2004 İngilizce (in English)
Transcription
2004 İngilizce (in English)
PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY REGISTRY OF THE NEPHROLOGY, DIALYSIS AND TRANSPLANTATION IN TURKEY REGISTRY 2004 Central Registry Committee Ekrem EREK Kamil SERDENGEÇTİ Chairman President of Turkish Society of Nephrology Gültekin SÜLEYMANLAR General Secretary of Turkish Society of Nephrology İstanbul - 2005 PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY Important Note All copyrights are reserved for Turkish Society of Nephrology. Articles and figures might not be published without reference. Contents and Design: OMEGA Contract Research Organization Printing: Art Ofset Printing date: June 2005 INTRODUCTION 15 Years in Turkish Nephrology Registry Nephrology, Dialysis and Transplantation studies which are started in 1989 including solely Istanbul, are being performed in country wide since 1990 and published by Turkish Society of Nephrology, annually (except 1994). On the following two pages, you might see the names of the books and people who have worked throughout the publishing process. Till 1993 a lot of friends of us have taken place in Central Registry Committee. I am grateful to them. For efforts they spent in communicating with foreign and domestic nephrology centers and for supports in evaluating and commenting the collected data, I especially thankful to Kamil Serdengeçti, President of Turkish Society of Nephrology and to Gültekin Süleymanlar, General Secretary, who are the indispensable and permanent names of our society. Mehmet Rıza Altıparmak and Nurhan Seyahi, two young assistant members of Central Registry Committee have spent too much effort. Many thanks to them and to Lale Sever who has given her best support in evaluation of pediatric nephrology results. Registry studies which were performed with an amateur spirit till three years ago, are being executed by a professional company since 2002, under control, support and audition of our Central Registry Committee. You might see the graphics showing the now and then of the Turkish Registry for a period of 15 years. In recent years, Turkish Nephrology Registry has started to take place in two big registries as a result of contribution established with ERA-EDTA and USRDS. For the support they gave to Turkish Nephrology Registry, we are grateful to Kitty Jager, Director of the ERAEDTA Nephrology Center and to Allan J. Collins, Director of the USRDS Coordinating Center. You might also find the figures of this two big registries and comparative graphics by USRDS, including Turkish results. Turkish Registry of 2004 is completed again with the extreme supports of the responsible persons of nephrology, dialysis and transplantation centers. We stated the names of both them and the centers at the back pages of this book. By this means we voice our gratitudes to them. We are also grateful to managers and the staff of Omega Contract Research Organization who have collected the data under the control and support of our Central Registry Committee and prepared the analysis report, and to Fresenius Medical Care, the company that has yet once more sponsored the printing of this book. June 2005, Cerrahpaşa, Istanbul Prof. Dr. Ekrem EREK Turkish Society of Nephrology, Chairman to Central Registry Committee Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 i TURKISH SOCIETY OF NEPHROLOGY REGISTRY GENERAL COMMITTEE General Coordinator: Prof. Dr. Kamil SERDENGEÇTİ President of Turkish Society of Nephrology EDTA-ERA Registry Coordinator for Turkey Assistant Coordinator: Prof. Dr. Gültekin SÜLEYMANLAR General Secretary of Turkish Society of Nephrology Assistant Members to Central Registry Committee: Assoc. Prof. Mehmet Rıza ALTIPARMAK, Dr. Nurhan SEYAHİ Coordinator for Pediatric Nephrology: Prof. Dr. Lale SEVER Regional Coordinators for Ankara and Mid-Turkey: Şali ÇAĞLAR, Mehmet HABERAL, Enver HASANOĞLU, Şükrü SİNDEL, Neval DUMAN, Ayşın BAKKALOĞLU, Oğuz SÖYLEMEZOĞLU, Ayşe ÖNER, Haluk KİPER, Cengiz UTAŞ, Süleyman TÜRK, Necmettin GÜVENCE Regional Coordinators for Istanbul and Thrace Region: Emel AKOĞLU, Mehmet SEVER, Rezzan ATAMAN, Mine BESLER, Funda TÜRKMEN, Uluğ ELDEGEZ, Muzaffer SARIYAR, Saniye ŞEN, Metin ERMAN, Nedim SARSMAZ Hülya Karadayı ERGİN Regional Coordinators for Bursa and Marmara Region: Mustafa YURTKURAN, Kamil DİLEK, Mustafa GÜLLÜLÜ, Nilay OKTAY, Betül KALENDER Regional Coordinators for Izmir and Aegean Region: Ali BAŞÇI, Sevgi MİR, Taner ÇAMSARI, Fehmi AKÇİÇEK Cüneyt HOŞCOŞKUN, Adam USLU Regional Coordinators for Black Sea Region: Tekin AKPOLAT, Nurol ARIK, Şükrü ULUSOY Regional Coordinators for Eastern Turkey: Yılmaz SELÇUK, Reha ERKOÇ Regional Coordinators for Southeastern Turkey: Bünyamin IŞIKOĞLU, Emin YILMAZ, Asım GÖYMEN Regional Coordinators for Adana and Çukurova Region: Yahya SAĞLIKER, Uğur EKREN, Zeki GÜLOĞLU, Saime PAYDAŞ Regional Coordinators for Antalya and Mediterranean Region: Gülşen YAKUPOĞLU, Fevzi ERSOY, Alper DEMİRBAŞ Communication and Assistance in Data Collection: Executive Secretary: Mübeccel AKYÜZ Central Registry Committee Secretary: Şükran AKPINAR Project Management: Omega Contract Research Organization Project Managers: Ebru MUTLU, Hakan YILMAZ Assistant Project Manager Kartal ÇETİNTÜRK Regional Project Managers: Öznur BİÇEROĞLU, Yeşim KOÇ (Ankara), Güliz ÖZGEN (İstanbul), Buket ÜNAK (İzmir), Mesut BAHAR (Samsun) Data Analysis and Reporting: Oktay ÖZDEMİR, Ferit ÜN, Bülent SAKAOĞLU Database Management and Software Development: Berk ÖZDEMİR, Taner SUNDU, Taner VAROL Data Entry Officers: Fatih ELİTOĞ, Emre ÖZKAN Review of Forms: Hakan YILMAZ, Kartal ÇETİNTÜRK, Serpil ÇOBAN Graphics and Translation: Murat KİRTİŞ ii Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 The Registry Books Published in Last 15 Years 1. Today of Hemodialysis in Istanbul, Istanbul 1989 Publishing Committee: Ekrem Erek, Serhat Perk. Publisher: Turkish Society of Nephrology, number of pages: 48 2. Today of Nephrology, Dialysis and Transplantation in Turkey, 1990 Publishing Committee: Ekrem Erek, Serhan Dalmak. Publisher: Turkish Society of Nephrology, number of pages: 97. 3. Nephrology, Dialysis and Transplantation in Turkey, Registry 1991 Publishing Committee: Ekrem Erek, Rezzan Ataman, Serran Dalmak, Süheyla Apaydın. Publisher: Turkish Society of Nephrology, number of pages: 49. 4. Nephrology, Dialysis and Transplantation in Turkey, Registry 1992-1993 Publishing Committee: Ekrem Erek, Kamil Serdengeçti, Rezzan Ataman, Süheyla Apaydın. Publisher: Turkish Society of Nephrology, number of pages: 55. 5. Nephrology, Dialysis and Transplantation in Turkey, Registry 1995 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 80. 6. Nephrology, Dialysis and Transplantation in Turkey, Registry 1996 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 48. 7. Nephrology, Dialysis and Transplantation in Turkey, Registry 1997 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 50. 8. Nephrology, Dialysis and Transplantation in Turkey, Registry 1998 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 94. 9. Nephrology, Dialysis and Transplantation in Turkey, Registry 1999 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 82. 10. Nephrology, Dialysis and Transplantation in Turkey, Registry 2000 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 119. 11. Nephrology, Dialysis and Transplantation in Turkey, Registry 2001 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 74. 12. Nephrology, Dialysis and Transplantation in Turkey, Registry 2002 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 71. 13. Nephrology, Dialysis and Transplantation in Turkey, Registry 2003 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 74. 14. Nephrology, Dialysis and Transplantation in Turkey, Registry 2004 (English) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 91. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 iii DEMOGRAPHICS OF TURKEY Background : Modern Turkey was founded in 1923 by Kemal ATATÜRK after a war of independence, following the fall of the 620-years-old Ottoman Empire. Under his leadership, the country adopted wide-ranging social, legal, and political reforms. Location : Southeastern Europe and southwestern Asia Area : Total: 780.580 sq km Population : 73.330.000 Age structure : 0-14 years: 26% (male 9.232.439/female 8.897.135) 15-64 years: 67.3% (male 23.806.367/female 23.053.536) 65 years and over: 6.7% (male 2.140.242/female 2.530.840) (2005 est.) Median age : Total: 27.7 years Population growth rate : 1.8% (2005 est.) Life expectancy at birth : Total population: 72.36 years Male: 69.94 years Female: 74.91 years (2005 est.) Total fertility rate : 1.94 children born/woman (2005 est.) Number of medical faculties : 35 state, 6 private (January 2001) Number of physicians : 95.192 (2002) : : 43.662 51.530 Number of nurses : 70.270 (4020 private) Per capita income : 4250 $/year (2004) specialists general practitioners iv Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 CONTENTS Page 2004 Registry............................................................................................................................ 1 Clinical Nephrology ................................................................................................................... 3 Renal Replacement Therapies .................................................................................................. 7 Hemodialysis .................................................................................................................. 7 Peritoneal Dialysis......................................................................................................... 29 Renal Transplantation ................................................................................................... 43 Pediatric Nephrology............................................................................................................... 53 Pediatric Hemodialysis .................................................................................................. 55 Pediatric Peritoneal Dialysis .......................................................................................... 59 Pediatric Renal Transplantation..................................................................................... 63 Comparative Figures from World and Turkey .......................................................................... 65 Centers Included in the Registry.............................................................................................. 75 ABBREVIATIONS APD ...................... Automated peritoneal dialysis BP ........................ Blood pressure CAPD ................... Continuous ambulatory peritoneal dialysis CGN ..................... Chronic glomerulonephritis CRF ...................... Chronic renal failure DM........................ Diabetes mellitus EPO...................... Erythropoietin ESRD ................... End stage renal disease GFR...................... Glomerular filtration rate HD ........................ Hemodialysis HT ........................ Hypertension PD ........................ Peritoneal dialysis pmp ...................... Per million population RRT ...................... Renal replacement therapy RTx....................... Renal transplantation TIN ....................... Tubulointerstitial nephritis TSN ...................... Turkish Society of Nephrology Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 v 2004 REGISTRY Number of centers invited to Registry (including pediatric nephrology centers)............ 459 Number of centers that do not fit Registry inclusion criteria ........................................................ 9 Number of centers without HD unit................................................................................ 3 Number of centers where HD units were closed in 2004................................................ 5 Number of centers that could not be reached ................................................................ 1 Number of centers that fit Registry inclusion criteria .............................................................. 450 Number of non-responding centers ......................................................................................... 10 Number of responding centers and response rate............................................... 440 (97.8%) Number of centers per million population................................................................................ 6.2 HD centers Number of specialist physicians ................................................................................ 439 Number of general practitioners ................................................................................ 699 Total number of physicians ..................................................................................... 1138 Number of nurses ................................................................................................... 2827 Number of HD equipments...................................................................................... 5964 PD centers Number of specialist physicians .................................................................................. 85 Number of general practitioners .................................................................................. 38 Total number of physicians ....................................................................................... 123 Number of nurses ..................................................................................................... 124 Pediatric nephrology centers Number of centers invited to Registry ................................................................................. 32 Number of responding centers and response rate.................................................. 32 (100%) Number of centers with HD units................................................................................. 23 Number of centers with PD units ................................................................................. 30 Number of centers where RTx is performed ................................................................ 15 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 1 CLINICAL NEPHROLOGY Incident ESRD* patients in 2004 Pre-dialysis patients.............................................................................................. 