.001) and incidence of new HD patients (from 54.3 p.m.p. to 92 p.m.p.; p<0.01). In 1996 all 17 HD centers in Lithuania were public. Private HD centers appeared in 1998 and reached 43.2% of all HD centers (n=16) in 2003. 44.8% of HD patients were dialyzed in private HD centers. The mean age of HD patients increased from 47.2+/-16.1 years in 1996 to 57.5+/-14.9 years in 2003 (p<0.001). HD population became older. The percentage of patients over 60 years old increased from 22.8% to 49.7% (p<0.001) and over 70 years old--from 54% to 21.9% (p<0.001). The main underlying disease of end-stage renal disease was chronic glomerulonephritis but its rate had decreased from 54.5% in 1996 to 26.5% in 2003 (p<0.001). During this period there was a statistically significant increase in the incidence of end-stage renal disease due to diabetics (from 7.1% to 18.0%; p<0.01), hypertensive nephropathy (from 3.1% to 9.4%; p<0.05), and chronic pyelonephritis (from 11.2% to 18.6%; p<0.01). In summary during the last seven years HD service in Lithuania expanded significantly, and rapid development of private HD was observed. The number of HD patients was rising continuously with predominance of diabetic, hypertensive and elderly patients.

[Hospitalizations and comorbidity of diabetic patients on hemodialysis]. / Diabetu serganciu hemodializuojamu ligoniu hospitalizavimas bei gretutine patologija.

We analysed ambulatory case records of all patients dialysed in 7 hemodialysis centers of Kaunas region during the year 2002 (n=186). Separate analysis of 42 diabetic patients was performed and compared with non-diabetics. Mortality was higher in diabetic patients in comparison with non-diabetics (22.5% and 7.3%, respectively; p<0.01). The mean number of associated diseases was 3.0+/-1.2 per diabetic patient. Disability status was worse in diabetic patients (p<0.01). Hospitalization rate of diabetic patients was 1.5 hospitalizations per patient-year at risk, length 27.3 days per patient-year at risk; duration of one hospital stay was 18 days. The most frequent causes of hospitalization: infections (33% of all hospitalizations), diabetes complications (20%) and cardiovascular pathology (18%). Due to infections diabetic patients on hemodialysis were treated in hospital at longest. In incident diabetic patients (n=16) late referral was observed in 50% of patients and hemodialysis was started through central venous catheter. Starting hemodialysis diabetic patients were treated for longer periods in hospital than non-diabetic patients (duration of one hospitalization 40.6+/-24.4 and 21.3+/-10.4 days, respectively; p<0.001).

[Factors influencing survival of hemodialysis patients: data from hemodialysis center of Kaunas University of Medicine Hospital 1994-2004]. / Hemodialize gydomu ligoniu isgyvenimui itakos turintys veiksniai (Kauno medicinos universiteto kliniku Hemodializiu centro 1994-2004 m. duomenys).

We analyzed data of 383 hemodialysis patients admitted to the hemodialysis center of Kaunas University of Medicine Hospital between 1 January 1994 and 31 December 2004. The aim of the study was to estimate their survival and identify it influencing factors. Demographic data (gender, birth date), cause of renal insufficiency, date of hemodialysis (HD) initiation, blood analyses at the start of HD (hemoglobin, C-reactive protein, serum albumin, creatinine, calcium, phosphate), how HD were started (through central venous catheter or permanent vascular access), time of the first nephrologist consultation before initiating of HD were recorded for each patient in a special form. The total survival rate was estimated using the Kaplan-Maier method. Mean survival of HD patients was only 21.93 months (95% confidence intervals (CI) 18.7-25.16 months). It was influenced by a high early mortality (17.23% of patients died within the first three months from the beginning of HD (36.5% of all dead patients)). The lowest survival rate was of those patients who started HD immediately after the first consultation with a nephrologist. Early referral to nephrologist, normal serum albumin and C-reactive protein concentrations had a positive impact on survival in hemodialysis patients.