TÜRKİYE’DE NEFROLOJİ - DİYALİZ ve TRANSPLANTASYON · questions and the format of online Patient Based National ... based data forms, and in evaluation of the results and in

TRK NEFROLOJ DERNE YAYINLARI PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY

TRKYEDE NEFROLOJ - DYALZ

ve TRANSPLANTASYON

REGISTRY OF THE NEPHROLOGY, DIALYSIS AND

TRANSPLANTATION IN TURKEY

REGISTRY 2009

Yayna Hazrlayanlar Editors

Kamil SERDENGET Gltekin SLEYMANLAR Mehmet Rza ALTIPARMAK Registry Kurulu Bakan

Chairman of the Registry Committee Trk Nefroloji Dernei Bakan

President of the Turkish Society of NephrologyRegistry Genel Koordinatr

General Coordinator of the Registry

Regisrty Kurulu yesi Member of the Registry Committee

Nurhan SEYAH

Regisrty Kurulu yesi Member of the Registry Committee

stanbul 2010

ii National Hemodialysis, Transplantation and Nephrology Registry Report of Turkey, 2009

TRK NEFROLOJ DERNE YAYINLARI PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY

nemli Not Important Note

Bu kitabn btn haklar Trk Nefroloji Derneine aittir. Makale ve bulgular kaynak gsterilmeden yeniden yaynlanamaz.

All copyrights are reserved for Turkish Society of Nephrology.

Articles and figures can not be published without reference.

Dizgi ve Tasarm Contents and Design: Yorum Danmanlk Bask Printing: Pasifik Reklam ve Tantm Hizmetleri / Metris Matbaaclk

Bask Tarihi Printing date: Eyll September 2010

Trkiye 2009 yl Ulusal Hemodiyaliz, Transplantasyon ve Nefroloji Kayt Sistemi Raporu iii

NSZ INTRODUCTION TND Merkez Bazl Ulusal Kayt Sistemi 1990 ylnda balatldnda 67 Merkezde 3069 olan HD hasta says, fiilen Erek-Serdengeti-Sleymanlar ls tarafndan tamamyla amatrce srdrlen ilk 10 yln bitiminde 2000 ylnda 333 merkezde 14086ya ve geri dn oran da %77.5e ulam bulunmaktayd.

Bundan sonraki yllarda, Merkez Bazl Ulusal Kayt Sistemi veri toplama ilemi profesyonel bir firma araclyla ama yine kat formlara dayal olarak yrtld. 2007 ylnda ise, Merkez verilerinin internet araclyla online (evrimii) toplanmasna baland.

Bu yl, 2009 ylna ait Merkez Bazl Ulusal Kayt Sistemi verileri hemen tamamyla online yntemle topland. 839 merkezde 60 bine yaklaan hasta says (ocuk hastalar dahil) ve artk %96ya ulaan elektronik form doldurma oran, online yntemin artk oturduunu ve byk bir baaryla yrmekte olduunu kantlamaktadr. Faks, kargo gibi geleneksel yntemlerle cevap veren merkezlerle birlikte cevap verme oran %99.5e ulamtr. Ayrca, yukardaki 1990 rakkamlarna tekrar gz atarak, getiimiz 20 yl ierisinde lkemizde RRTnin nereden nereye geldiini gururla saptamakta da yarar vardr.

Bu arada, Merkez Bazl Ulusal verilerin dnda 1995 ylndan balayarak kat formlarda tek tek Hasta Bazl Kaytlar da tutulmu ve arivlenmitir. Bu Hasta Bazl Ulusal verilerin sizlere geen yl ayr bir kitapk biiminde zet sonular sunulan 10 yllk istatistiksel analizi ve survival deerlendirmeleri ise, ksa bir sre ierisinde uluslararas bir dergide yaymlanacaktr.

Ancak, gerek ERA-EDTA Avrupa online Registrysine, gerekse USRDS ve dier dnya registrylerine gerek anlamda entegre olabilmek iin Hasta Bazl Ulusal Kayt Sisteminin bundan byle online olarak srdrlmesi zorunlu hale gelmitir. Hasta Bazl Ulusal Kayt Sisteminin online format ve sorular u anda btnyle hazrlanm olup, sistem ksa sre ierisinde hizmete alacaktr. Bu durumu sizlere TNDnin bir 40. yl mjdesi olarak bildirmekten mutluluk duyuyoruz.