30.8% HD patients .......................................................................................................... 58.9% PD patients............................................................................................................. 8.0% Tx patients.............................................................................................................. 2.3% Prevalent ESRD patients, as of the end of 2004 Pre-dialysis patients.............................................................................................. 25.5% HD patients .......................................................................................................... 58.4% PD patients........................................................................................................... 10.0% Tx patients.............................................................................................................. 6.1% Primary renal diseases in incident ESRD patients in 2004 Diabetes mellitus .................................................................................................. 25.3% Hypertensive renal disease ................................................................................... 17.2% Chronic glomerulonephritis ................................................................................... 13.4% Other diseases ..................................................................................................... 20.5% Etiology unknown ................................................................................................. 23.6% Primary renal diseases in prevalent ESRD patients, as of the end of 2004 Diabetes mellitus .................................................................................................. 23.1% Hypertensive renal disease ................................................................................... 19.8% Chronic glomerulonephritis ................................................................................... 16.3% Other diseases ..................................................................................................... 22.5% Etiology unknown ................................................................................................. 18.3% * GFR less than 15 mL/min for non-diabetic patients and GFR less than 20 mL/min for diabetic patients are accepted as ESRD. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 3 Response rate by years 100 94.1 96.2 94.4 2002 2003 97.6 Percent 90 80 77.5 70 60 2000 2001 2004 Treatment modalities in incident RRT patients (2004) 100 84.1 % of pts. 80 60 40 11.6 20 3.3 0 HD PD Tx Treatment modalities in prevalent RRT patients (2004) 100 % of pts. 80 78.4 60 40 13.4 20 8.2 0 HD 4 PD Tx Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Etiology of incident ESRD patients (2004) Diabetes mellitus 25.3 Hypertensive renal disease 17.2 Chronic glomerulonephritis 13.4 5.8 Urologic disease Chronic interstitial nephritis 4.0 Cystic renal disease 3.9 6.8 Miscellaneous Etiology unknown 23.6 0 10 20 30 % of pts. Etiology of prevalent ESRD patients (2004) Diabetes mellitus 23.1 Hypertensive renal disease 19.8 Chronic glomerulonephritis 16.3 Urologic disease 5.7 Cystic renal disease 5.3 Chronic interstitial nephritis 4.9 6.6 Miscellaneous Etiology unknown 18.3 0 10 20 30 % of pts. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 5 TRENDS IN CLINICAL NEPHROLOGY BY YEARS RRT patients with diabetic nephropathy by years 30 25.3 25.3 % of pts. 22.8 20 15.3 18.1 16.9 16.4 15.8 13.6 10 4.6 4.5 0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2003 2004 RRT patients with cystic renal disease by years % of pts. 15 10 6.6 6.0 5 5.8 4.5 4.1 4.2 3.9 2.8 2.5 0 1991 1996 1997 1998 1999 2000 2001 2003 2004 Discussion Evaluation is performed based on the results provided by 440 centers (number of pediatric nephrology centers: 32). In the year 2004, the point prevalence and incidence rates of ESRD treated with RRT are found as 444 pmp and 123 pmp, respectively. There is an increase in both point prevalence and incidence rates as compared to last year. First three etiologic diseases causing chronic renal disease among incident ESRD patients in 2004 are found as diabetes mellitus (25.3%), hypertension (17.2%) and chronic glomerulonephritis (13.4%), respectively. First three etiologic diseases causing chronic renal disease among prevalent ESRD patients as of the end of 2004 are found as diabetes mellitus (23.1%), hypertension (19.8%) and chronic glomerulonephritis (16.3%), respectively. 6 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 RENAL REPLACEMENT THERAPIES HEMODIALYSIS Incident regular HD patients in 2004 Male ..................................................................................................................... 54.9% Female ................................................................................................................. 45.1% 0-15 years of age.................................................................................................... 0.4% 16-19 years of age.................................................................................................. 1.3% 20-44 years of age................................................................................................ 21.7% 45-64 years of age................................................................................................ 48.9% 65-74 years of age................................................................................................ 20.8% 75+ years of age..................................................................................................... 6.8% Prevalent regular HD patients as of the end of 2004 .................................................... 25.321 Male ..................................................................................................................... 56.2% Female ................................................................................................................. 43.8% 0-15 years of age.................................................................................................... 0.3% 16-19 years of age.................................................................................................. 1.4% 20-44 years of age................................................................................................ 28.8% 45-64 years of age................................................................................................ 42.9% 65-74 years of age................................................................................................ 20.7% 75+ years of age..................................................................................................... 5.8% Frequency of HD sessions in regular HD patients, as of the end of 2004 Once weekly ........................................................................................................... 1.6% Twice weekly ........................................................................................................ 13.6% Three times weekly ............................................................................................... 84.8% Duration of dialysis in regular HD patients, as of the end of 2004 0-5 years .............................................................................................................. 69.6% 6-10 years ............................................................................................................ 22.4% 11-15 years ............................................................................................................ 6.2% 16-20 years ............................................................................................................ 1.5% 20+ years ............................................................................................................... 0.2% Number of dialysers consumed in 2004 ....................................................................... 3.234.687 Synthetic .............................................................................................................. 54.0% Semi-synthetic ...................................................................................................... 35.8% High-flux ................................................................................................................. 8.9% Cuprophane............................................................................................................ 1.3% Percentage of regular HD patients with urea reduction rate higher than 0.65, as of the end of 2004 ........................................................................................................ 68.1% Percentage of HD centers where urea kinetics model is used in 2004 ............................... 62.2% Kt/V values in regular HD patients, as of the end of 2004 <0.80 ...................................................................................................................... 2.2% 0.81-1.00 ................................................................................................................ 8.5% 1.10-1.20 .............................................................................................................. 25.6% 1.21-1.80 .............................................................................................................. 58.7% >1.80 ....................................................................................................................... 50% Types of vascular access in regular HD patients, as of the end of 2004 AV fistula (native) ................................................................................................. 90.1% Persistent (tunnel) catheter ..................................................................................... 3.5% AV graft (prosthesis) ............................................................................................... 2.6% Miscellaneous......................................................................................................... 3.7% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 7 AV fistula localization in regular HD patients, as of the end of 2004 Forearm 1/3 distal region ...................................................................................... 42.0% Forearm 1/3 mid-region ........................................................................................ 25.0% Arm 1/3 distal ....................................................................................................... 23.7% Snuff-box ................................................................................................................ 8.5% Femoral .................................................................................................................. 0.8% Anticoagulation method in regular HD patients, as of the end of 2004 Standard heparinization ........................................................................................ 56.5% Low-molecular weight heparinization .................................................................... 42.5% Regional heparinization .......................................................................................... 0.1% Miscellaneous......................................................................................................... 0.9% Hypertension in regular HD patients, as of the end of 2004 Hypertensive ........................................................................................................ 40.7% BP >140/90 mmHg, on antihypertensive treatment ................................... 13.5% BP >140/90 mmHg, not on antihypertensive treatment ............................... 6.9% BP <140/90 mmHg, on antihypertensive treatment ................................... 20.3% Normotensive (BP <140/90 mmHg, not on antihypertensive treatment) ................. 59.3% Cardiovascular diseases in regular HD patients, as of the end of 2004 Left ventricular hypertrophy................................................................................... 19.3% Coronary heart disease........................................................................................... 9.5% Heart failure............................................................................................................ 6.8% Arrythmia ................................................................................................................ 5.5% Miscellaneous......................................................................................................... 5.2% Percentage of regular HD patients with hypoalbuminemia (less than 3.5 g/dL), as of the end of 2004 ........................................................................................................ 12.9% Erythropoietin treatment in regular HD patients, as of the end of 2004 Percentage of HD patients on erythropoietin treatment ......................................... 62.8% Percentage of HD patients with erythropoietin resistance ........................................ 7.7% Iron treatment in regular HD patients, as of the end of 2004 HD patients on iron treatment ............................................................................... 58.9% Oral iron treatment .................................................................................................. 5.0% Parenteral iron treatment ...................................................................................... 53.9% Serum intact PTH levels (pg/mL) in regular HD patients, as of the end of 2004 <100 ..................................................................................................................... 26.7% 100-300 ................................................................................................................ 36.6% 300-500 ................................................................................................................ 17.7% 500-1000 .............................................................................................................. 11.7% >1000 ..................................................................................................................... 6.1% Phosphate-binding treatment in regular HD patients, as of the end of 2004 HD patients on phosphate-binding treatment ........................................................ 87.3% Calcium acetate.................................................................................................... 