At the end of 2009 in Croatia, 4124 patients were alive owing to renal replacement therapy (RRT). In relation to general population, prevalence of RRT was 930 per million population (pmp). Extent of RRT in Croatia is comparable to developed European countries. Two thirds of patients are treated by haemodialysis (65,5%). The number of patients on haemodialysis is lower that in the previous year. Good news in haemodialysis section are the consequence of exceptionally numerous and successful transplantation activity. Percent of patients with functional kidney graft has reached 28% of RRT, and annual increase in transplant prevalence was 13% in 2009. Population on RRT grows owing to transplantation, despite decrease of haemodialysis population. Peritoneal dialysis has experienced only modest advance, far from what is proclaimed to be the optimal utilization.
During 2009, RRT for terminal renal failure was started in u 692 persons. Incidence rate was 156 pmp. As observed generally, males predominate with a male to female ratio of 3:2.
Age of patients starting RRT in 2009 ranged from 0 to 91 years. Peak of the age distribution curve is displaced to the right with highest frequency in 70-79 year group. Median age of incident patients was 67 years, meaning that half of the new patients were 67 or older. Median age has not changed from the year 2006.
In Croatia, diabetes is the cause of one third of renal failures treated by renal replacement. Diabetes is the leading cause of renal insufficiency during all 10 years of CRRRT. Vascular renal disease is second in frequency from the year 2003 on, when it outnumbered glomerulonephritis and turned it down to the third position..
Incidence rate of RRT in Croatia 2009 was 156 pmp, not much different from previous years. Incidence rate was growing exponentially till 2004, and stabilized thereafter. It seems that needs for RRT in Croatia are fulfilled, as number of new patients is stagnating without administrative, financial or technical restrains for dialysis treatment.
While incidence rate is stabilized, annual growth of prevalence in 2009 was 2,4%.
Time trends in prevalence of RRT during 10 years of CRRRT is depicted by red curve. Slow but continuous increase in RRT prevalence is present. Green curve represents patients treated by haemodialysis. Number of patients treated by haemodialysis is decreasing from the year 2007. Area between yellow and green curve represents patients with functioning kidney graft. Group of transplanted patients has the fastest growth and maintains growth of RRT population against decreasing haemodialysis numbers. Area between yellow and red curve represents peritoneal dialysis group. The number of peritoneal dialysis patients has not changed much.
Crude mortality rate (deaths per 100 patient years) on RRT in 2009 in Croatia was comparable to Euro-DOPPS report. Number of deaths and crude mortality rate in 2009 was lower than in 2008.
Survival plot includes data of all incident patients (from day 1) throughout 10 years, from 2000 to 2009. Crude five-year survival unadjusted for patient and disease characteristics was 47%, and 10-year survival was 26%. Data presented in this way are not suitable for comparison with others and for following treatment quality because population differences might obscure effect of treatment..
To enable comparison with ERA-EDTA Registry it is necessary to display data in the same way. When data for patients on RRT from day 91 were adjusted using the same parameter values as ERA-EDTA Registry, 5-year adjusted survival on RRT in Croatia 2009 was 55,74%, comparable to European results..
Adjusting is required likewise to uncover time trends in the same region/population , as RRT population is changing over time. As an example, we were interested in possible changes in treatment quality between the first half and the second 5 years off decade covered by CRRRT. At the left, unadjusted data are presented. Later cohort survival (2005-2009) is worse than previous cohort 2000-2004, alarming for possible deterioration in treatment. After adjusting for variables affecting survival, treatment result of the recent cohort do not seem to be worse than for 2000-2004 cohort.
By Cox regression analysis, year of start of RRT was shown to affect survival. More recent start of RRT was shown to increase survival by 2% for year (ExpB), with significance p=0,047.
Survival improvement with recent start of RRT is visualized by separation and positioning of survival plots according to time of start of treatment.
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