TNDnin 20. ylnda Genel Sekreter olarak Merkez Bazl Ulusal Kayt sistemini, 25. ylnda ise Bakan olarak Hasta Bazl Ulusal Kayt Sistemini balatan Prof. Dr. Ekrem Erek hocamza Ulusal Kayt Sisteminin 20., TNDnin ise 40. yln kutladmz bugnlerde TND adna bir kez daha teekkr ederiz.

Bu ylki online verilerin deerlendirilmesi ve kitap haline getirilmesinde byk emekleri geen Registry Kurulu yeleri Prof. Dr. Mehmet Rza Altparmak ve Do. Dr. Nurhan Seyahiye ve teknik altyap ve verilerin toplanmas ve analizi asndan destekleri iin de Do. Dr. Oktay zdemir bakanlndaki Yorum Danmanlk ekibine zellikle teekkr ederiz.

When TSN Center Based Registry System was first initiated in 1990, there were 3069 patients from 67 centers. This figure has come up to 14086 patients from 333 centers (%77.5 response rate) at the end of the 10 amateur years (in 2000) under the leadership of Erek-Serdengeti-Sleymanlar trio.

In following years Center Based National Registry System was again conducted by a proffessional company but again via printed forms. In 2007, online collection of center based data was started.

This year Center Based National Registry System data of 2009 were totally collected via online forms. With nearly 60 thousand patients (including pediatric patients) from 839 centers and with electronic form filling rate of 96% the success of online data collection is undeniable. With conventional methods like fax/cargo, response rate has reached to 99.5%. Besides, when we take a look at the figures of 1990 given above, the progress in RRT in Turkey in last 20 years could be proudly stated.

Along with the Center Based National Registry System data, printed forms per each patient have also been filled in and archived since the beginning of 1995. The survival comments and the detailed figures with statistical analysis over 10 years period which were previously presented yourselves as booklets as a summary will shortly be published on an international journal.

However, online forms for Patient Based National Registry System is a necessity for full integration to ERA-EDTA European Registry, USRDS and other registries. The questions and the format of online Patient Based National Registry System are ready and will be available shortly. We are proud to give this great new as the 40th anniversary gift of TND.

We would like to take this opportunity to thank to Prof. Dr. Ekrem Erek who has started Center Based National Registry System on TSNs 20th anniversary under his position as General Secretary and also Patient Based National Registry System on TSNs 25th anniversary with his position as Chairman. Thanks to him that we are today celebrating the 20th anniversary of National Registry System with the 40th anniversary of TSN.

We also tender our special thanks to Prof. Dr. Mehmet Rza Altparmak and Assoc. Prof. Dr. Nurhan Seyahi, who are other members of Registry Committee, for their great effort and contribute in collection and evaluation of online center based data forms, and in evaluation of the results and in editing the Registry Book, to the staff of Yorum Consultancy leaded by Assoc. Prof. Dr. Oktay zdemir for data collection, for infrastructural support and for analyzing the collected data.

Prof. Dr. Kamil SERDENGET Prof. Dr. Gltekin SLEYMANLAR Registry Kurulu Bakan Registry Kurulu Genel Koordinatr Chairman of Registry Committee General Coordinator of Registry Committee TND nceki Bakan TND Bakan Past President of TSN President of TSN

Eyll September 2010

iv National Hemodialysis, Transplantation and Nephrology Registry Report of Turkey, 2009

TRK NEFROLOJ DERNE REGISTRY KURULU TURKISH SOCIETY OF NEPHROLOGY REGISTRY COMMITTEE

Bakan: Prof. Dr. Kamil SERDENGETI stanbul niversitesi Cerrahpaa Tp Fakltesi Trk Nefroloji Dernei nceki Bakan Past President of the Turkish Society of Nephrology Genel Koordinatr, Proje Tasarm ve D likiler: Prof. Dr. Gltekin SLEYMANLAR General Coordinator, Akdeniz TF Project Design and Foreign Affairs Trk Nefroloji Dernei Bakan : President of the Turkish Society of Nephrology Registry Kurulu yeleri: Members of the Registry Committee: Prof. Dr. Mehmet Rza ALTIPARMAK stanbul niversitesi Cerrahpaa Tp Fakltesi Do. Dr. Nurhan SEYAH stanbul niversitesi Cerrahpaa Tp Fakltesi Do. Dr. Aykut SFL Dokuz Eyll niversitesi Tp Fakltesi