66.7% Calcium carbonate................................................................................................ 13.3% Aluminium hydroxide .............................................................................................. 4.7% Sevelamer .............................................................................................................. 2.0% Miscellaneous......................................................................................................... 0.7% Active vitamin D treatment in regular HD patients, as of the end of 2004 HD patients on vitamin D treatment....................................................................... 41.3% Oral vitamin D treatment ....................................................................................... 14.3% IV vitamin D treatment .......................................................................................... 27.0% 8 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Hepatitis serology in regular HD patients, as of the end of 2004 HBsAg (+)............................................................................................................... 4.9% Anti-HCV Ab (+).................................................................................................... 19.3% Both HBsAg and Anti-HCV Ab (+) ........................................................................... 1.5% Deaths in regular HD patients, in 2004 Deaths due to any cause .......................................................................... 3.441 (14.4%) within the first 90 days of dialysis ................................................................ 4.5% after 90 days of dialysis .............................................................................. 9.9% Causes of death Deaths due to cardiovascular causes ....................................................... 46.7% Deaths due to cerebrovascular accidents ................................................. 12.6% Deaths due to malignancies...................................................................... 10.4% Deaths due to infections ............................................................................. 9.7% Deaths due to other causes ...................................................................... 20.4% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 9 Age distribution of incident regular HD patients (2004) % of pts. 80 60 48.9 40 21.7 20 0.4 1.3 0-15 16-19 20.8 6.8 0 20-44 45-64 65-74 75+ Years of age Mean age of incident regular HD patients (2004) Years of age 60 53.2 54.4 53.8 Male Female Total 40 20 0 Age distribution of incident regular HD patients with diabetic nephropathy (2004) 51.8 % of pts. 60 40 29.0 11.9 20 0.3 0.3 0-15 16-19 6.7 0 20-44 45-64 65-74 75+ Years of age 10 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Age distribution of prevalent regular HD patients (2004) 60 % of pts. 42.9 40 28.8 20.7 20 0.3 1.4 0-15 16-19 5.8 0 20-44 45-64 65-74 75+ Years of age Age distribution of prevalent regular HD patients with diabetic nephropathy (2004) 52.3 % of pts. 60 40 28.6 13.0 20 0.0 0.2 0-15 16-19 6.0 0 20-44 45-64 65-74 75+ Years of age Frequency of HD sessions in regular HD patients (2004) 84.8 % of pts. 90 60 30 13.6 1.6 0 1/week 2/week Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 3/week 11 Distribution of dialyser membranes in regular HD patients (2004) % of pts. 60 54.0 35.8 40 20 8.9 1.3 0 Synthetic Semisynthetic High-flux Cuprophane Urea Reduction Rate (URR) in regular HD patients (2004) % of pts. 80 68.1 60 40 31.9 20 0 ≤0.65 >0.65 Urea kinetics model usage in HD centers (2004) 80 % of centers 62.2 60 40 37.8 20 0 Yes 12 No Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 60.2 28.7 2/week 7.9 12.8 3/week 4.7 2.0 20 7.9 40 25.2 60 3.6 % of pts. 80 47.1 Kt/V ratios in regular HD patients (2004) 0 ≤0.80 0.81-1.00 1.01-1.20 1.21-1.80 >1.80 Types of vascular access in regular HD patients (2004) 90.1 100 % of pts. 80 60 40 20 3.5 2.6 3.7 Persistent (tunnel) catheter AV graft (prosthesis) Misc. 0 AV fistula (native) 70.7 29.3 61.3 38.7 29.3 40 29.3 60 70.7 73.4 80 26.6 % of pts. 100 70.7 AV fistula localization in regular HD patients (2004) Right Left 20 0 Forearm 1/3 distal region Forearm 1/3 mid region Arm 1/3 distal region Femoral region Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Snuff-box 13 AV fistula localization in regular HD patients (2004) 60 % of pts. 42.0 40 25.0 23.7 20 8.5 0.8 0 Forearm 1/3 Forearm 1/3 Arm 1/3 distal region mid region distal region Snuff-box Femoral region Anticoagulation methods used in regular HD patients (2004) % of pts. 60 56.5 42.5 40 20 0.1 0.9 Regional heparinization Misc. 0 Standard heparinization Low molecular weight heparinization Blood pressure status in regular HD patients (2004) 80 % of pts. 59.3 60 40 20.3 20 6.9 13.5 0 BP <140/90 mmHg untreated 14 BP <140/90 mmHg treated BP >140/90 mmHg untreated BP >140/90 mmHg treated Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Cardiovascular diseases in regular HD patients (2004) Left ventricle hypertrophy 19.3 Heart failure 6.8 Arrythmia 5.5 Angina pectoris 5.5 Peripheral arterial disease 2.9 Coronary by-pass surgery 1.7 Acute myocardial infarction 1.2 Cerebrovascular accident 1.1 Coronary angioplasty / stent 1.1 Pericarditis 0.7 Infective endocarditis 0.5 0 5 10 15 20 % of pts. Serum albumin levels in regular HD patients (2004) 87.1 % of pts. 90 60 30 12.9 0 <3.5 g/dL Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 >3.5 g/dL 15 Erythropoietin usage in regular HD patients (2004) 80 % of pts. 62.8 60 37.2 40 20 0 Yes No Regular serum ferritin measurement in HD centers (2004) 79.5 % of centers 80 60 40 20.5 20 0 Yes No Iron treatment in regular HD patients (2004) 60 53.9 % of pts. 41.1 40 20 5.0 0 Oral 16 Parenteral None Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Renal bone disease tests performed in HD centers (2004) Routine biochemical tests 97.5 Bone X-rays 74.7 Serum intact parathormone 70.2 Parathyroid scintigraphy 27.5 Bone-specific alkaline phosphatase 21.6 13.4 Serum aluminium Serum Vit-D metabolites 8.2 Deferoxamine test 6.0 Bone biopsy 4.2 Serum osteocalcin 3.7 0 20 40 60 80 100 % of centers Serum intact parathormone levels in regular HD patients (2004) 36.6 % of pts. 40 26.7 17.7 20 11.7 6.1 0 <100 100-300 300-500 500-1000 >1000 pg/mL Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 17 Phosphorus binding agents used in regular HD patients (2004) Calcium acetate 66.7 Calcium carbonate 13.3 Aluminium hydroxide 4.7 2.0 Sevelamer Misc. 0.7 None 12.7 0 20 40 60 80 % of pts. Active vitamin D used in regular HD patients (2004) 58.7 % of pts. 60 40 27.0 20 14.3 0 Oral 18 IV None Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Hepatitis serology in regular HD patients (2004) 19.3 % of pts. 20 10 4.9 1.5 0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+) Duration of dialysis in regular HD patients (2004) % of pts. 80 69.6 60 40 22.4 20 6.2 1.5 0.2 16-20 >20 0 ≤5 6-10 11-15 Years Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 19 Causes of death in regular HD patients (2004) Cardiovascular 46.7 Cerebrovascular accident 12.6 Malignancy 10.4 Infection 9.7 Hepatic failure 1.9 Pulmonary emboli 1.2 Misc. 17.3 0 10 20 30 40 50 % of cardiovascular deaths % of total deaths Deaths due to cardiovascular diseases in regular HD patients (2004) 60 45.6 44.3 40 20 7.2 2.5 0 Heart failure Ischemic heart disease Arrythmia Misc. Discussion 20 Evaluation is performed based on the results provided by 395 hemodialysis (HD) centers. The number of the centers contributed (n: 388), the number of HD equipments (n: 5964), and the number of HD patients (n: 25321) are increased by 13.0% compared to last year. The proportion of patients who are 15 years old or younger is 0.3%. With a percentage of 79.0%, HD is the most commonly used RRT method in Turkey. The total number of physicians and nurses are 1138 and 2829, respectively. There are some differences in numbers as compared to the numbers from Ministry of Health. There are several reasons of this: unlike the report of Ministry of Health, this report does not include; o the incident HD patients of 2005, o the numbers of died HD patients, o the potential HD patients of the centers newly established their HD equipments. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 The proportion of diabetic patients among the HD patients is increased from 19.2% to %23.0 and this fact shows that diabetes mellitus, as a cause of ESRD, has an increasing rate in Turkey as well. The age range of HD patients: 49.8% of all patients and 52.4% of diabetic patients are in the age range of 45 and 64. Frequency of HD sessions: three times weekly for 84.8%, twice weekly for 13.6%, and once weekly for 1.6%. There is an increase in the frequency of 3 sessions/week compared to last year. A total of 3.235.000 dialysers are used in 385 centers in the year 2004. Decrease in cuprophane usage (1.3%) continues while there is a significant increase in synthetic membrane usage. Synthetic membranes are the most commonly prescribed membranes (54%) in the year 2004. High-flux membrane usage is 8.9%. There is an increase in urea kinetics model usage in the evaluation of dialysis sufficiency; it is used by 62.2% of the centers. Urea Reduction Rate is lower than 0.65 in 68.1% of chronic HD patients. Kt/V is higher than 1.2 in 63.7% of the patients. AV fistula is the vascular access route in 90.1% of HD patients and is opened on left arm with a proportion of over 70%. In 57.1% of the patients, dialysis is continued with the initial AV fistula. In 42.5% of the HD patients, low molecular weight heparine is used for anticoagulation. The frequency of hypertension in HD patients is found as 40.7%. Serum albumin level which is one of the reliable indicators of nutrition is lower than 3.5 g/dL in 12.9% of the HD patients. Results are better as compared to last year. The proportion of the patients whose serum albumin level is higher than 4.0 g/dL is 33.6%. The frequency of EPO usage in HD patients is 62.8% and there is a decrease when compared to last year. Target HB level (>11 g/dL) is reached in only 58.3% of the patients receiving EPO. EPO resistance is found in 7.7% of HD patients. This figure shows decrease as compared to last year (10.6%). Iron treatment is administered in 58.9% of HD patients (oral: 5.0%, parenteral: 53.9%). Routine serum ferritin tests are performed in 79.5% of the centers. Routine biochemical tests (97.5%), bone X-rays (74.7%), and parathyroid scintigraphy (70.2%) are the most commonly used tests for renal bone disease in HD patients. The proportions of patients with iPTH level <100 pg/mL and >1000 pg/mL are 26.7% and 6.1%, respectively. Calcium acetate (66.7%), calcium carbonate (13.3%), and sevelamer (2.0%) are used as phosphorus binding agents in HD patients. There is a decrease in the rates of oral (14.3%) and IV (27%) active vitamin D usage compared to last year. Parathyroidectomy is performed in 226 patients. Venous bicarbonate level test is practiced in only 6.6% of the centers, for acidose follow up. There found no change in the frequency of HBV infection in HD patients compared to last year. The frequency of anti-HCV (+) patients continues to decrease (from 24.6% to 19.3%). Dialysis duration is longer than 6 years in more than 30% of HD patients. 31.0% of the HD patients died within the first 3 months, which is same as last year. With a rate of 46.7%, cardiovascular diseases are the most common cause of death in HD patients. Cerebrovascular accident, malignancy and infection come after it, respectively. HD is the most commonly used RRT method in ESRD patients in Turkey (79%). While the number of patients keeps increasing, improvements in HD conditions and efforts to provide a more qualified dialysis are being carried on. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 21 TRENDS IN REGULAR HEMODIALYSIS THERAPY BY YEARS 12196 11339 7014 1996 9658 6527 5000 1995 3069 10000 5400 15000 3494 Count 20000 14086 23387 20600 25000 18815 30000 25321 Number of regular HD patients by years 2004 2003 2002 2001 2000 1999 1998 1997 1993 1991 1990 0 Frequency of HD sesions in regular HD patients by years % of pts. 100 80 60 40 20 1/week 2/week 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1993 1991 0 3/week Types of dialysate used in regular HD patients by years % of pts. 100 80 60 40 20 Bicarbonate 22 2002 2001 2000 1999 1998 1997 1995 0 Acetate Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 90.1 87.5 83.0 100 88.4 Types of vascular access in regular HD patients by years % of pts. 80 60 9.1 2.5 3.5 3.5 5.5 3.5 2.6 3.8 20 14.1 2.9 40 1998 1999 2003 2004 0 AV fistula Catheter Graft Other Hypoalbuminemia (<3.5 g/dL) in regular HD patients by years 40 34.5 % of pts. 30 19.8 23.0 20 18.3 16.2 14.7 17.3 19.2 15.4 12.9 10 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Erythropoietin usage in regular HD patients by years 80 63.4 55.0 60 % of pts. 67.6 69.5 69.5 69.3 66.5 65.5 62.8 44.2 40 38.0 20 0 1991 1993 1996 1997 1998 1999 2000 2001 2002 2003 2004 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 23 % of pts. 12 9 Erythropoietin resistance in regular HD patients by years 10.6 9.5 7.7 6 3 0 2002 2003 2004 Iron treatment in regular HD patients by years 80 73.5 60.4 58.9 2003 2004 % of pts. 60 40 20 0 1995 Active vitamin D usage in regular HD patients by years 90 85.0 73.6 70.6 % of pts. 62.2 60 50.5 45.2 40.4 41.3 2003 2004 30 0 1995 24 1998 1999 2000 2001 2002 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Frequency of HBsAg (+) regular HD patients by years 15.0 15 12.7 11.1 10.5 % of pts. 10.0 10 8.1 7.9 7.5 7.6 6.5 5.9 6.4 5 0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Frequency of Anti-HCV (+) regular HD patients by years 60 54.6 % of pts. 41.7 36.2 40 29.6 28.8 26.3 23.2 20.8 20 0 1997 1998 1999 2000 2001 2002 2003 2004 % of total deaths Deaths due to cardiovascular disease in regular HD patients by years 60 50.6 51.9 1995 1996 50.0 48.4 45.5 45.0 46.4 49.0 46.7 1997 1998 1999 2000 2002 2003 2004 40 20 0 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 25 % of total deaths Deaths due to cerebrovascular accident in regular HD patients by years 20 15 10.6 11.2 1995 1996 13.1 12.9 1997 1998 15.0 13.4 12.6 12.6 2002 2003 2004 10 5 0 1999 % of total deaths Deaths due to infections in regular HD patients by years 15 11.6 9.3 10 10.0 11.6 10.4 9.9 2001 2002 9.7 8.0 7.8 5 0 1996 1997 1998 1999 2000 2003 2004 % of total deaths Deaths due to malignancies in regular HD patients by years 26 12 9 6.0 6.5 1998 1999 10.4 9.1 9.1 8.9 2001 2002 2003 6 3 0 2004 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 % of total deaths Deaths due to hepatic failure in regular HD patients by years 10 8 4.8 6 4 2.8 3.0 1996 1997 3.5 2.8 3.1 2.4 1.9 2003 2004 2 0 1998 1999 2001 2002 Discussion The proportion of regular HD patients is increased by 15-20% in the last 15 years. The increase in the weekly HD sessions is more significant for 3 sessions/week. Hygienic conditions have provided the significant decrease in the percentage of HBsAg (+) regular HD patients through years. The decrease in the proportion of anti-HCV (+) patients can be prevented by hygienic conditions, too. Acetate usage as a dialysate has almost left its place to bicarbonate. In Turkey, the most commonly preferred vascular access route is native AV fistula. Unlike USA the proportion of graft is too small. The percentage of EPO usage has showed no significant change through years, while there is an decrease in vitamin D usage, which is a result of . This decrease is a result of strict follow-up of patients. Hypolbuminemia is decreased to 12.9% in 2004. This result is very satisfactory as a matter of nutrition. Decrease in iron treatment is observed through 15 years. Through 15 years there observed no significant change in the percentage of deaths due to cardiovascular, cerebrovascular accident or infection. There is a slight increase in the proportion of deaths due to malignancy. Preventing the factors causing resistance, the frequency of EPO resistance is decreased. