NDT Advance Access originally published online on May 30, 2006
Nephrology Dialysis Transplantation 2006 21(7):2025-2026; doi:10.1093/ndt/gfl258
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Commentary on the highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe
Email: ondrej.viklicky{at}medicon.czSir,
We read with interest an article by Rutkowski [1] published in the January issue of NDT. We found several concerns within this article that we feel warrant some comment.
There is general agreement that during the last 15 years there have been dramatic political changes in the former Communist countries within the part of Europe informally known as ‘Central and Eastern Europe’. In the majority of these countries, political changes were followed by rapid economical changes, including changes in renal health care. In our opinion, it is impossible to attempt a comparison of this large region, since some of the mentioned countries were industrially quite developed, even before the Second World War. Thus, the common political history that joined the countries of this region is very short.
There is another, more important concern about Rutkowski's article. The data that is shown was obtained from colleagues from the Central and Eastern European Advisory Board for Chronic Renal Failure or members of the National Renal Registries, but the recent list of such experts was not provided. Renal registries already exist in some of these countries, but not in all of them; the provided figures might thus come from individual feelings rather than from objective numbers.
The weakness of the article is particularly illustrated in Figure 2 of [1], where Rutkowski presents renal transplant activity in 2002 according to absolute numbers of kidney transplants. This comparison lacks an objective base, since it was not related to the total population of the country. Thus, readers cannot obtain relevant information on the real transplant activity of the mentioned countries. Using Rutkowski's data, we recalculated the renal transplant activity of the aforementioned countries per million of population (Figure 1). Surprisingly, Bosnia was shown to have one of the best transplant programmes in the region, contradictory to Rutkowski's statement that after the disintegration of former Yugoslavia, renal transplantation ceased completely.
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Similarly, the obtained mortality data are incomparable among those countries. That is why the information on its definition is missing. In the Czech Republic, the national registry of dialysis therapy has just been recently introduced; thus, data used in Rutkowski's article may suffer from a biased view.
Recently, the International Registry of Organ Donation and Transplantation was established [2]. Already published data showed that within the ‘Central and Eastern European’ countries, the renal transplant activity in the Czech Republic has recently reached 39.3, in Latvia 30.9, Hungary 28.4, Poland 27.1, Estonia 24.0, Slovakia 18.3, Lithuania 16.7 and Romania 0.7 deceased donor kidney transplants p.m.p., respectively. Similarly, the living donor kidney transplantation programme has been rather developed in Slovakia (3.9 living donor transplants p.m.p.), the Czech Republic (3.8), Estonia (3.6), Georgia (1.6), Lithuania (1.2), Hungary (1.1), Poland (1.0) and Latvia (0.4), respectively [2].
In order to compare renal health care among European countries, the establishing of reliable databases and registries is obviously necessary. Confusing information might underestimate the general view on renal health care in the region.
Conflict of interest statement. None declared.
Transplant Center Institute for Clinical and Experimental Medicine Videnska 1958, 14000 – Prague 4 Czech Republic
References
- Rutkowski B. Highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe. Nephrol Dial Transplant 2006; 21: 4–10
[Abstract/Free Full Text] - 2004 Donation and transplantation preliminary figures. IRODaT. Organs and Tissues 2005; 8: 7–10[CrossRef]
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