Ankara ve Anadolu Blge Koordinatrleri Regional Coordinators for Ankara and Mid-Turkey: etin TURGAN, kr SNDEL, Kenan ATE, Neval DUMAN, Nurhan ZDEMR, Ayla SAN, Ahmet Uur YALIN, Cengiz UTA, Sleyman TRK, Blent TOKGZ, Serap DEMR

stanbul ve Trakya Blge Koordinatrleri Regional Coordinators for Istanbul and Thrace Region: Mehmet kr SEVER, Aydn TRKMEN, Mehmet KO, Sinan TRABULUS, Nazm DENZL, Abdlkadir NSAL, Rmeyza KAZANCIGL, Sedat STNDA

Bursa ve Marmara Blge Koordinatrleri Regional Coordinators for Bursa and Marmara Region: Kamil DLEK, Mustafa GLLL, Mahmut Yavuz, Itr YEENAA, Nilay OKTAY, Betl KALENDER

zmir ve Ege Blge Koordinatrleri Regional Coordinators for Izmir and Aegean Region: Ali BAI, Sevgi MR, Taner AMSARI, Fehmi AKEK, Cneyt HOCOKUN, Adam USLU, Ali elik, Ercan OK, Mustafa CRT, Belda DURSUN

Karadeniz Blge Koordinatrleri Regional Coordinators for Black Sea Region: Kuddusi Cengiz, Tekin AKPOLAT, Nurol ARIK, kr ULUSOY

Erzurum ve Dou Anadolu Blge Koordinatrleri Regional Coordinators for Eastern Turkey: Hseyin ELKER, Reha ERKO, Hlya TAKAPAN, Ayhan Doukan, Mustafa KELE, Abdullah UYANIK

Diyarbakr ve Gneydou Anadolu Blge Koordinatrleri Regional Coordinators for Southeastern Turkey: Emin YILMAZ, Asm GYMEN

Adana ve ukurova Blge Koordinatrleri Regional Coordinators for Adana and Cukurova Region: Saime PAYDA, brahim KARAYAYLALI, Neslihan SEYREK, Ahmet Alper KIYKIM

Antalya ve Akdeniz Blge Koordinatrleri Regional Coordinators for Antalya and Mediterranean Region: Glen YAKUPOLU, Fevzi ERSOY, Alihan GRKAN, Turul SEZER, Ramazan ETNKAYA

Pediatrik Nefroloji Koordinatr Coordinator for Pediatric Nephrology: Ouz SYLEMEZOLU, Pediatrik Nefroloji Dernei Bakan President of Pediatric Nephrology Society

Veri Toplanmasnda letiim ve Yardm Communication and Assistance in Data Collection: Mbeccel AKYZ, Il EMEL

Veri Toplama Data Collection: Ceyda ZMUTLU AVES Teknoloji AVES Technology Services

Veritaban ve Veri Giri Program Database Management and Software Development: AVES Teknoloji AVES Technology Services Blent SARI, Ercment SARI, Beyhan SLAM,

Veri Analizi ve Raporlama Data Analysis and Reporting: Yorum Danmanlk Ltd. Yorum Consultancy Ltd. Sorumlu Analyzer: Oktay ZDEMR, Sorumlu yardmcs Assistant: Murat KRT

Tablolar, Grafikler ve ngilizce eviriler Tables, Graphics and Translation: Murat KRT

Trkiye 2009 yl Ulusal Hemodiyaliz, Transplantasyon ve Nefroloji Kayt Sistemi Raporu v

NDEKLER CONTENTS Sayfa Page

2009 Kayt Sistemi 2009 Registry............................................................................................................ 1-2

Trkiyede Renal Replasman Tedavisi: Genel Bilgiler Renal Replacement Therapy in Turkey: General Considerations................................................................ 3

Hemodiyaliz Hemodialysis .................................................................................................................... 5-19

Periton Diyalizi Peritoneal Dialysis .................................................................................................... 20-28

Bbrek Transplantasyonu Kidney Transplantation.............................................................................. 29-36

Pediatrik Nefroloji Pediatric Nephrology ............................................................................................ 37-38

Pediatrik Hemodiyaliz Pediatric Hemodialysis ................................................................................... 39-44

