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Renal Registry of Turkey: Change of Renal Replacement Modalities in the Last 15 yearsSeyahi N1 , Ates K1,Sezer S1, Altiparmak MR1, Tonbul Z1, Duman S1, Kocyigit I1, Suleymanlar G1

1Turkish Society of Nephrology Registry Committee

BACKGROUND

❖ The national renal registry studies provide epidemiologic and demographic

picture of patients with renal diseases and treatment and local follow-up

practices..

❖ Turkey ranks seventeenth among the world’s most populous countries with

a population of approximately 80 million in 2016 and annual rate of growth

of population as 1.35%.

❖ Founded in 1970, TSN has been coordinating annual national renal

registry with its own resources since 1990. The registry has been

collecting data on nephrology, dialysis and transplantation from all centers

treating patients with renal diseases in Turkey.

❖ The results of the registry have been published by TSN as yearly booklets

and are available online (http://www.tsn.org.tr/) in English since 1998,

which are comprehensive source on national nephrology, dialysis and

transplantation status in Turkey. The results of the registry have also been

included in ERA-EDTA and USRDS reports.

❖ In this poster, detailed and updated status of RRT for ESRD in Turkey

depending on the national registry data for the last 10 years is presented.

SUBJECTS AND METHODS

Data collection

❖ The registry form includes questions on facilities of the centre;

characteristics of patients with renal diseases, dialysis patients, or patients

who had kidney transplantation; and treatment and follow-up procedures

for these patients.

❖ Since 2006, centers have been entering their data to a central electronic

database that is managed by TSN. Since 2013 TSN registry is in close

collaboration with Ministry of Health and also recruiting data from their

database

RESULTS

Incidence and prevalence of ESRD leading to RRT

❖ The number of patients on renal replacement therapy is increasing, at

the end of 2015, 73660 patients were on renal replacement therapy. The

prevalence and incidence of end-stage renal disease was 935 and 147

per million population respectively.Both prevalence and incidence of

ESRD show tendency of increase over the last years, particularly

between 2001 and 2015 (Figure 1).

❖ The most common RRT modality in prevalent ESRD was hemodialysis

(77.3% of patients) followed by peritoneal dialysis (5.3%) and

transplantation (17.4%) in 2015 (Table 1). While the numbers of

hemodialysis and transplant patients increased consistently from 2008 to

2015, number of peritoneal dialysis patients decreased during this

period.

Figure 1. The point prevalence and incidence of ESRD leading to

RRT per pmp in Turkey.

Demographics/ Etiology of hemodialysis patients

❖ The total number of patients who started hemodialysis in 2015 is

9590. All of the patients who underwent hemodialysis treatment,

56.4% were male, 43.6% were female and their age distributions are

shown in Table 2.

❖ Diabetes mellitus (41%) was the leading etiological factor in these

patients, followed by hypertension (25.2%), glomerulonephritis

(5.5%), polycystic kidney disease (3.8%), amyloidosis (1.9%) and

other reasons. 11% of patients have no primary disease.

❖ The three most common etiologies for ESRD leading to RRT were

diabetes mellitus, hypertension, and chronic glomerulonephritis. The

frequency of diabetes mellitus has increased rapidly in recent years

(Figure 2).

❖ It is remarkable that the rate of diabetes mellitus and hypertension

increased in patients with ESRD while renal pathologies like chronic

glomerulonephritis, urologic disease etc. decreased over the 15

years of registry (Figure 3).

Figure 2. Trends in the most common underlying etiologic causes of RRT

patients in Turkey.

Clinical characteristics of hemodialysis patients

❖ The change in the technical characteristics of hemodialysis treatment is

shown in Table 3. Synthetic and semi-synthetic membranes as well as

high-flux membranes appear to be used increasingly. Recently, the

frequency of hemodialysis is three times a week in the majority of patients

❖ There was an increasing tendency in Kt / V over the years

❖ In the majority of patients (69.9%) Kt / V was above 1.4 at the end of 2015.

Kidney Transplantation

❖ While living donor is the most common donor source in kidney

transplantation patients, a large proportion of patients final situation

is functioning graft as of the end of 2015 (Table 4 and 5).

Figure 6. Percentage of cadaveric donor over the years.

CONCLUSION

❖ In conclusion,RRT modality in Turkey is focused primarily on

hemodialysis. The trend of the past 15 years in Turkish Renal

Registry indicates that while the the number of peritoneal

dialysis decreases, an increase in the number of

transplantation is observed.

