A roadmap for optimizing chronic kidney disease patient care and patient-oriented research in the Eastern European nephrology community

Chronic renal failure; Dialysis; Kidney transplantationInsuficiència renal crònica; Diàlisi; Trasplantament de ronyóInsuficiencia renal crónica; Diálisis; Trasplante de riñónChronic kidney disease (CKD) is a major health problem because of its high prevalence, associated complications and high treatment costs. Several aspects of CKD differ significantly in the Eastern European nephrology community compared with Western Europe because of different geographic, socio-economic, infrastructure, cultural and educational features. The two most frequent aetiologies of CKD, DM and hypertension, and many other predisposing factors, are more frequent in the Eastern region, resulting in more prevalent CKD Stages 3–5. Interventions may minimize the potential drawbacks of the high prevalence of CKD in Eastern Europe, which include several options at various stages of the disease, such as raising public, medical personnel and healthcare authorities awareness; early detection by screening high-risk populations; preventing progression and CKD-related complications by training health professionals and patients; promoting transplantation or home dialysis as the preferred modality; disseminating and implementing guidelines and guided therapy and encouraging/supporting country-specific observational research as well as international collaborative projects. Specific ways to significantly impact CKD-related problems in every region of Europe through education, science and networking are collaboration with non-nephrology European societies who have a common interest in CKD and its associated complications, representation through an advisory role within nephrology via national nephrology societies, contributing to the training of local nephrologists and stimulating patient-oriented research. The latter is mandatory to identify country-specific kidney disease–related priorities. Active involvement of patients in this research via collaboration with the European Kidney Patient Federation or national patient federations is imperative to ensure that projects reflect specific patient needs.The treatment of kidney failure is costly, therefore financial support from governments is essential to ensure that all patients receive appropriate treatment. This imposes a major burden on the economy. According to the World Bank, only 74% of governments in Eastern and Central Europe provide full support for KRT [7]. Funding of treatment in earlier stages of CKD is even more problematic because of the high number of patients and because the diagnosis may not be made in a timely manner. Although no objective data are available, it is very likely that public funding at earlier stages of CKD is less common or, at least, less comprehensive than reimbursement of KRT

Acute kidney injury: highlights from the ERA-EDTA Congress in London

The ERA-EDTA 52nd Congress was held in London, 28-31 May 2015. In the scientific programme, overall, during the symposium, there were 18 lectures, 3 minilectures, 15 free communications and 135 poster presentations on acute kidney injury (AKI). Among many excellent reports and presentations, I selected three hot topics on AKI for the readership of Nephrology Dialysis Transplantation

Once More - Still Another Disaster: The Van Earthquake

The article is about the contributions of the Turkish Society of Nephrology Renal Disaster Group to saving and providing help to the earthquake victims and to the treatment of survivors. The lessons learned from the earthquake and the experiences that may provide examples to other associations are summarized and presented to those working in Healthcare Services

Posttransplant Tuberculosis

Tuberculosis is a major problem in the posttransplantation period, because of its high incidence and prevalence, difficulty in diagnosis as well as high risk of morbidity and mortality. In solid-organ transplant recipients, the diagnosis of tuberculosis is complex because it is paucisymptomatic. Tuberculin skin testing results may be negative, and interferon-gamma release assays may be insufficiently sensitive. Furthermore, imaging technique findings are mostly atypical, and sputum smear results can be negative despite the presence of active disease. Therefore, most tuberculosis cases are overlooked, and thus, treatment initiation is often delayed

Patients with a Failed Renal Transplant

Renal transplantation is the best method of renal replacement therapy for patients with end-stage renal disease. On the other hand in the early or late period of transplantation, majority of patients suffer from allograft failure and return to the dialysis. These patients carry the risks of adverse effects of previous immunosuppressive therapy (i.e infections and cancers). Furthermore, worse quality of life and many limitations of dialysis result in psychological problems. The controversial issues in treatment of these patients can be summarized under the headings of : 1- In which stage of allograft failure these patients should return to dialysis? 2- Which is the most appropriate renal replacement therapy after the renal allograft failure? 3- What are the main problems during dialysis practice and how should these problems be managed? 4- How should the immunosupression regimen be managed? 5- What are the indications for transplant nephrectomy? 6- What are the advantages and drawbacks of retransplantation? In this review these problems were discussed

Vascular Access

Hemodialysis patients are connected to life by means of vascular access. The complications of vascular access represent one of the most important causes of morbidity, mortality and high healthcare costs in the hemodialysis patients. Although it is known that the best vascular access is AVF, the fistula use rate is still low in most countries. This review will examine; association of various vascular access with morbidity, mortality and dialysis costs; different practice patterns in the world and reasons of this; finally, solutions for vascular access problems

Once More - Still Another Disaster: The Van Earthquake

The article is about the contributions of the Turkish Society of Nephrology Renal Disaster Group to saving and providing help to the earthquake victims and to the treatment of survivors. The lessons learned from the earthquake and the experiences that may provide examples to other associations are summarized and presented to those working in Healthcare Services

RECOMMENDATIONS FOR THE MANAGEMENT OF CRUSH VICTIMS IN MASS DISASTERS

"Recommendations for the management of crush victims in mass disasters" aims to assist medics, paramedics and rescue team members who provide care during disasters. Development of the recommendations followed an explicit process of literature review and, also interne and face-to-face discussions. The chapters cover medical and logistic measures, to be taken both at the disaster field and in the hospitals, to cope with the problems created by a catastrophe. Recommendations were based on retrospective analyses and case reports on past disasters, and also expert judgment or opinion. Since there are no randomized controlled trials, no GRADE approach was used to develop the recommendations, and no strengths of recommendations or levels of evidence are provided