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 27 PERITONEAL DIALYSIS Incident CAPD patients in 2004 ....................................................................................... 1.230 Male ..................................................................................................................... 52.1% Female ................................................................................................................. 47.9% 0-15 years of age.................................................................................................... 1.9% 16-19 years of age.................................................................................................. 2.1% 20-44 years of age................................................................................................ 34.1% 45-64 years of age................................................................................................ 42.4% 65-74 years of age................................................................................................ 15.9% 75+ years of age..................................................................................................... 3.7% Incident APD patients in 2004 ............................................................................................ 271 Male ..................................................................................................................... 57.6% Female ................................................................................................................. 42.4% 0-15 years of age.................................................................................................... 1.5% 16-19 years of age.................................................................................................. 1.8% 20-44 years of age................................................................................................ 46.1% 45-64 years of age................................................................................................ 38.0% 65-74 years of age................................................................................................ 10.3% 75+ years of age..................................................................................................... 2.2% Prevalent PD patients as of the end of 2004 ................................................................... 3.320 Duration of dialysis in PD patients, as of the end of 2004 0-5 years .............................................................................................................. 87.8% 6-10 years ............................................................................................................ 11.7% 11-15 years ............................................................................................................ 0.5% Hypertension in PD patients, as of the end of 2004 Hypertensive ........................................................................................................ 51.3% BP >140/90 mmHg, on antihypertensive treatment ................................... 26.4% BP >140/90 mmHg, not on antihypertensive treatment ............................... 6.3% BP <140/90 mmHg, on antihypertensive treatment ................................... 28.6% Normotensive (BP < 140/90 mmHg, not on antihypertensive treatment) ................ 38.7% Cardiovascular diseases in PD patients, as of the end of 2004 Left ventricular hypertrophy................................................................................... 12.8% Coronary heart disease........................................................................................... 4.1% Heart failure............................................................................................................ 3.8% Arrythmia ................................................................................................................ 3.1% Miscellaneous......................................................................................................... 5.2% Percentage of PD patients with hypoalbuminemia (less than 3.5 g/dL), as of the end of 2004 ........................................................................................................ 28.9% Erythropoietin treatment in PD patients, as of the end of 2004 Percentage of PD patients on erythropoietin treatment.......................................... 56.7% Percentage of PD patients with erythropoietin resistance ........................................ 8.4% Iron treatment in PD patients, as of the end of 2004 PD patients on iron treatment ............................................................................... 59.8% Oral iron treatment ................................................................................................ 44.4% Parenteral iron treatment ...................................................................................... 15.4% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 29 Serum intact PTH levels (pg/mL) in PD patients, as of the end of 2004 <100 ..................................................................................................................... 25.8% 100-300 ................................................................................................................ 33.0% 300-500 ................................................................................................................ 22.2% 500-1000 .............................................................................................................. 11.8% > 1000 .................................................................................................................... 7.2% Phosphate-binding treatment in PD patients, as of the end of 2004 PD patients on phosphate-binding treatment ......................................................... 86.2% Calcium acetate.................................................................................................... 56.4% Calcium carbonate................................................................................................ 20.0% Aluminium hydroxide .............................................................................................. 6.1% Sevelamer .............................................................................................................. 2.5% Miscellaneous......................................................................................................... 1.2% Active vitamin D treatment in PD patients, as of the end of 2004 PD patients on vitamin D treatment ....................................................................... 40.2% Oral vitamin D treatment ....................................................................................... 37.8% IV vitamin D treatment ............................................................................................ 2.4% Hepatitis serology in PD patients, as of the end of 2004 HBsAg (+)............................................................................................................... 4.8% Anti-HCV Ab (+)...................................................................................................... 8.9% Both HBsAg and Anti-HCV Ab (+) ........................................................................... 0.7% Complications in PD patients, in 2004 Percentage of PD patients who experienced peritonitis ......................................... 29.3% Rate of peritonitis...................................................................................... 1/29.7 months Other complications Hyperlipidemia ......................................................................................... 23.4% Obesity....................................................................................................... 8.4% Hernia ........................................................................................................ 7.2% Psychological problems .............................................................................. 6.0% Insufficient dialysis ..................................................................................... 5.6% Hyperglycemia ........................................................................................... 3.1% Causes of deaths in PD patients, in 2004 Deaths due to cardiovascular causes .................................................................... 37.1% Deaths due to infections ....................................................................................... 17.3% Deaths due to cerebrovascular accident ................................................................. 8.2% Deaths due to malignancies .................................................................................... 3.3% Deaths due to other causes .................................................................................. 34.0% 30 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Age distribution of incident CAPD patients (2004) % of pts. 50 42.4 34.1 40 30 15.9 20 10 1.9 2.1 0-15 16-19 3.7 0 20-44 45-64 65-74 75+ Years of age Age distribution of incident APD patients (2004) 46.1 % of pts. 50 38.0 40 30 20 10 10.3 1.5 1.8 0-15 16-19 2.2 0 20-44 45-64 65-74 75+ Years of age Mean age of incident PD patients (2004) Years of age 60 48.7 48.2 48.5 Male Female Total 40 20 0 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 31 Age distribution of incident PD patients with diabetic nephropathy (2004) 54.4 % of pts. 60 40 22.3 18.0 20 4.6 0.0 0.6 0-15 16-19 0 20-44 45-64 65-74 75+ Years of age Blood pressure status in PD patients (2004) 40 38.7 % of pts. 28.6 26.4 20 6.3 0 BP <140/90 mmHg untreated 32 BP <140/90 mmHg treated BP >140/90 mmHg untreated BP >140/90 mmHg treated Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Cardiovascular diseases in PD patients (2004) 12.8 Left ventricle hypertrophy Heart failure 3.8 3.1 Arrythmia Peripheral arterial disease 2.3 Angina pectoris 2.1 Cerebrovascular accident 0.8 Coronary angioplasty / stent 0.8 Coronary by-pass surgery 0.7 Infective endocarditis 0.7 Acute myocardial infarction 0.5 Pericarditis 0.5 0 5 10 15 % of pts. Serum albumin levels in PD patients (2004) % of pts. 80 71.1 60 40 28.9 20 0 <3.5 g/dL Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 >3.5 g/dL 33 Complications other than peritonitis in PD patients (2004) 23.4 Hyperlipidemia 8.4 Obesity 7.2 Hernia Psychological problems 6.0 Insufficient dialysis 5.6 Drainage dysfunction 4.4 Hyperglycemia 3.1 0 10 20 30 % of pts. Erythropoietin usage in PD patients (2004) 60 56.7 % of pts. 43.3 40 20 0 Yes 34 No Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Iron treatment in PD patients (2004) 50 44.4 40.2 % of pts. 40 30 15.4 20 10 0 Oral Parenteral None Serum intact parathormone levels in PD patients (2004) % of pts. 40 30 33.0 25.8 22.2 20 11.8 7.2 10 0 <100 100-300 300-500 500-1000 >1000 pg/mL Phosphorus binding agents used in PD patients (2004) Calcium acetate 56.4 Calcium carbonate 20.0 Aluminium hydroxide 6.1 Sevelamer 2.5 Misc. 1.2 None 13.8 0 20 40 60 % of pts. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 35 Active vitamin D used in PD patients (2004) 59.8 % of pts. 60 40 37.8 20 2.4 0 Oral IV None Hepatitis serology in PD patients (2004) 10 8.9 % of pts. 8 6 4.8 4 2 0.7 0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+) Duration of dialysis in PD patients (2004) % of pts. 100 87.8 80 60 40 11.7 20 0.5 0.0 11-15 >15 0 ≤5 6-10 Years 36 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Causes of death in PD patients (2004) 37.1 Cardiovascular 17.3 Infection Cerebrovascular accident 8.2 Malignancy 3.3 Pulmonary emboli 2.2 Hepatic failure 0.5 Misc. 31.3 0 10 20 30 40 % of total deaths % of cardiovascular deaths Deaths due to cardiovascular diseases in PD patients (2004) 60 53.3 40 32.6 20 8.1 5.9 Arrythmia Misc. 0 Ischemic heart disease Heart failure Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 37 Discussion Evaluation is performed based on the results provided by 51 centers performing chronic peritoneal dialysis. There are 48 certificated PD nurses working in these centers. There are 2683 CAPD patients and 637 APD patients as of the end of 2004. The proportion of pediatric patients in CAPD and APD are 1.9% and 1.5%, respectively. The frequency of peritonitis is found as 29.7 patient-months and there is a significant improvement compared to last year. Hypertension (61.3%) and hyperlipidemia (23.4%) are the most common non-infectious complications. Serum albumin level is lower than 3.5 g/dL in 28.9% of the PD patients. This figure is higher compared to last year. There is no difference in EPO usage (56.7%) in PD patients. Target HB level (<11 g/dL) is reached in only 64.6% of the patients receiving EPO. EPO resistance is found in 8.4% of PD patients. Iron treatment is administered in 59.8% of PD patients (oral: 44.4%, parenteral: 15.4%). Routine serum ferritin tests are performed in 79.5% of the centers. The proportion of patients with iPTH level <100 pg/mL and >1000 pg/mL are 25.8% and 7.2%, respectively. Calcium acetate (56.4%), calcium carbonate (20%), and sevelamer (2.5%) are used as phosphorus binding agents in PD patients. There is a decrease in the rates of oral (37.8%) and IV (2.4%) active vitamin D usage compared to last year. Parathyroidectomy is performed in 47 PD patients. When compared to last year, there found a decrease in the frequency of HBsAg (+) and Anti-HCV (+) patients; (4.8% and 8.9%, respectively). With a rate of 37.1%, cardiovascular disease is the most common cause of death in PD patients and infections and cerebrovascular accidents come after, respectively. Cause of death ranking is similar to the previous years. 