Dialysis and aphaeresis in the Republic of Macedonia "a success story"

The first haemodialysis (HD) in the Republic of Macedonia (RM) was performed in 1959 in a patient with acute renal failure (ARF) using Kolff-Brigham rotating drum artificial kidney at the Blood Transfusion Institute in Skopje. In 1965 the Renal Unit at the Dept. of Medicine, Medical Faculty, Skopje obtained a modern, new artificial "Websinger" kidney with sigma motor pump and possibilities for use of disposable Kolff "twin coil" dialyser. Between 1959 and 1971, HD was performed only in patients with ARF. In May 1971 at the Renal Unit, a Unit for chronic HD was founded and the program of maintenance haemodialysis (MHD) was started with five Stuttgart Fresenius machines and 12 patients dialysed on twin coil dialyzers. 1173 patients were treated in 18 HDC in the RM in 2007. 320 machines were used; 299 (93%) for bicarbonate HD and 21 (7%) for acetate HD. In all centers the water for HD was processsed by reverse osmosis. There was no reuse of dialysers. All patients received the same treatment. The patients received epoetin (recombinant human erythropoetin - alpha and beta) to maintain hemoglobin between 100 and 120 g/L. Our patients received epoetin between 62% and 100 % in HDC according the individual need. The Cimino - Brescia arterial-venous fistula was typically used as permanent vascular access. Prevalence of the HBV in patients on MHD varied between 6-28% in different centers. Prevalence of HCV in patients on MHD was between 37-78% in some centers. Nosocomial infection is probably one of causes of the so high prevalence of HCV in our patients. We do not have HIV infection in patients on MHD. The survival rate of our patients treated with MHD was 60% at 5 years, 37% at 10 years, 25% at 15 years and 9% at 20 years. PD was started in 1995 in children and in 1996 in adults. Now, there are 24 adult patients treated with PD. Since 1985 membrane PE has been in regular use. Most therapeutic procedures were performed on patients from the Dept. of Neurology. 1216 patients were on RRT in 2005. On HD were 1077 (89%), with transplanted kidney 121 (10%) and on PD - 18 (1%). 601, 4 patients were on RRT per million of population. The activity of the Macedonian nephrology societies helped a lot in the development of the nephrology and dialysis inviting distinguished nephrologists from Europe and the world and transferring the achievement of the world in our practice. Having in mind that CKD, ESRD and RRT are a great burden for the health budget, we need early diagnosis a