[Influence of referral pattern to nephrologist on start of hemodialysis]

In 2000-2001, 145 patients started hemodialysis due to end-stage renal disease in Hemodialysis unit at Kaunas University of Medicine. According to referral pattern to nephrologist all patients were divided into two groups: I group--< 3 months until start of hemodialysis--late referrals, II group--> 3 months until start of hemodialysis--early referrals. Comparing these groups, the results revealed worse clinical condition, much more catheterization of central vein (76.3%), prolonged hospitalization and major mortality within 12 moths from the start of hemodialysis, particularly within first 3 months, in late referrals.

[Prevalence of antibodies to hantavirus among hemodialysis patients with end-stage renal failure in Kaunas and its district]

The objective of this study was to investigate the prevalence of antibodies to hantaviruses among hemodialysis patients with end-stage renal failure in Kaunas and its district.

MATERIAL AND METHODS

Serums of 218 patients from four dialysis centers of Kaunas district were tested by using the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay (ELISA). The reactivity of ELISA-positive sera was proven in Western blot tests using various hantavirus recombinant nucleocapsid proteins. The yeast-expressed nucleocapsid proteins were used for testing.

RESULTS

Antibodies against Dobrava/Hantaan and Puumala hantaviruses were found in 16 patients (seroprevalence 7.4%). Most of the sera were positive for Dobrava hantavirus (81%). The ratio of males to females was 1.2:1. Seroprevalence was significantly higher in older patients.

CONCLUSIONS

Results indicate that antibodies to two hantaviruses (Dobrava/Hantaan virus and Puumala virus) are prevalent among hemodialysis patients in Kaunas district with approximately the same seroprevalence as in neighboring countries.

[Estimated average yearly treatment expenditures for hemodialysis patients (data of Kaunas University of Medicine Hospital in the year 2005)]

With increasing number of hemodialysis patients, expenditures for the treatment of hemodialysis patients are rising every year. The objective of our study was to collect and analyze the data on estimated average treatment expenditures, which were covered by State Patients' Fund, for patients undergoing hemodialysis in Kaunas University of Medicine Hospital in 2005 and the costs of medications paid by patient and to compare with the analogical data of the year 2001. We analyzed ambulatory case records of all 106 patients with end-stage renal disease who were hemodialyzed in Kaunas University of Medicine Hospital from November 1, 2004, to October 31, 2005. Data on medications used and number of hemodialysis procedures and hospitalizations were collected. On average, 2.8+/-0.4 hemodialysis procedures per patient a week were carried out. Expenditures for hemodialysis procedures were 38 094.12+/-5003.17 litas (11,041 euros) per patient per year, and this accounted for 63% of all expenditures for hemodialysis patient. Hospitalization rate was 1.4+/-1.8 per patient a year; expenditures for hospitalizations were 1538.4+/-1941 litas (446 euros) per patient a year (3% of all expenditures for hemodialysis patients). The mean number of drugs prescribed per patient monthly was 7.7+/-2.17 including 2.12+/-1.6 antihypertensive medications. The total costs of drugs reimbursed by State Patients' Fund were 20,639.82+/-15,439.3 litas (5983 euros) per patient per year, of which 92% was spent on erythropoietin and intravenous iron. The average expenditures for health insurance of hemodialysis patients were 60,272.35+/-16,624.18 litas (17,470 euros) per patient a year. One patient had to pay 1.9+/-1.6 litas for medications per day and 699.71+/-583.6 litas (203 euros) per year. The comparison of the data gathered in 2001 and 2005 revealed an increase in the total expenditures for hemodialysis patients due to increase in the expenditures for hemodialysis procedures and medications.

[Factors influencing survival of hemodialysis patients: data from hemodialysis center of Kaunas University of Medicine Hospital 1994-2004]

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.