38 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 TRENDS IN PERITONEAL DIALYSIS THERAPY BY YEARS Number of PD patients by years 3320 3500 3000 2556 2728 Count 2500 1927 1787 1903 2000 1500 1194 1111 1030 1124 1000 500 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Hypoalbuminemia (<3.5 g/dL) in PD patients by years % of pts. 60 40 36.0 40.2 36.7 34.9 25.3 23.5 22.7 30.4 30.8 28.9 20 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Erythropoietin usage in PD patients by years 80 62.3 % of pts. 60 49.8 55.2 55.8 53.1 56.7 43.8 43.0 42.5 40 23.4 20 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 39 Erythropoietin resistance in PD patients by years 20 15.3 % of pts. 15 10.0 10 8.4 5 0 2002 2003 2004 Iron treatment in PD patients by years 80 63.7 59.8 % of pts. 60 40 20 0 2003 2004 Active vitamin D usage in PD patients by years 80 % of pts. 60 56.8 47.2 53.7 56.9 47.4 38.7 40 42.8 40.2 2003 2004 20 0 1997 40 1998 1999 2000 2001 2002 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Frequency of HBsAg (+) PD patients by years 14.2 15 % of pts. 11.0 10.5 9.2 10 8.6 7.2 5.8 5.6 5.6 5.5 5 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Frequency of Anti-HCV (+) PD patients by years 25 21.3 % of pts. 20 21.3 20.8 21.3 16.7 15.1 15 10 13.8 11.3 9.6 7.3 5 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 % of total deaths Deaths due to cardiovascular diseases in PD patients by years 49.2 50 40 39.5 42.4 41.7 1997 1998 46.3 42.7 42.4 31.9 37.1 30 20 10 0 1995 1996 1999 2001 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 2002 2003 2004 41 % of total deaths Deaths due to cerebrovascular accident in PD patients by years 20 15 15.9 13.0 12.7 10.6 10.2 11.7 9.8 13.7 11.9 8.2 10 5 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 % of total deaths Deaths due to infections in PD patients by years 30 23.7 26.1 23.9 20.8 20 14.4 12.8 11.1 14.2 18.2 17.3 10 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 % of total deaths Deaths due to malignancies in PD patients by years 4.7 5 4 3.2 1999 2000 3.3 2.5 3 1.8 2 1 3.8 3.4 0.6 0.6 1995 1996 0 1997 1998 2002 2003 2004 Discussion Starting from 1995 number of the PD patients shows an increasing trend. The increase in the proportion of patients receiving EPO is significant. Cardiovascular diseases are the most significant cause of death for 15 years. The proportion of HBsAg (+) PD patients varies from year to year, while the frequency of anti-HCV (+) PD patients is higher between the years 1997-2000 as compared to last 5 years. 42 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 RENAL TRANSPLANTATION Incident RTx patients in 2004 ............................................................................................. 665 Male ..................................................................................................................... 68.0% Female ................................................................................................................. 32.0% 0-15 years of age.................................................................................................... 4.1% 16-19 years of age.................................................................................................. 5.6% 20-44 years of age................................................................................................ 73.7% 45-64 years of age................................................................................................ 16.7% 65+ years of age..................................................................................................... none Living donor .......................................................................................................... 72.1% Related .................................................................................................... 85.6% Spouse ..................................................................................................... 12.9% Non-related ................................................................................................ 1.5% Cadaver................................................................................................................ 27.9% Prevalent RTx patients as of the end of 2004 ................................................................. 3.395 Hypertension in RTx patients, as of the end of 2004 Hypertensive ........................................................................................................ 71.8% BP >140/90 mmHg, on antihypertensive treatment ..................................... 9.5% BP >140/90 mmHg, not on antihypertensive treatment ............................... 1.1% BP <140/90 mmHg, on antihypertensive treatment ................................... 61.2% Normotensive (BP <140/90 mmHg, not on antihypertensive treatment) ................. 28.2% Cardiovascular diseases in RTx patients, as of the end of 2004 Left ventricular hypertrophy................................................................................... 11.0% Coronary heart disease........................................................................................... 2.2% Arrythmia ................................................................................................................ 0.9% Heart failure............................................................................................................ 0.5% Miscellaneous......................................................................................................... 0.7% Hepatitis serology in RTx patients, as of the end of 2004 HBsAg (+)............................................................................................................... 1.4% Anti-HCV Ab (+)...................................................................................................... 7.9% Both HBsAg and Anti-HCV Ab (+) ........................................................................... 0.2% Status of the incident RTx patients, as of the end of 2004 Functioning graft ................................................................................................... 80.3% Allograft dysfunction ............................................................................................. 12.6% Returned to HD....................................................................................................... 3.8% Died ....................................................................................................................... 3.3% Causes of graft loss in RTx patients, as of the end of 2004 Chronic rejection................................................................................................... 48.9% Death ................................................................................................................... 38.4% Relapse of the primary disease ............................................................................... 4.7% Acute rejection........................................................................................................ 4.1% Primary non-functioning .......................................................................................... 2.8% Misc........................................................................................................................ 1.1% Causes of deaths in RTx patients, in 2004 Deaths due to infections ....................................................................................... 51.1% Deaths due to cardiovascular causes .................................................................... 25.5% Deaths due to cerebrovascular accident ................................................................. 6.4% Deaths due to malignancies .................................................................................... 4.3% Deaths due to other causes .................................................................................. 12.7% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 43 Age distribution of incident RTx patients (2004) 73.7 % of pts. 80 60 40 16.7 20 4.1 5.6 0-15 16-19 0.0 0 20-44 45-64 65+ Years of age Living 16-19 20-44 45-64 0.0 0 0-15 Cadaver 0.0 8.1 4.2 20 6.5 40 15.7 22.8 60 2.7 % of pts. 80 69.7 69.2 Age distribution of incident RTx patients by donor type (2004) 65+ Years of age Mean age of incident RTx patients (2004) Years of age 40 34.5 32.9 Male Female 36.3 32.8 34.0 Cadaver Total 20 0 44 Living Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Hepatitis serology in RTx patients (2004) 10 7.9 % of pts. 8 6 4 2 1.4 0.2 0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+) Blood pressure status in RTx patients (2004) 80 % of pts. 61.2 60 40 28.2 20 9.5 1.1 0 BP <140/90 mmHg untreated BP <140/90 mmHg treated BP >140/90 mmHg untreated Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 BP >140/90 mmHg treated 45 Cardiovascular diseases in RTx patients (2004) Left ventricle hypertrophy 11.0 Angina pectoris 1.1 Arrythmia 0.9 Coronary angioplasty / stent 0.6 Heart failure 0.5 Peripheral arterial disease 0.4 Acute myocardial infarction 0.3 Cerebrovascular accident 0.2 Coronary by-pass surgery 0.2 Infective endocarditis 0.1 0 3 6 9 12 % of pts. Status of incident RTx patients (2004) % of pts. 90 80.3 60 30 12.6 3.8 3.3 Returned to HD Died 0 Functioning graft 46 Allograft dysfunction Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Causes of graft loss in prevalent RTx patients (2004) Chronic rejection 48.9 Death 38.4 Relapse of the primary disease 4.7 Acute rejection 4.1 Primary non-functioning 2.8 Misc. 1.1 0 10 20 30 40 50 % of pts. with graft loss Causes of death in prevalent RTx patients (2004) Infection 51.1 Cardiovascular 25.5 Cerebrovascular accident 6.4 Malignancy 4.3 Pulmonary emboli 2.1 Misc. 10.6 0 20 40 60 % of total deaths Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 47 Discussion Evaluation is performed based on the results provided by 25 centers. The number of the RTx patients on follow up is found as 3395 as of the end of 2004. The annual number of RTx is increased by 21.7% (n: 665). The rate of cadaver donation is 27.8%. The rate of RTx patients younger than 15 years old is 4.1%. Living donations were 85.6% from relatives, 12.9% from spouse and 1.5% from non-relatives. The frequency of diabetic nephropathy is 3.6% in RTx patients in 2004 and diabetes mellitus is found as comorbidity in 0.8%. Only 12% of the 25 centers performed pancreas Tx in 2004. Synchronous kidney and pancreas Tx is performed in 22 patients. The number of the Tx patients in whom kidney is transplanted first is 10. The number of the centers performing laparoscopic nephrectomy in living donors is 2 (8%). Antibody treatment is preferred for induction therapy in 58.3% (n: 388) of the RTx patients, in 2004. In 42.5% of them basiliximab, in 35.3% ATG (horse), in 18.8% daclizumab, and in 3.4% thymoglobulin (rabbit) is administered. Increase in the prescribing of the new immunosuppresive agents (mycophenolate mofetil, tacrolimus, IL-2r monoclonal antibodies) will lead to more selective, efficient and safe treatment protocols. Hypertension is observed in 71.8% of the patients as of the end of 2004. Blood pressure is out of control in 9.5% of treated patients. The proportions of HBsAg (+) and Anti-HCV (+) patients are 1.4% and 7.5%, respectively, as of the end of 2004. 29.2% of the centers are performing RTx to HBsAg (+) patients, while 66.7% performs RTx to anti-HCV (+) patients. These figures are decreased compared to last year. Due to the mortality analysis of the year 2004, infections are the most common cause of death (51.1%) and significantly increased compared to last year (34.8%). The most commonly observed infection is sepsis. Cardiovascular diseases, cerebrovascular accident and malignancy come after infections, respectively. Chronic rejection (48.9%) and death (38.4%) are the most common causes of graft loss in 2004; there found a significant change compared to last year. Serum creatinin level is <2 mg/dL in 80.3% of the RTx patients while it is >2 mg/dL in 12.6% of them, in 2004. The proportion of RTx patients who returned to HD is 3.8%, and 19 patients (3.3%) died. 48 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 TRENDS IN RENAL TRANSPLANTATION BY YEARS Number of RTx's performed by years 665 700 600 549 600 475 Count 500 364 400 300 215 382 360 370 193 200 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Distribution of RTx patients due to donor type by years 100 % of pts. 80 60 40 20 0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Living Cadaver Frequency of HBsAg (+) RTx patients by years 4 % of pts. 3 2.9 3.0 3.2 2 1.6 1 0 1997 1998 1999 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 2004 49 Frequency of Anti-HCV (+) RTx patients by years 30 % of pts. 24.0 23.9 22.5 20 8.1 10 0 1997 1998 1999 2004 % of total deaths Deaths due to cardiovascular disease in RTx patients by years 40 30.4 25.5 20 15.7 20.0 13.3 0 1996 1998 2000 2002 2004 % of total deaths Deaths due to cerebrovascular accident in RTx patients by years 30 20 10 8.7 6.4 4.1 0 2000 50 11.6 2002 2003 2004 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 % of total deaths Deaths due to infections in RTx patients by years 53.3 60 43.3 45.2 44.1 51.5 51.1 40.0 40 34.8 32.6 2002 2003 20 0 1995 1996 1998 1999 2000 2001 2004 % of total deaths Deaths due to malignancies in RTx patients by years 30 20 10 6.7 6.7 7.2 6.1 1998 2000 2001 2.9 8.6 11.6 4.3 0 1995 1996 2002 2003 2004 Discussion The number of RTx patients has increased starting from 1995, it is still too low compared to Europe. We believe that this number will increase with the help of the efforts being spent by Ministry of Health in establishing a better organized Tx system. Through 15 years, there is no significant decrease in the proportion of HBsAg (+) patients while a significant decrease in the frequency of anti-HCV (+) patients is observed. Starting from 2000, there observed an increase in the percentage of the deaths due to cardiovascular diseases. