[Changes in hemodialysis adequacy in Lithuania during 1999-2005]. / Hemodializes proceduros kokybes pokyciai Lietuvoje 1999-2005 m.

Despite the improvement of hemodialysis technique, mortality of chronic hemodialysis patients remains quite high. It considerably depends on dialysis adequacy. The aim of the study was to evaluate the adequacy of hemodialysis procedure and its changes in Lithuania during 1999-2005. Between 1999 and 2005 in December, all hemodialysis centers in Lithuania were annually visited, and data on the type of hemodialysis, duration of hemodialysis (hours per week), single-pool Kt/V were collected from all hemodialysis patients. The percentage of patients on bicarbonate hemodialysis sharply increased from 57.9% in 1999 to 100% in 2001 (P<0.001), and the duration of hemodialysis procedure increased (67.3% of hemodialysis patients were dialyzed 12 and more hours per week in 2005 vs. 41.3% in 1999, P<0.001). The percentage of patients who were dialyzed three times per week increased from 51% in 1999 to 77% in 2005 (P<0.001). The mean Kt/V was 0.81+/-0.53 in 1999, but it increased to 1.21+/-0.27 in 2005 (P<0.001). More than half (54%) of all hemodialysis patients in 2005 had Kt/V > or =1.2 vs. more than one-third (36%) in 1999 (P<0.001). The mean Kt/V of patients who were on dialysis three times per week was 1.25+/-0.6; two times per week, 1.30+/-0.8; and one time per week, 1.27+/-0.26 in 2003. In 2005, the results were 1.21+/-0.27, 1.22+/-0.26, and 1.16+/-0.29, respectively (P>0.05). CONCLUSIONS. 1. The improvement of the quality of hemodialysis was observed in Lithuania during 1999-2005: a) from 2001, patients received only bicarbonate hemodialysis; b) weekly duration of hemodialysis increased; c) Kt/V improved. 2. Despite the improvement of hemodialysis quality, it is not optimal yet and is associated with insufficient duration of hemodialysis.

[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.