❖ However, It is necessary to achieve a significant increase in

the cadaveric donor rather than living donor transplantation.

n %

Hemodialysis 56951 77.31

Peritoneal dialysis 3909 5.31

Transplantation * 12800 17.38

Total 73660 100.00

TABLE 2. Distribution of chronic HD/PD patients or patients followed with functioning graft (including pediatric patients) according to RRT type as of the end of 2015.TABLE 2. Distribution of chronic HD/PD patients or patients followed with functioning graft (including pediatric patients) according to RRT type as of the end of 2015.TABLE 2. Distribution of chronic HD/PD patients or patients followed with functioning graft (including pediatric patients) according to RRT type as of the end of 2015.

Table 1. Distribution or according to RRT type as of the end of 2015.

AgeMale Female Total

n % n % n %

0-19 62 0.65 58 0.60 120 1.25

20-44 701 7.31 435 4.54 1136 11.85

45-64 2265 23.62 1478 15.41 3743 39.03

65-74 1444 15.06 1166 12.16 2610 27.22

≥75 1018 10.61 963 10.04 1981 20.65

Total 5490 57.25 4100 42.75 9590 100.00

Table 2. Age and gender distribution of incident hemodialysis patients

in 2015.

2003 2004 2005 2006 2007 2008 2009 2013 2014 2015

Type of vascular access

AV fistula 87,5 90,1 88,7 85,7 86,0 85,4 84,0 82,9 81,1 80,4

Permanent (tunnelled)

catheter

3,5 3,5 3,6 6,9 7,0 7,7 9,3 11,7 13,4 14,4

AV graft 3,5 2,6 2,7 3,2 2,9 2,9 2,7 1,8 1,6 1,5

Others 5,5 3,8 5,0 4,2 4,1 4,0 4,0 3,6 3,9 3,8

Dialyser type

Synthetic - 54,0 43,0 62,8 67,2 60,3 65,0 58,9 - -

Semi-synthetic - 35,8 47,8 22,1 19,1 17,6 14,0 7,0 - -

High-flux - 8,9 9,0 15,0 13,7 21,8 21,0 34,1 33,3 36,3

Kuprofan - 1,3 0,2 0,1 0,0 0,3 0,0 0 - -

HD frequency

Once weekly 1,9 1,6 1,7 1,5 0,9 0,9 0,9 0,6 0,6 0,5

Twice weekly 15,6 13,6 10,2 9,3 7,8 7,5 7,0 7,7 7,9 8,0

3 times weekly 82,5 84,8 88,1 89,2 89,9 90,2 90,1 90,1 90,8 90,7

Nocturnal HD or >3 times

weekly- - - - 1,4

1,4 2,0 0,7 0,8 0,8

Kt/V urea value

<1,20 - 36,3 27,8 14,5 12,7 11,3 10,2 11,0 11,3 9,8

≥1,20 - 63,7 72,2 85,5 87,3 88,8 89,8 89,0 88,7 90,2

Table 3. Changes in the technical characteristics of hemodialysis treatment over

the years (expressed as percentage of patients)

0

5

10

15

20

25

30

35

40

45

1995 2001 2007 2009 2010

2011 2012 2013 2014 2015

DM CGN HT PKD PN OTHER UNKNOWN

Figure 3. Changes in primary etiology over the years in patients

receiving HD

Peritoneal Dialysis

❖ The number of peritoneal dialysis patients decreased from 2008 to 2015

(Figure 4) .

Figure 4. Trends in the number of peritoneal dialysis patients over the

years

n %

Followed with functioning graft 2463 97.20

Returned to dialysis 28 1.10

Died 43 1.70

Total 2534100.0

0

n %

Kidney transplantation from living donor 2534 79.09

Kidney transplantation from deceased donor 670 20.91

Total 3204 100.00

Table 4. Distribution of kidney transplantation patients according to

donor source in 2015.

Table 5. Distribution of all kidney transplantation patients transplanted

in 2015 according to final situation as of the end of 2015.

❖ The number of translplantations over the years is shown in

Figure 5. While an increase in the all of transplantation was

observed over the years, a lower rate increase in the number of

cadaveric transplants is observed( Figure 6).

Figure 5. Number of transplantation over the years

1--REGSeyahi Nurhan DOI: 10.3252/pso.eu.54ERA.2017

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