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 51 PEDIATRIC NEPHROLOGY * Primary renal diseases in incident pediatric RRT patients in 2004 ............................ (n:174) Congenital urologic anomalies (including vesicoureteral reflux) ............................. 25.9% Primary glomerulonephritis ................................................................................... 20.7% Neurogenic bladder ................................................................................................ 5.7% Renal hypoplasia / dysplasia................................................................................... 4.0% Secondary glomerulonephritis................................................................................. 3.4% Other diseases ..................................................................................................... 14.3% Etiology unknown ................................................................................................. 25.9% * Comments on the results of Pediatric Nephrology, Dialysis and Transplantation are made by Prof. Dr. Lale SEVER (İstanbul University Cerrahpaşa Faculty of Medicine Departmant of Pediatrics Division of Clinical Nephrology) Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 53 Etiology of incident pediatric RRT patients (2004) Congenital urologic anomalies 25.9 20.7 Primary glomerulonephritis Neurogenic bladder 5.7 4.0 Renal hypoplasia/dysplasia Urolithiasis 3.4 Secondary glomerulonephritis 3.4 Misc. 10.9 25.9 Etiology unknown 0 5 10 15 20 25 30 % of pts. Discussion Pediatric patient forms are sent to 33 pediatric nephrology centers and 32 of them have responded. In 30 of responding centers chronic PD patients, and in 23 of responding centers chronic HD patients are being followed-up as of the end of 2004. RTx is performed in 13 of pediatric nephrology centers, in 2004. The number of the centers with RTx patients is 15, as of the end of 2004. There are 61 pediatric nephrologists in 32 pediatric nephrology centers. There are 28 pediatricians continuing their education in pediatric nephrology, as of the end of 2004. There are more than 800 RRT patients in nephrology centers, as of the end of 2004. The percentages of PD and HD patients are 51% and 13%, respectively. The proportion of RTx patients is 36%. Primary renal disease is unknown in 1/4 of the incident RRT patients. Etiologic causes of ESRD congenital urologic anomalies in 1/4 and primary and secondary glomerulonephritis, each in 1/4. 54 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 PEDIATRIC HEMODIALYSIS Prevalent pediatric regular HD patients, as of the end of 2004......................................... 116 Male ..................................................................................................................... 50.0% Female ................................................................................................................. 50.0% 0-6 years of age...................................................................................................... 0.8% 7-10 years of age.................................................................................................... 9.8% 11-15 years of age................................................................................................ 49.2% 15+ years of age................................................................................................... 40.2% Frequency of HD sessions in pediatric regular HD patients, as of the end of 2004 Once weekly ........................................................................................................... 3.3% Twice weekly ........................................................................................................ 12.3% Three times weekly ............................................................................................... 83.6% More than three times weekly ................................................................................. 0.8% Duration of dialysis in pediatric regular HD patients, as of the end of 2004 0-6 months ........................................................................................................... 10.7% 7-12 months ........................................................................................................... 6.6% 13-24 months ....................................................................................................... 25.4% 25-60 months ....................................................................................................... 36.1% 60+ months .......................................................................................................... 21.3% Types of vascular access in pediatric regular HD patients, as of the end of 2004 AV fistula .............................................................................................................. 77.0% Catheter ............................................................................................................... 15.6% AV graft .................................................................................................................. 7.4% Percentage of pediatric regular HD patients under antihypertensive treatment................... 52.5% Hepatitis serology in pediatric regular HD patients, as of the end of 2004 HBsAg (+)............................................................................................................... 7.8% Anti-HCV Ab (+).................................................................................................... 17.6% Both HBsAg and Anti-HCV Ab (+) ........................................................................... 2.9% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 55 Age distribution of prevalent pediatric regular HD patients (2004) 60 49.2 % of pts. 40.2 40 20 9.8 0.8 0 0-6 >6-10 >10-15 >15 Years of age Types of vascular access in pediatric regular HD patients (2004) 80 77.0 % of pts. 60 40 15.6 20 7.4 0 AV fistula Catheter AV graft Hepatitis serology in pediatric regular HD patients (2004) 20 17.6 % of pts. 15 10 7.8 5 2.9 0 HBsAg (+) 56 Anti-HCV (+) HBsAg (+) and Anti-HCV (+) Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Discussion Only 10% of the regular HD patients are younger than 10 years old. Hemodialysis duration is longer than 2 years in approximately 60% of HD patients. AV fistula is being used for vascular access in the vast majority of HD patients (77%). Proportion of HBsAg (+) pediatric HD patients is 10%, while this figure is 20% for anti-HCV Ab (+) pediatric HD patients. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 57 PEDIATRIC PERITONEAL DIALYSIS Prevalent pediatric PD patients, as of the end of 2004...................................................... 421 Male ..................................................................................................................... 47.1% Female ................................................................................................................. 52.9% 0-2 years of age...................................................................................................... 2.4% 3-6 years of age...................................................................................................... 9.9% 7-10 years of age.................................................................................................. 22.4% 11-15 years of age................................................................................................ 33.9% 15+ years of age................................................................................................... 31.5% Duration of dialysis in pediatric PD patients, as of the end of 2004 0-6 months ........................................................................................................... 12.1% 7-12 months ......................................................................................................... 17.9% 13-24 months ....................................................................................................... 21.2% 25-60 months ....................................................................................................... 30.8% 60+ months .......................................................................................................... 17.9% PD treatment modality in pediatric PD patients, as of the end of 2004 CAPD ................................................................................................................... 53.4% APD ..................................................................................................................... 46.6% Percentage of pediatric PD patients under antihypertensive treatment............................... 63.5% Hepatitis serology in pediatric PD patients, as of the end of 2004 HBsAg (+)............................................................................................................... 2.7% Anti-HCV Ab (+)...................................................................................................... 1.9% Both HBsAg and Anti-HCV Ab (+) ........................................................................... 0.5% Peritonitis in pediatric PD patients in 2004 Percentage of PD patients who experienced peritonitis ......................................... 33.9% Rate of peritonitis All PD patients.............................................................................. 1/25.7 months All CAPD patients ......................................................................... 1/35.5 months All APD patients ........................................................................... 1/24.3 months Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 59 PD treatment modality in pediatric PD patients as of the end of 2004 60 53.4 % of pts. 46.6 40 20 0 CAPD APD Age distribution of prevalent pediatric PD patients (2004) 40 33.9 31.5 % of pts. 30 22.4 20 9.9 10 2.4 0 0-2 >2-6 >6-10 >10-15 >15 Years of age Hepatitis serology in pediatric PD patients (2004) 4 % of pts. 3 2.7 1.9 2 1 0.5 0 HBsAg (+) 60 Anti-HCV (+) HBsAg (+) and Anti-HCV (+) Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Peritonitis in pediatric PD patients (2004) 80 66.1 % of pts. 60 40 23.5 20 6.1 4.3 2 >2 0 None 1 Number of episodes Discussion One-third of the PD patients are younger than 10 years old, as of the end of 2004. PD duration is more than 2 years in nearly 50% of the patients. PD duration for 18% of the patients is more than 5 years. The proportion of APD patients is 47%. The proportions of positivity of hepatitis serology are lower than HD patients; HBsAg (+) 3.2% and anti-HCV Ab (+) 2.4%. Average peritonitis rate is found as 1/25.7 patient-months. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 61 PEDIATRIC RENAL TRANSPLANTATION Incident pediatric RTx patients in 2004................................................................................ 59 Male ..................................................................................................................... 50.8% Female ................................................................................................................. 49.2% 0-6 years of age...................................................................................................... 5.1% 7-10 years of age.................................................................................................... 6.8% 11-15 years of age................................................................................................ 45.8% 15+ years of age................................................................................................... 42.4% Living donor .......................................................................................................... 50.8% Cadaver................................................................................................................ 49.2% Prevalent pediatric RTx patients, as of the end of 2004 .................................................... 279 Duration of waiting of pediatric patients transplanted in 2004 Preemptive Tx ...................................................................................................... 12.7% <6 months ............................................................................................................ 20.8% 6-12 months ........................................................................................................... 5.5% 13-24 months ....................................................................................................... 25.5% 25-60 months ....................................................................................................... 29.1% >60 months ............................................................................................................ 7.3% Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 63 Age distribution of incident pediatric RTx patients (2004) 60 % of pts. 45.8 42.4 40 20 5.1 6.8 0-6 >6-10 0 >10-15 >15 Years of age Duration of waiting of pediatric patients transplanted (2004) 40 29.1 % of pts. 25.5 20.8 20 12.7 7.3 5.5 0 Preemptive <6 months Tx 6-12 months 13-24 months 25-60 months >60 months Discussion The number of RTxs performed in 2004 is 59. This figure is similar to the last year. The donors in half of the RTxs are living related donors. The duration of waiting on dialysis is more than 2 years in 36% of pediatric RTx patients. 64 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Comparative Figures from World and Turkey Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 65 Figure 1. Worldwide incident rates (per million population)* (USRDS 2004). * Data represent the most current information available (primarily 2002). Data from Israel, Japan, Luxembourg, & Taiwan represent dialysis only. