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Nephrol Dial Transplant (2004) 19: 840-843
Nephrol Dial Transplant Vol. 19 No. 4 © ERA-EDTA 2004; all rights reserved

Original Article

Analgesic nephropathy in Hungary: the HANS study

István Pintér1,2, János Mátyus3, Zoltán Czégány4, Judit Harsányi5, Marietta Homoki6, Miklós Kassai7, Éva Kiss8, István Kiss9, Erzsébet Ladányi10, Lajos Locsey11, Lajos Major12, Mihály Misz13, Lajos Nagy14, Kálmán Polner15, Jeno Rédl16, István Solt17, Béla Tichy18, Marietta Török19, Gábor Varga20, Gyula Wagner21, Imre Wórum22, Béla Zsoldos23, László Pótó24, Katalin Dérczy1, István Wittmann1 and Judit Nagy1

1Department of Nephrology, University of Pécs, 2Fresenius Dialysis Center, Pécs, 3First Department of Internal Medicine, University of Debrecen, 4EuroCare Dialysis Center, Gyor, 5Dialysis Center of St Rókus Hospital, Budapest, 6Nephrocentrum, Budapest, 7Fresenius Dialysis Center, Hódmezovásárhely, 8Gambro Dialysis Center, Szeged, 9EuroCare Dialysis Center, Budapest, 10Fresenius Dialysis Center, Miskolc, 11EuroCare Dialysis Center, Debrecen, 12Fresenius Dialysis Center, Esztergom, 13Fresenius Dialysis Center, Eger, 14EuroCare Dialysis Center, Tatabánya, 15Dialysis Center, St Margit Hospital, Budapest, 16Gambro Dialysis Center, Szolnok, 17EuroCare Dialysis Center, Székesfehérvár, 18Fresenius Dialysis Center, Kiskunfélegyháza, 19Gambro Dialysis Center, Karcag, 20EuroCare Dialysis Center, Veszprém, 21EuroCare Dialysis Center, Szekszárd, 22Fresenius Dialysis Center, Kecskemét, 23Fresenius Dialysis Center, Salgótarján and 24Central Scientific Laboratories, University of Pécs, Hungary

Correspondence and offprint requests to: Judit Nagy MD, PhD, Second Department of Medicine and Nephrological Center, Pécs University, Faculty of Medicine, Pacsirta u. 1, H-7624 Pécs, Hungary. Email: nagyju{at}bel2.pote.hu

Background. The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem.

Methods. Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively.

Results. Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01).

Conclusions. Phenacetin should be banned. Our study results support the need for longitudinal cohort and case–control studies in Hungary.

Keywords: analgesic nephropathy; Hungary; renal replacement therapy


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