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 67 Figure 2. European countries/regions contributing to ERA-EDTA Registry (ERA-EDTA registry newsletter, December 2004). Registries contributing individual patient data to the ERA-EDTA Registry database Registries sending aggregated data to be included in the annual report No registry / no contribution / data not eligible for analysis 68 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 3. Incidence of ESRD in some countries in 2003 (USRDS 2004). Taiw an United States Japan Qatar Israel Germany Belgium Greece Spain/Canary Islands Spain/Valencia Canada Spain/Catalonia Luxembourg Uruguay Austria Korea (Repub of) Denmark Chile Sw eden Turkey 122 Croatia New Zealand Scotland Netherlands Poland Malaysia Australia Norw ay Spain/Basque Country Finland Iceland Latvia Philippines Russia Bangladesh 0 100 200 300 400 Rate per million population Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 69 Figure 4. Prevalence of ESRD in some countries in 2003 (USRDS 2004). Japan Taiw an United States Spain/Valencia Spain/Catalonia Spain/Canary Islands Germany Canada Spain/Basque Country Belgium Greece Uruguay Austria Sw eden Chile Denmark Korea, Republic of Scotland Croatia New Zealand Israel Australia Netherlands Norw ay Finland Qatar Luxembourg Iceland Malaysia Poland Turkey 387.5 Latvia Russia Bangladesh Philippines 0 300 600 900 1200 1500 1800 Rate per million population 70 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 5. Prevalent dialysis patients by modality in some countries in 2003 (USRDS 2004). In-center HD Home HD PD Bangledesh Luxembourg Japan Chile Spain/Catalonia Germany Uruguay Russia Taiw an Spain/Valencia Austria United States Croatia Spain/Canary Islands Qatar Greece Israel Poland Belgium Malaysia Turkey Norw ay Canada Finland Korea Scotland Denmark Sw eden Spain/Basque Country Netherlands Iceland Australia New Zealand 0 20 40 60 80 100 % of pts. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 71 Figure 6. Transplant rates in some countries in 2003 (USRDS 2004). Spain/Canary Islands Spain/Catalonia United States Spain/Valencia Norw ay Austria Qatar Netherlands Sw eden Canada Luxembourg Finland Denmark Australia New Zealand Belgium Germany Scotland Uruguay Poland Israel Greece Iceland Taiw an Chile Korea, Republic of Turkey 8.1 Malaysia Spain/Basque Country Thailand Philippines Russia Bangladesh 0 20 40 60 80 Rate per million population 72 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 7. Prevalence of functioning graft in some countries in 2003 (USRDS 2004). Spain/Canary Islands Spain/Catalonia Norw ay United States Spain/Valencia Sw eden Austria Spain/Basque Country Finland Belgium Canada Netherlands Scotland Australia New Zealand Denmark Qatar Iceland Germany Chile Korea, Republic of Greece Poland Uruguay Croatia Malaysia 37.9 Turkey Thailand Russia Bangladesh Philippines 0 200 400 600 Rate per million population Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 73 Table 1. Total RRT expenses in Turkey, France, Germany, Japan and USA (Erek et al. Nephrology 2004; 9: 33-38). Total RRT expenses ($) Treatment modality Turkey France Germany Japan U.S.A. HD 22.759 78.947 44.500 46.000 46.000 CAPD 22.350 23.684 29.000 APD 25.714 RTx (first year) 23.393 RTx (second year) 10.028 29.605 40.000 - - - 41.000 - 35.545 50.000 60.000 19.000 27.000 Table 2. Annual growth rate of world population and number of ESRD, HD, PD and RTx (ESRD patients, 2003, p. 4. Fresenius M.C.) Approximate annual growth rates World population 1.2% ESRD 6% HD 6% PD 6% RTx 5% Table 3. World population and number of ESRD, HD, PD and RTx patients. (ESRD patients in 2003, p. 4. Fresenius M.C.) ESRD patients 1.681.000 HD 1.158.000 PD 141.000 RTx 382.000 World population 6.3 billion Table 4. Gross mortality rate in Turkey and world. (Nephrol Dial Transplant 2002; 17: 2092). USA (1999) Japan (1997) EU (15 countries) TURKEY a 74 Expansion rate of RRT stock (%) Gross mortality rate of RRT patients (%) 9 19.7 7.8 9.3 8.2 (2.3-13) 10.4a 17b 9.4 Death range on RRT in Europe (pmp) is 35-89. b HD 18.5%, CAPD 6%, RTx 1.7%. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 CENTERS INCLUDED IN THE REGISTRY Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 75 CENTERS INCLUDED IN THE REGISTRY in alphabetical order by cities No Center code City Name of center Responsible person 1 2 21EAA 21BJA ADANA ADANA ADANA NUMUNE EĞİTİM VE ARŞ. HST. ADANA SSK HST. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 21SDA 21DPA 21AKA 21LVA 21MPA 21WLA 21BZA 21DLA 21CNA 21RPA 21UMA 21FSA 21MHA 21PCA 21PUA 21SGA 21MNA 21LHA 21KNA 21EZA 21CBA 21FTA 21EYA 21KHA 21AJA 21KDA 21.Ara 21NKA 21RCA 21NQA 21VNA 21EDA 21GRA 21VWA 21GXA ADANA ADANA ADANA ADANA ADANA ADANA ADAPAZARI ADAPAZARI ADIYAMAN ADIYAMAN ADIYAMAN AFYON AFYON AFYON AFYON AFYON AFYON AFYON AĞRI AKSARAY AMASYA AMASYA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA 38 39 40 41 42 43 44 45 21GYA 21ADA 21AUA 21NHA 21HDA 21AFA 21LNA 21LQA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA ANKARA BAŞKENT Ü ADANA ARŞ. VE UYG. MERKEZİ PEDİYATRİ BAŞKENT ÜNİVERSİTESİ ADANA HST. ÇUKUROVA ÜTF MERKEZİ ÇUKUROVA ÜTF PEDİYATRİ FRESENİUS ADANA DİYALİZ MERKEZİ FRESENİUS GÜNEYDOĞU ADANA DİYALİZ MERKEZİ ÖZEL SAKARYA NEFROMED DİYALİZ MERKEZİ SSK ADAPAZARI HST. ADIYAMAN DEVLET HST. FRESENİUS ADIYAMAN DİYALİZ MERKEZİ GÖLBAŞI DEVLET HST. AFYON DEVLET HST. AFYON ÖZEL DİYALİZ MERKEZİ AFYON SKK HST. BOLVADİN DEVLET HST. ÇAY DEVLET HST. DİNAR DEVLET HST. SANDIKLI DEVLET HST. AĞRI DEVLET HST. AKSARAY DEVLET HST. MERZİFON DEVLET HST. SABUNCUOĞLU ŞEREFEDDİN DEVLET HST. ANKARA ATATÜRK EĞİTİM VE ARŞ.HST. ANKARA NEFROMED GÖRKEM TIP ANKARA ÜTF İBN-İ SİNA HST. ANKARA ÜTF PEDİYATRİ BAŞKENT ÜTF BAŞKENT ÜTF PEDİYATRİ BEYPAZARI DEVLET HST. ÇINAR DİYALİZ MERKEZİ ÇUBUK DEVLET HST. DR. SAMİ ULUS ÇOCUK SAĞLIĞI VE HAST. HST. ECE DİYALİZ FATİH ÜNİVERSİTESİ HST. FRESENİUS SAĞLIK HİZMETLERİ YAŞAM DİYALİZ MERKEZİ GAMBRO DİYALİZ MERKEZİ GATA NEFROLOJİ BD GAZİ ÜTF NEFROLOJİ BD GAZİ ÜTF PEDİYATRİ GÜNEŞLİ DİYALİZ MERKEZİ HACETTEPE ÜTF HACETTEPE ÜTF PEDİYATRİ ÖZEL GÖNÜL DİYALİZ MERKEZİ SIDDIG MOMİN ADAM ELİF GÜRBÜZ KASIM YILDIZER ÜMİT SAATÇİ DİLEK TORUN SAİME PAYDAŞ ALİ ANARAT SIDDIK MONİN ADAM PINAR ERGİN SEDAT AYDIN BÜLENT KARAMAN ABDULKADİR DEMİR 46 21YDA ANKARA POLATLI DUATEPE DEVLET HST. 47 48 21UXA 21YMA ANKARA ANKARA 49 50 51 21BKA 21YCA 21ZKA ANKARA ANKARA ANKARA S. KOÇHİSAR DEVLET HST. SAĞLIK BAKANLIĞI DIŞKAPI ÇOCUK HAST. EĞT. VE ARŞ. HST. SB. ETLİK İHTİSAS HST. SEVGİ DİYALİZ MERKEZİ SİNCAN KOÇ DİYALİZ MERKEZİ Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 HÜSEYİN ÖZTOP A.KADİR ERÇOLAK GÜLDANE ÇETİNKAYA HASAN SUNGUR ALİ OSMAN AVCI ÖZCAN ÇELİK HÜLYA ÜNAL ŞENCAN BANU ERKALKAN YASİN TAŞDEMİR AHMET AYDOĞDU ALİ SEZGİN RUHİ KALAYCIOĞLU HÜLYA GÜVENCE ALEV ÖZSARI MESİHA EKİM NURHAN ÖZDEMİR ÜMİT SAATÇİ SERDAR ŞİRİN MANSUR KAYATAŞ RAHMAN SİYAHHAN AYŞE ÖNER MELTEM AYLI TANJU İNANÇ M.DENİZ AVCI CANAN VAR İZZET YAVUZ ŞÜKRÜ SİNDEL ABDÜLGAFFAR VURAL ÇETİN TURGAN AYŞİN BAKKALOĞLU MÜZEYYEN IŞIKMAN GÖNÜL ALTUN DOĞAN ÇİFTÇİ CAHİT YALÇIN AHMET NOYAN NİLGÜN ÇAKAR NAZLI KARA TURGAY BAŞAY İZZET YAVUZ AHMET DİRİKOÇ 77 No Center code City Name of center Responsible person 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 21AHA 21YKA 21YAA 21KJA 21SHA 21VVA 21HPA 21PVA 21GWA 21UUA 21PKA 21GSA 21VGA 21VHA 21LBA 21PGA 21BRA 21BYA 21AZA 21JUA 21DDA 21JYA 21UWA 21PPA 21YVA 21DHA 21BEA 21RNA 21URA 21KFA 21STA 21GZA 21RDA 21VFA 21ZPA 21KKA 21HJA 21CXA 21FUA 21CZA 21TPA 21CHA 21WWA 21CDA 21GQA 21KTA 21JGA 21VRA 21LCA 21TQA 21FRA 21FQA 21WMA 21MZA 21BNA 21UZA 21CTA 21LRA 21VKA 21DNA ANKARA ANTAKYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ANTALYA ARDAHAN ARTVİN ARTVİN ARTVİN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN AYDIN BALIKESİR BALIKESİR BALIKESİR BALIKESİR BALIKESİR BALIKESİR BALIKESİR BALIKESİR BARTIN BATMAN BAYBURT BİLECİK BİLECİK BİNGÖL BİTLİS BOLU BOLU BOLU BURDUR BURDUR BURDUR BURSA BURSA BURSA BURSA TÜRKİYE YÜKSEK İHTİSAS HST. ANTAKYA EMİR DİYALİZ MERKEZİ ADALİA DİYALİZ MERKEZİ AKDENİZ ÜTF PEDİYATRİ ALANYA DEVLET HST. ANTALYA BAŞKENT ÜNİVERSİTESİ HST. ANTALYA DEVLET HST. ANTALYA DEVLET HST. PEDİYATRİ CAN DİYALİZ MERKEZİ ELMALI DEVLET HST. FİNİKE DEVLET HST. FRESENİUS ANTALYA TATİL DİYALİZ MERKEZİ KORKUTELİ DEVLET HST. MANAVGAT DEVLET HST. NEFROTALYA NEFROLOJİ MERKEZİ OLBİA DİYALİZ MERKEZİ ÖZEL CAN HST. SSK ANTALYA BÖLGE HST. AKDENİZ ÜTF HST. ARDAĞAN DEVLET HST. ARTVİN DEVLET HST. HOPA DEVLET HST. ŞAVŞAT DEVLET HST. ADNAN MENDERES ÜTF ADNAN MENDERES ÜTF PEDİYATRİ AYDIN DEVLET HST. AYDIN SSK HST. GÜNEŞ ÖZEL DİYALİZ MERKEZİ KUŞADASI DEVLET HST. NAZİLLİ DEVLET HST. ÖDEMİŞ İKİNCİ BAHAR DİYALİZ MERKEZİ ÖZEL AYDIN DİYALİZ MERKEZİ ÖZEL KUŞADASI HST. SÖKE FEHİME KOCAGÖZ DEVLET HST. VOLAKA DİYALİZ MERKEZİ AYVALIK DEVLET HST. BALIKESİR ATATÜRK DEVLET HST. BALIKESİR DEVLET HST. BURHANİYE DEVLET HST. DR. M. GÜVEN KARAHAN BANDIRMA DEVLET HST. EDREMİT DEVLET HST. GÖNEN DEVLET HST. ÖZEL UMUT HEMODİYALİZ MERKEZİ BARTIN DEVLET HST. BATMAN DEVLET HST. BAYBURT DEVLET HST. BİLECİK DEVLET HST. BOZÜYÜK ERTUĞRUL GAZİ DEVLET HST. BİNGÖL DEVLET HST. BİTLİS DEVLET HST. DÜZCE DEVLET HST. İZZET BAYSAL BOLU DEVLET HST. ÖZEL NEFRO BOLU HEMODİYALİZ BUCAK DEVLET HST. BURDUR DEVLET HST. GÖLHİSAR DEVLET HST. BURSA DEVLET HST. BURSA ULUDAĞ PEDİATRİ BURSA YÜKSEK İHTİSAS EĞİTİM VE ARŞ. HST. ÇEKİRGE DEVLET HST. MEDİHA BORAN İDRİS EMİR HALİM YAVUZ AYŞE GÜR GÜVEN ERDEM BABACAN HÜSEYİN ÇELİK METİN SARIKAYA 78 MÜJDAT YENİCESU ÖZER YAZICI ENVER AYAR METİN SARIKAYA KEMAL ALADAĞLI SAİD ÖZER GÜLTEKİN SÜLEYMANLAR MUZAFFER SAPAN YAMAN ERSOY NEVCAN AKTUĞ F.FEVZİ ERSOY NEJAT AKIN ENVER AKBAŞ EGEMEN ARIKAN YAVUZ AKALTUN HARUN AKAR FERAH SÖNMEZ ÜLGER AVCI KADİR SARI OSMAN GÖK BÜLENT ILDIZ YAŞAR GÜNDOĞDU GÜNAY ÖNDER ÜLGER AVCI YUSUF TUNA ORHAN YAVUZ MEVLUT HAMAMCI O.NURİ TOPAL SEZGİN ÇETİN RIZA TOKSOY ERHAN ÇOLAK MEHMET TEMELLİ SEYFULLAH AKKILIÇ AYHAN AĞAOĞLU ŞAHİN ÇEÇEN FADIL EDEBALİ HÜSEYİN TÜRKER BAHRİ GÜNDOĞAN SÜLEYMAN EKİZ MEHMET YILDIRIM FİKRET BAŞTIMAR MUSTAFA EROĞLU NATAY TUĞRUL GÜLDEHEN AKBAŞ İBRAHİM AYDIN MEHMET BÜLBÜL TARKAN HAYDAROĞLU MEHMET USTA OSMAN DÖNMEZ ALTAY TÜRKSÖZ ŞENİZ SEVİNİR Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 No Center code City Name of center Responsible person 112 113 114 115 116 117 118 119 120 121 21JPA 21MCA 21UNA 21WZA 21MSA 21ZRA 21ZSA 21HCA 21ALA 21MBA BURSA BURSA BURSA BURSA BURSA BURSA BURSA BURSA BURSA ÇANAKKALE DİAMED ÖZEL DİYALİZ MERKEZİ İNEGÖL DEVLET HST. İZNİK DEVLET HST. KARACABEY DEVLET HST. MUSTAFA KEMAL PAŞA DEVLET HST. ÖZEL MUSTAFA KEMALPAŞA DİYALİZ MERKEZİ R. T. S. ÖZEL DİYALİZ REN TIP ÖZEL DİYALİZ MERKEZİ ULUDAĞ ÜTF NEFROLOJİ BD ÇANAKKALE ÇAN DEVLET HST. 122 123 21EBA 21HUA ÇANAKKALE ÇANAKKALE 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 21ZEA 21ECA 21MKA 21FVA 21TRA 21FLA 21LXA 21ULA 21CWA 21CLA 21GTA 21NYA 21BDA 21CJA 21PQA 21FNA 21WAA 21KBA 21KEA 21ZAA 21FFA 21VBA 21FXA 21YHA 21DQA 21CRA 21LSA 21ATA 21DGA 21CFA 21EKA 21BWA 21MDA 21HFA 21AYA 21EEA 21FPA 21WYA 21UVA 21TUA 21YRA 21EGA 21NMA 21NPA 21FWA 21SJA ÇANAKKALE ÇANKIRI ÇORUM ÇORUM ÇORUM ÇORUM ÇORUM DENİZLİ DENİZLİ DENİZLİ DENİZLİ DENİZLİ DİYARBAKIR DİYARBAKIR DİYARBAKIR DİYARBAKIR DÜZCE EDİRNE EDİRNE EDİRNE EDİRNE EDİRNE ELAZIĞ ELAZIĞ ELAZIĞ ERZİNCAN ERZİNCAN ERZURUM ERZURUM ERZURUM ESKİŞEHİR ESKİŞEHİR ESKİŞEHİR ESKİŞEHİR ESKİŞEHİR GAZİANTEP GAZİANTEP GAZİANTEP GAZİANTEP GAZİANTEP GAZİANTEP GİRESUN GİRESUN GİRESUN GÜMÜŞHANE HAKKARİ ÇANAKKALE DEVLET HST. ÇANAKKALE DİYALİZ SAĞLIK YARDIM VE KÜLTÜR VAKFI DİYALİZ MERKEZİ ÖZEL ÇANAKKALE MİLLET DİYALİZ MERKEZİ ÇANKIRI DEVLET HST. ALACA DEVLET HST. ÇORUM DEVLET HST. İSKİLİP DEVLET HST. SSK ÇORUM HST. SUNGURLU DEVLET HST. ÇİVRİL DEVLET HST. DENİZLİ DEVLET HST. ERPA ÖZEL SAĞLIK HST. PAMUKKALE DİYALİZ MERKEZİ PAMUKKALE ÜTF NEFROLOJİ BD DİCLE ÜTF DİYARBAKIR DEVLET HST. ÖZEL DİYARBAKIR DİYALİZ MERKEZİ SSK DİYARBAKIR HST. ÖZEL DÜZCE DİYALİZ MERKEZİ EDİRNE DEVLET HST. KEŞAN DEVLET HST. SELİMİYE DEVLET HST. TRAKYA ÜTF HST. UZUNKÖPRÜ DEVLET HST. ELAZIĞ DEVLET HST. ELAZIĞ HARPUT DEVLET HST. FIRAT ÜNİVERSİTESİ FIRAT TIP MERKEZİ ERZİNCAN DEVLET HST. ERZİNCAN SSK HST. ATATÜRK ÜTF ERZURUM NUMUNE HST. ERZURUM SSK HST. ESKİŞEHİR DEVLET HST. ONYAK HEMODİYALİZ MERKEZİ RTS YAŞAM DİYALİZ MERKEZİ SSK ESKİŞEHİR BÖLGE HST. OSMANGAZİ ÜTF HST. GAZİANTEP AV. CENGİZ GÖKÇEK DEVLET HST. GAZİANTEP SSK HST. GAZİANTEP ÜTF NİZİP DEVLET HST. ÖZEL GÜNEYDOĞU HEMODİYALİZ EMRKEZİ GAZİANTEP ÜTF PEDİYATRİ GİRESUN DEVLET HST. GÖREK DEVLET HST. TİREBOLU DEVLET HST. GÜMÜŞHANE DEVLET HST. HAKKARİ DEVLET HST. UMUR DORA İ.HALİL SÖZMEN ÜMİT AYÇİÇEK ARİF ÜNAL HÜSEYİN ERENER HÜSEYİN ERENER ERDOĞAN GÜL N.İLAY OKTAY MUSTAFA GÜLLÜLÜ SABRİ KÖSE RAMAZAN DOĞRU ALİ DEĞİRMENCİ SEMRA MENGÜ Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 KAYHAN TANGÖR AYKUT BAŞER YASİN CENGİZ RECEP BURHANOĞLU ENGİN DEĞİRMENCİ TİMUR HARZADIN SEZGİN BAŞKAN HAYRULLAH SERT REMZİ DÜNDAR REMZİ DÜNDAR NECDET DOĞAN MURAT ÇOLAKOĞLU M.EMİN YILMAZ HASAN TURAN UĞUR NEDİM YÜCE ŞENER CİHAN RAMAZAN ATAGÜN ASLAN SEFER FİKRİ ŞENTÜRK HÜSEYİN AKPINAR SEDAT ÜSTÜNDAĞ SAMİ AYDIN ÖZLEM ERDİNÇ MEHMET ÇİNKILINÇ HÜSEYİN ÇELİKER ADALET ÖZÇİÇEK ÖZER TERZİOĞLU ALİ RIZA ODABAŞ DEMET YİĞİT SELİM ATAMAN BÜLENT ÖZGÜR İNCİ KİPER MEHMET EROL NECDET ATALIK MEHMET SOYDAN NECATİ BİLGİN GALİP AKSOY CELALETTİN USULAN VERDA ERBEKTE NECATİ BİLGİN AYŞE BALAT ALPER AK MEHMET ÖZKAN SELAHATTİN BOZKURT ZEYNEL BAYRAKTAR MEDENİ ŞERMET 79 No Center code City Name of center Responsible person 170 21FYA HATAY ANTAKYA DEVLET HST. 171 172 21MMA 21YEA HATAY HATAY 173 174 175 176 177 178 179 180 181 21JZA 21RUA 21KLA 21BPA 21MTA 21KAA 21WQA 21SKA 21VQA HATAY HATAY IĞDIR ISPARTA ISPARTA ISPARTA ISPARTA ISPARTA İÇEL 182 183 184 185 186 187 188 189 190 191 192 21HVA 21AXA 21LAA 21FBA 21YZA 21WSA 21SQA 21MWA 21PSA 21PRA 21FGA İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL BAŞKENT ÜNİVERSİTESİ İSKENDERUN DİYALİZ MERKEZİ FRESENİUS GÜNEYDOĞU DİYALİZ HİZM. LTD. ŞTİ. ANTAKYA ŞUBESİ HATAY İSKENDERUN DEVLET HST. İSKENDERUN RNC HEMODİYALİZ MERKEZİ IĞDIR DEVLET HST. ISPARTA DEVLET HST. MEDİANT ISPARTA ÖZEL DİYALİZ MERKEZİ SÜLEYMAN DEMİREL ÜNİVERSİTESİ SÜLEYMAN DEMİREL ÜTF PEDİYATRİ YALVAÇ DEVLET HST. TARSUS DEVLET HST.SAĞLIK EĞİTİM VAKFI DİYALİZ MERKEZİ AVCILAR HAYAT HST. BAŞKENT ÜNİVERSİTESİ İSTANBUL DİYALİZ MERKEZİ BAYRAKTAR DİYALİZ MERKEZİ DİAMED A.Ş. DİAMED ŞİŞLİ DİYALİZ MERKEZİ DİYALİSANS DİYALİZ VE SAĞLIK HİZMETLERİ A.Ş. DOĞAN HST. DR. LÜTFÜ KIRDAR KARTAL EĞİTİM VE ARŞ.HST. DR. SADİ KAVUK EĞİTİM ARŞ.HST. DUYGU HST. FATİH SULTAN MEHMET EĞİTİM VE ARŞ.HST. İDRİS EMİR MUSA YÜKSEKGÖNÜL ZEKİ GÖLOĞLU MUSA YÜKSEKGÖNÜL 193 194 195 196 197 198 21SNA 21HWA 21BBA 21TGA 21TNA 21AQA İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL FRESENİUS EKOMED DİYALİZ MERKEZİ FRESENİUS SAĞLIK HİZMETLERİ A. Ş. AVCILAR ŞUBESİ GATA HAYDARPAŞA EĞİTİM HST.NEFROLOJİ SERVİSİ GAZİEMİR DİYALİZ MERKEZİ GÖK HEMODİYALİZ MERKEZİ HAYDARPAŞA NUMUNE HST. 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 21PTA 21ACA 21DBA 21MQA 21AWA 21AAA 21DVA 21ABA 21PJA 21KYA 21PWA 21LDA 21DMA 21TVA 21NAA 21RLA 21WBA 21WNA 21NWA 21LTA 21LZA 21PEA 21SSA 21NNA 21JBA 21NUA 21BVA İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL IŞIL SAĞLIK HİZMETLERİ-ÇAMLICA MEDİCAM DİYALİZ İ. Ü.CERRAHPAŞA TIP FAKÜLTESİ DİYALİZ MERKEZİ İNTERNATİONAL HOSPİTAL İSTANBUL ÖZEL MERTER VATAN DİYALİZ MERKEZİ İSTANBUL REN-MED DİYALİZ MERKEZİ İSTANBUL TF PEDİYATRİ İSTANBUL Ü CERRAHPAŞA TF PEDİYATRİ İSTANBUL ÜTF İSTİNYE DEVLET HST. KOŞUYOLU ATA HEMODİYALİZ MERKEZİ KOZYATAĞI DİYALİZ MERKEZİ KÜÇÜKYALI DİYALİZ MERKEZİ MARMARA ÜNİVERSİTESİ KADİR HAS MARMARA ÜTF PEDİYATRİ MEDİKARE DİYALİZ MERKEZİ ÖZEL BAHÇELİEVLER DİYALİZ MERKEZİ ÖZEL ÇAPA HST. ÖZEL GAZİOSMANPAŞA HST. ÖZEL KARAMAN DİYALİZ MERKEZİ ÖZEL KARTAL HST. ÖZEL MALTEPE ONUR DİYALİZ MERKEZİ ÖZEL RENİN DİYALİZ MERKEZİ ÖZEL SİLİVRİ MİLLET HST. ÖZEL UMUT DİYALİZ MERKEZİ ÖZEL YAŞAR HST. ÖZEL ZEYTİNBURNU DAMLA DİYALİZ MERKEZİ ÖZGÖZÜKARA DİYALİZ MERKEZİ 80 MUSTAFA ALÇIKAYA MUSTAFA ALÇIKAYA EMİN AKYILDIZ TAHSİN MİNKAR NEŞE TUNÇ M. TUĞRUL SEZER FARUK ÖKTEM ERDOĞAN YAVUZ MAHMUT AKGÖZ TANER YÜCETÜRK METİN ERMAN KEMAL ÖNEN YILDIZ BARUT T.RIFKI EVRENKAYA NAİL SUAT ÜNVER MURAT KUYUMCU MUSTAFA TEKÇE NURSEL KORKMAZ MURAT MIHÇIOĞLU SEHER RAHİME KEBAPCIOĞLU ELBİS AHBAP A. HALİT EROL SUAT ÜNVER PINAR ÜRETMEN PINAR SEYMEN YILDIZ BARUT FUNDA TÜRKMEN MEHMET ALİ TARIM EKREM EREK ALİ GÜRÇAY YALÇIN ÖZBAHAR NEDİM SARSMAZ AYDAN ŞİRİN LALE SEVER NİLGÜN AYSUNA YALÇIN ÖZBAHAR DAVİD ÇUKRAN FUAD KARSLI SALİH ÖNCEL SERHAN TUĞLULAR HARİKA ALPAY HAKAN KAPTANOĞLU MEHMET ŞÜKRÜ SEVER MEHMET EMİN YILMAZ MUSTAFA CANBAKAN ENVER BERBER MEHMET ALİ ÇOBANOĞLU BİLGİN ÇAPANOĞLU ZERRİN EREN GÜNAY DOĞAN MUAZZEZ SEZER CAYMAZ GÜRKAN YURTERİ AYDOĞAN ÖBEK ABDULLAH ÖZGÖZÜKARA Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 No Center code City Name of center Responsible person 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 21LYA 21BTA 21YSA 21ANA 21JHA 21ZCA 21BAA 21SMA 21DZA 21ZJA 21MAA 21EFA 21TXA 21BUA 21CEA 21KVA 21NJA 21FZA 21DTA İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İSTANBUL İZMİR İZMİR GÜLÇİN KANTARCI FATMA KARAKULLUKÇU 245 246 247 248 249 250 251 21JVA 21MGA 21MJA 21BMA 21TYA 21NXA 21CGA İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR 252 253 254 255 256 257 258 259 260 261 21SUA 21CKA 21AEA 21KQA 21KSA 21LEA 21NZA 21EHA 21ZMA 21NVA İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR PENDİK DEVLET HST. RTS TRANSMED DİYALİZ MERKEZİ S.B HASEKİ EĞİTİM VE ARŞ. HST. SAĞLIK BAKANLIĞI İSTANBUL EĞİTİM VE ARŞ.HST. SAĞLIKLI YAŞAM DİYALİZ MERKEZİ SSK BAKIRKÖY DOĞUMEVİ VE ÇOCUK HST. SSK GÖZTEPE EĞT. HST. SSK GÖZTEPE EĞT. VE ARŞ. HASTANESİ PEDİYATRİ SSK NİŞANTAŞI DİYALİZ MERKEZİ SULTANBEYLİ DİYALİZ MERKEZİ ŞAHVA REŞİTPAŞA DİYALİZ MERKEZİ ŞİŞLİ ETFAL EĞİTİM VE ARŞ.HST. ŞİŞLİ ETFAL HASTANESİ PEDİYATRİ TEPEBAŞI VATAN HST. TÜRK BÖBREK VAKFI AHMET ERMİŞ HST. TÜRKMED DİYALİZ MERKEZİ ÜMRANİYE ATA DİYALİZ MERKEZİ AYTUN ÇIRAY ÖDEMİŞ DEVLET HST. BAŞKENT ÜNİVERSİTESİ ZÜBEYDE HANIM UYGULAMA VE ARAŞTIRMA MERKEZİ BERGAMA DEVLET HST. ÇEŞME DEVLET HST. ÇİĞLİ DEVLET HST. DOKUZ EYLÜL HST. DOKUZ EYLÜL ÜTF PEDİYATRİ DR. ERTUĞRUL AKER TİRE DEVLET HST. DR.BEHÇET UZ ÇOCUK SAĞLIĞI VE HAST. EĞT VE ARŞ. HST. EGE GÜNEŞ DİYALİZ MERKEZİ EGE SAĞLIK VAKFI EGE ÜTF EGE ÜTF PEDİYATRİ EŞREFPAŞA BELEDİYE HST. FOÇA DEVLET HST. İKİNCİ YAŞAM DİYALİZ MERKEZİ İZMİR ATATÜRK EĞİTİM VE ARŞ.HST. İZMİR CENTRAL HOSPİTAL DİYALİZ MERKEZİ İZMİR SEVGİ DİYALİZ MERKEZİ 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 21PAA 21WGA 21ZBA 21HLA 21RMA 21ZLA 21NSA 21GUA 21KWA 21ASA 21JJA 21BFA 21UQA 21JWA 21UPA 21UTA 21DEA 21MRA 21SWA 21NTA 21GLA İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR İZMİR K. MARAŞ K. MARAŞ K. MARAŞ K. MARAŞ KARABÜK KARAMAN İZMİR TEPECİK EĞT. VE ARŞ. HST. PEDİYATRİ NARLIDERE DİYALİZ MERKEZİ NASIR DİYALİZ MERKEZİ ALSANCAK DEVLET HST. ÖZEL ANKA DİYALİZ MERKEZİ ÖZEL ÇİĞİLİ UMUT DİYALİZ MERKEZİ ÖZEL EGE NEFROLOJİ DİYALİZ MERKEZİ ÖZEL İZMİR HST. ÖZEL NEFRON KARŞIYAKA DİYALİZ MERKEZİ SSK TEPECİK EĞİTİM VE ARŞ.HST.ERİŞKİN HEMODİYALİZ ŞİFA TIP MERKEZİ TC SAĞLIK BAKANLIĞI İZMİR EĞİTİM VE ARŞ.HST. TORBALI M. ENVER ŞENERDEM DEVLET HST. UĞUR DİYALİZ MERKEZİ URLA DEVLET HST. AFŞİN DEVLET HST. DEVLET HST.HÜSNÜ ÖKSÜZ DİYALİZ MERKEZİ ELBİSTAN DEVLET HST. FRESENİUS KAHRAMANMARAŞ DİYALİZ MERKEZİ KARABÜK VATAN HST. KARAMAN DEVLET HST. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 MİNE BESLER ERALP KUYUCU GÖNÜL AYDOĞAN HÜLYA ERGİN VEDAT ÇELİK SERHAT AZİZERLİ TUNCER PAKİZ ABDÜLKADİR ÜNSAL GÜL ÖZÇELİK Ekrem EREK BİLAL GÖRÇİN ÇETİN ÖZENER GÜNDÜZ GÜVEN BARAN ARAL YELDA ÇINAR YILDIRIM KEMAL ÖNER NEBİL UĞURSAL ASSLI KILAVUZ AYKUT SİFİL SALİH KAVUKÇU UĞUR GÖNENÇ MUSTAFA BAK UFUKÜNER F. SEVGİ POSTOĞLU ALİ BAŞÇI SEVGİ MİR SERDAR VARER YILDIRAY ŞİMŞEK İSMAİL İRFAN YALÇIN MUSTAFA CİRİT EROL SALK ERDAL KARACA BANU KINAY NEŞAT AKSU HASAN TÜRKOĞLU MUSTAFA CİRİT ERDAL KARACA MEHMET SONBAHAR ASLI KILAVUZ GÜLAY AŞÇI ATİLLA ÜZÜM SONER DUMAN FATİH AKMAN TUNCAY SOYAL HÜSEYİN UZUNER ERTUĞRUL UĞURTAŞ A. ÖZLEM DURMUŞ NİHAT KURTULUŞ ŞAHİN SAYAN İSMET ÖNDER IŞIK HAMDİ EKİCİ ÖNDER IŞIK MUSTAFA YETKİN ÖZCAN SERDOHAN 81 No Center code City Name of center Responsible person 283 284 285 286 287 288 21GAA 21CSA 21SXA 21LMA 21SYA 21DRA KARS KASTAMONU KASTAMONU KASTAMONU KAYSERİ KAYSERİ 289 290 291 292 293 294 295 296 297 298 299 300 301 302 21JCA 21ELA 21FKA 21UAA 21WCA 21YTA 21FAA 21CQA 21SZA 21ZHA 21YFA 21JAA 21LJA 21FMA KAYSERİ KAYSERİ KAYSERİ KAYSERİ KAYSERİ KIRIKKALE KIRIKKALE KIRKLARELİ KIRKLARELİ KIRKLARELİ KIRKLARELİ KIRŞEHİR KİLİS KOCAELİ KARS DEVLET HST. DR. MÜNİF İSLAMOĞLU KASTAMONU DEVLET HST. İNEBOLU DEVLET HST. TOSYA DEVLET HST. ERCİYES DİYALİZ MERKEZİ ERCİYES ÜNİVERSİTESİ SEMİHA KİBAR ORGAN NAKLİ VE DİYALİZ MERKEZİ ERCİYES ÜTF PEDİYATRİ KAYSERİ DEVLET HST. KAYSERİ SSK BÖLGE HST. ÖZEL MELİKGAZİ HST. RTS AHMET DİYALİZ MERKEZİ KIRIKKALE DİYALİZ MERKEZİ KIRIKKALE KADIN DOĞUM VE ÇOCUK HASTALIKLARI HST. KIRKLARELİ DEVLET HST. LÜLEBURGAZ DEVLET HST. ÖZEL DERMAN HST. ÖZEL ESEN DİYALİZ MERKEZİ KIRŞEHİR DEVLET HST. KİLİS DEVLET HST. ATALİZ DİYALİZ MERKEZİ 303 304 305 306 21DWA 21RYA 21REA 21PYA KOCAELİ KOCAELİ KOCAELİ KOCAELİ SÜLEYMAN POYRAZ ADEM ERSOY MEHMET ÖZBURAK MURAT KARAKAŞ MEHMET DEMİRKAYA RUHAN DÜŞÜNSEL HAKAN POYRAZOĞLU RUHAN DÜŞÜNSEL SABİHA KARAYA NEVZAT EKİNCİOĞLU ŞULE ULUSOY CENGİZ OKTAY OYMAK RAFET KOÇ RAFET KOÇ SAFİ KARAL MEHMET GÖRÇİN ZEKİ PAKSOY ÖZLEM ESKİOĞLU İSA TANYERİ ABDULLAH ÖZAYTÜRK FERHAN LATİFE YAVUZ GÖKÇE MİNE ERKAN HASAN ÇAKIR BEYTİ KARACA HASAN ÇAKIR 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 21GCA 21NFA 21WEA 21VMA 21TAA 21UBA 21RKA 21WKA 21GDA 21ERA 21UCA 21HYA 21TBA 21DCA 21EPA 21ZQA 21MYA 21KXA 21WRA 21DSA 21YLA 21RJA 21DXA 21PMA 21JDA 21FJA 21UEA 21CPA 21HKA 21FHA 21HNA 21PZA 21GBA KOCAELİ KOCAELİ KOCAELİ KOCAELİ KOCAELİ KOCAELİ KOCAELİ KOCAELİ KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KONYA KÜTAHYA KÜTAHYA KÜTAHYA KÜTAHYA MALATYA MALATYA MALATYA MALATYA MANİSA 82 DERİNCE DEVLET HST. GÖLCÜK DEVLET KARAMÜRSEL DEVLET HST. KOCAELİ BÜYÜKŞEHİR BELEDİYESİ BELDE A. Ş DİYALİZ MERKEZİ KOCAELİ DEVLET HST. KOCAELİ ÜTF KOCAELİ ÜTF PEDİYATRİ M. KAZIM DİNÇ KANDIRA DEVLET HST. NOVAK GEBZE DİYALİZ MERKEZİ ÖZEL MARUF DİYALİZ MERKEZİ R. N. C. RENAL NEFROLOJİ MERKEZİ RENALİS DİYALİZ MERKEZİ AKŞEHİR DEVLET HST. BEYŞEHİR DEVLET HST. CİHANBEYLİ DEVLET HST. ÇUMRA DEVLET HST. FRESENİUS KONYA DİYALİZ MERKEZİ KONYA EREĞLİ DEVLET HST. KONYA NUMUNE HST. ÖZEL İLGİ DİYALİZ MERKEZİ ÖZEL KONYA DİYALİZ MERKEZİ ÖZEL ÖLMEZ HEMODİYALİZ MERKEZİ ÖZEL RTS BEYHEKİM DİYALİZ MERKEZİ SELÇUK ÜTF SEYDİŞEHİR DEVLET HST. SİMAV DEVLET HST. SSK KONYA BÖLGE HST. TÜRKİYE SAĞLIK VE TEDAVİ VAKFI KONYA VAKIF HST. DOÇ. DR. MUSTAFA KALEMLİ TAVŞANLI DEVLET HST. EVLİYA ÇELEBİ DEVLET HST. GEDİZ DEVLET HST. KÜTAHYA DEVLET HST. FRESENİUS GÜNEYDOĞU HEMODİYALİZ MERKEZİ İNÖNÜ ÜTF MALATYA DEVLET HST. ÖZEL MALATYA HST. ALAŞEHİR DEVLET HST. BAYRAM KALAYCI AHMET YILMAZ ZELAL BİRCAN İSMAİL ERMAN KADİR FARUK DEMİRKOL FEVZİ AKÇINAR MUSTAFA AYDIN HASAN DERMENCİ İBRAHİM DUMAN ERSİN KOBANER HALİL İBARAHİM TORUN SERAP SEZER ZEKİ TOMBUL CENGİZ ÇALIŞIR HALİL ÖZTÜRK HÜSEYİN AKA MELİH ANIL HASAN HULUSİ SUR BANU TEK LÜTFULLAH ALTINTEPE BEKİR BORAZAN MUSTAFA ÖZGÜN MEHMET POLAT BEYHAN ULUER LÜTFÜ USLUER FAHRETTİN DEMİRER SAADETTİN HARMANDALI MUSTAFA EKER MUSTAFA ESENTÜRK HÜLYA TAŞKAPAN ERDAL GÖÇMEZ ERDAL GÖÇMEZ ZAFER ULAŞAN Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 No Center code City Name of center Responsible person 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 21PNA 21VYA 21RXA 21TCA 21HMA 21PXA 21NLA 21LLA 21TDA 21ZNA 21RWA 21MXA 21WPA 21EJA 21JXA 21YYA 21KMA 21RVA 21VCA 21MEA 21YGA 21KCA 21CMA 21NDA 21VTA 21GEA 21FDA 21ESA 21JSA 21EUA 21WTA 21BXA 21EMA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MANİSA MERSİN MERSİN MERSİN MERSİN MERSİN MERSİN MERSİN MUĞLA MUĞLA MUĞLA MUĞLA MUĞLA MUĞLA MUĞLA MUŞ NEVŞEHİR NEVŞEHİR NEVŞEHİR NİĞDE NİĞDE ORDU ORDU CELAL BAYAR ÜTF CELAL BAYAR ÜTF PEDİYATRİ DEMİRCİ DEVLET HST. EGE-SA MANİSA ÖZEL DİYAZLİ MERKEZİ MANİSA DEVLET HST. NEFRONEGE NEFROLOJİ MERKEZİ A.Ş. ÖZEL EGE DİYALİZ MERKEZİ SALİHLİ DEVLET HST. SOMA DEVLET HST. SOMA ÖZEL DİYALİZ MERKEZİ TURGUTLU DEVLET HST. ANAMUR ATA MERSİN DİYALİZ MERKEZİ MERSİN DEVLET HST. MERSİN SİLİFKE DEVLET HST. MERSİN ÜTF PEDİYATRİ RNC MERSİN DİYALİZ MERKEZİ SSK TARSUS HST. 75. YIL MİLAS DEVLET HST. BODRUM DEVLET HST. FETHİYE DEVLET HST. MARMARİS DEVLET HST. MUĞLA DEVLET HST. ÖZEL FETHİYE DİYALİZ MERKEZİ ÖZEL YÜCELEN HST. MUŞ DEVLET HST. KAPADOKYA DİYALİZ MERKEZİ NEVŞEHİR DEVLET HST. ÜRGÜP DEVLET HST. NİĞDE DEVLET HST. NİĞDE ÖZEL HEMODİYALİZ MERKEZİ ORDU DEVLET HST. ÜNYE DEVLET HST. SEYHUN KÜRŞAT 373 374 21MUA 21WDA OSMANGAZİ OSMANİYE 375 376 377 378 379 380 21JEA 21JTA 21EQA 21ENA 21DYA 21VZA OSMANİYE OSMANİYE RİZE RİZE RİZE SAKARYA OSMANGAZİ ÜTF PEDİYATRİ FRESENİUS SAĞLIK HİZMETLERİ A.Ş. OSMANİYE DİYALİZ MERKEZİ OSMANİYE DEVLET HST. OSMANİYE KADİRLİ DEVLET HST. PAZAR DEVLET HST. RİZE DEVLET HST. SSK RİZE BÖLGE HST. AKYAZI DEVLET HST. 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 21ZGA 21VDA 21CAA 21WFA 21TEA 21EVA 21KRA 21EWA 21BHA 21MVA 21HZA 21LWA 21ETA 21HBA 21TFA 21GFA SAKARYA SAKARYA SAKARYA SAKARYA SAKARYA SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SAMSUN SİİRT BİLGE HST. KARASU DEVLET HST. SAKARYA DEVLET HST. SAKARYA GEYVE DEVLET HST. SAKARYA HENDEK DEVLET HST. BAFRA DEVLET HST. ÇARŞAMBA DEVLET HST. HAVZA DEVLET HST. ONDOKUZ MAYIS ÜTF ONDOKUZ MAYIS ÜTF PEDİYATRİ ÖZEL BAFRA DİYALİZ MERKEZİ ÖZEL SAMSUN DİYALİZ MERKEZİ SAMSUN DEVLET HST. SSK SAMSUN BÖLGE HST. VEZİRKÖPRÜ DEVLET HST. SİİRT DEVLET HST. Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 NEJLA TÜRK ÇAKIR MEHMET ERTEM PERİHAN TUNCA SAVAŞ PARMAKSIZOĞLU İBRAHİM DİLEK FİKRİ EROL AHMET AHŞEN KADİR ÖZKAYA CUMA ÖZGÜR NASİP ŞAHİN MEHMET OLCAY MEHMET EMİN BAHÇE MEHMET FIRAT ALİ DELİBAŞ NECATİ KIRALP AHMET SEZER ÇETİN İNCE AKİF YILMAZ BEHZAT GÜLER TAYYİBE ERKENEZ NEZİB TUNCAY TALAT ÖRNEK ŞAHİN AYDIN MESUT ÇOLAK YUSUF KENAN İŞERİ SEVDAL BİRMAN SÜLEYMAN EKMEN TUNCAY GÜRBÜZ M. ATAKAN CANBULAT HÜSEYİN SAĞLAM ÖNDER BURSALI ADNAN BÜYÜKYAZICI NURDAN KURAL TURGAY GÜLER TURGAY GÜLER CENGİZ IŞIK RİNDOL CANKAR CENGİZ DUYGULU ALP ÖZATA BİRCAN YARICI SEYRAN DOĞAN AYHAN AYDIN SAMİ AYHAN FERİT YAVUZ YILMAZ SERAP ÇELİK İSMAİL HAKKI BALİÇ HASAN ŞEKERCİOĞLU ALİ BAKAN EROL CAFER KUDDUSİ CENGİZ OZAN ÖZKAYA HASAN ŞEKERCİOĞLU MEHMET KUNDAK KAMURAN KAYNAR M.AKİF UZUN YASİN GÜNEŞ TAHSİN ÇELEPKOLU 83 No Center code City Name of center Responsible person 397 398 399 400 401 402 403 404 405 406 407 21JQA 21DJA 21EXA 21GKA 21DUA 21VPA 21VAA 21LPA 21PBA 21RFA 21GHA SİNOP SİNOP SİNOP SİVAS SİVAS SİVAS SİVAS ŞANLIURFA ŞANLIURFA ŞANLIURFA ŞANLIURFA AYANCIK DEVLET HST. SİNOP ATATÜRK DEVLET HST. BOYABAT DEVLET HST. 1. İZZETTİN KEYKAVUS DEVLET HST. CUMHURİYET ÜNİVERSİTESİ SSK BÖLGE HST. SUŞEHRİ DEVLET HST. BİRECİK DEVLET HST. ÖZEL ŞANLI DİYALİZ MERKEZİ SSK ŞANLIURFA HST. (BALIKLIGÖL DEVLET HST. ) ŞANLIURFA DEVLET HST. 408 409 410 411 21VLA 21WHA 21PFA 21HXA TEKİRDAĞ TEKİRDAĞ TEKİRDAĞ TEKİRDAĞ 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 21GMA 21HGA 21CVA 21RHA 21HTA 21RZA 21LFA 21HQA 21DAA 21RGA 21RBA 21PHA 21BCA 21CUA 21USA 21LGA 21CCA 21GNA 21NRA 21WVA 21LUA 21HHA 21MLA 21VEA 21GPA 21GGA 21GJA 21DFA 21CYA TEKİRDAĞ TEKİRDAĞ TOKAT TOKAT TOKAT TOKAT TOKAT TOKAT TRABZON TRABZON TRABZON TRABZON TRABZON TRABZON TUNCELİ UŞAK UŞAK VAN VAN VAN YALOVA YALOVA YOZGAT YOZGAT YOZGAT ZONGULDAK ZONGULDAK ZONGULDAK ZONGULDAK ÇORLU DEVLET HST. ÖZEL ÇORLU ŞİFA HST. ŞARKÖY DEVLET HST. TBV TEKİRDAĞ ŞUBESİ HACI HÜSEYİN TERZİ DİYALİZ MERKEZİ TEKİRDAĞ DEVLET HST. TRAKYA DİYALİZ MERKEZİ DR. CEVDET AYKAN DEVLET HST. MED-LİFE ÖZEL DİYALİZ MERKEZİ NİKSAR DEVLET HST. TOKAT ERBAA DEVLET HST. TURHAL DEVLET HST. ZİLE DEVLET HST.SALİHA KIRGÖZ FARABİ HST.TRABZON KARADENİZ TEKNİK ÜTF PEDİYATRİ ÖZEL KARADENİZ HST. SÜRMENE DEVLET HST. TRABZON NUMUNE HST. TRABZON SSK HST. TUNCELİ DEVLET HSTANESİ UMUT HEMODİYALİZ MERKEZİ LTD. ŞTİ. UŞAK DEVLET HST. YÜKSEK İHTİSAS HST. YÜZÜNCÜ YIL ÜTF YÜZÜNCÜ YIL ÜTF PEDİYATRİ BAŞKENT ÜNİVERSİTESİ ELMALIK DİYALİZ MERKEZİ YOLOVA DEVLET HST. SORGUN DEVLET HST. YERKÖY DEVLET HST. YOZGAT DEVLET HST. KARABÜK DEVLET HST. KARADENİZ EREĞLİ DEVLET HST. SSK ZONGULDAK BÖLGE HST. ZONGULDAK DEVLET HST. İSKENDER YÜKSEL KAMİL DURMUŞ OKHAN ÇETİN CEVAT TÜRKAY FÜSUN GÜLTEKİN MELİH KINCIR ÖZDAL ÖZTEKİN AHMET ÖZBAY ATİLLA ŞENOCAK YILMAZ ERTÖRER HİKMET ŞEYHANLIGİL FEYZULLAH UÇMAK NECİP ERŞAN HÜSEYİN ÖZDEMİR MUZAFFER SEZER MİNE ÖZÇAKI 84 MEHMET TÜRK ALAATTİN AKAY İDRİS MALKAN MUSTAFA SERT SELAMİ AYDIN MEHMET YAMAK NUSRET AYDOĞAN ŞÖHRET TUNAY ŞÜKRÜ ULUSOY ELİF BAHAT HAMZA BOZALİOĞLU DURSUN İNAN CEVAT TOPAL TANER ŞEN MEHMET ÖZDEMİR SELAHATTİN ÇAKIROĞLU SELAHATTİN ÇAKIROĞLU HASAN GÜLER REHA ERKOÇ FAHRETTİN ALKAYA MUSTAFA MEHMETOĞLU RIZA MERSİN MURAT YILDIZ ARİF YÜCEL ESER MUSTAFA ÖZCAN NAKİ GÖKHAN TURAN AHMET BOZKAYA ŞEHMUS ERTOP Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004