Pediatrik Periton Diyalizi Pediatric Peritoneal Dialysis ..................................................................... 45-51

Pediatrik Bbrek Transplantasyonu Pediatric Kidney Transplantation............................................... 52-56

19 Yllk Registryden Rakamlar Figures from Registry of 19 Years .................................................. 57-61

Diyaliz ve Transplantasyonda Trkiyeden ve Dnyadan Genel Bilgiler General Information about Dialysis and Transplantation from Turkey and World.............................. 63-72

Kayt Sistemine Katlan Merkezler Centers Included in the Registry.................................................. 73-88

KISALTMALAR ABBREVIATIONS APD ........................ Aletli periton diyalizi BTx ......................... Bbrek transplantasyonu ESA (EPO).............. Eritropoiezi stimule edici ajan HD........................... Hemodiyaliz HT ........................... Hipertansiyon mnb ......................... Milyon nfus bana PD ........................... Periton diyalizi RRT......................... Renal replasman tedavisi SAPD ...................... Srekli ayaktan periton diyalizi SDBY...................... Son dnem bbrek yetmezlii TND ........................ Trk Nefroloji Dernei

APD......................... Automatic peritoneal dialysis CAPD...................... Continuous ambulatory peritoneal dialysis CV ........................... Cardiovascular ESA (EPO) .............. Erythropoiesis stimulating agent ESRD....................... End stage renal disease HD........................... Hemodialysis HT ........................... Hypertension PD ........................... Peritoneal dialysis pmp.......................... Per million population RRT ......................... Renal replacement therapy KTx.......................... Kidney transplantation TSN.......................... Turkish Society of Nephrology

Trkiye 2009 yl Ulusal Hemodiyaliz, Transplantasyon ve Nefroloji Kayt Sistemi Raporu 1

2009 KAYIT SSTEM 2009 REGISTRY TND 2009 kayt sistemine kaydedilen kurum says Number of institutions registered in 2009................................................................................................ 843 nternet kanalyla yant veren kurum says Number of institutions responding via internet ........................................................................................ 802 Kargo, telefon, faks vb. yntemlerle yant veren kurum says Number of institutions responding via conventional methods ................................................................... 37 Yant veren toplam kurum says ve oran Total number of responding institutions and response rate .....................................................839 (%99.5) TABLO 1. Merkez tipine gre cevap verme says. TABLE 1. Number of responding centers according to their type.

Erikin merkezleri Adult centers

Hedeflenen merkez says

Number of targetted centers

Cevap veren merkez says

Number of responding centers

Cevap veren merkez yzdesi

Percent of responding centers

(%)

HD 795 791 99.5

PD 97 97 100.0

Tx 42 41 97.6

Pediatri merkezleri Pediatry centers

HD 20 20 100.0

PD 40 40 100.0

Tx 17 17 100.0

Yllara gre yant oranResponse rate by years

77.5

94.1 94.4 97.6 93.2 96.699.4 99.4 99.596.2

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Yl / Year

Yz

de /

Per

cent

2 National Hemodialysis, Transplantation and Nephrology Registry Report of Turkey, 2009

HD merkezleri HD centers Sorumlu uzman hekim says Number of specialist physicians............................................................................................................... 793 Sorumlu pratisyen hekim says Number of general practitioners ............................................................................................................ 1139 Merkezde alan toplam hekim says Total number of physicians working in the center ................................................................................. 1932 Merkezde alan toplam hemire says Total number of nurses working in the center........................................................................................ 4919 Merkezdeki HD cihaz says Number of HD machines in the center ................................................................................................. 13278

PD merkezleri PD centers Sorumlu nefroloji uzman hekim says Number of nephrologists .......................................................................................................................... 158 Toplam hemire says Total number of nurses ............................................................................................................................ 172 APD cihaz says Number of APD machines in the center ................................................................................................... 212

Deerlendirme Discussion

Deerlendirme, 839 kurumdan gelen bilgilere dayanarak yaplmtr. Bu kurumlardan 802si verilerini internet zerinden online olarak gndermi, 37si ise telefon, faks ya da kargo yoluyla cevap vermitir. nternet kanalyla yant veren kurumlarn orannda geen seneye oranla hafif art olmutur (%96). Yeni veri toplama ynteminin artk genel olarak kabul grd grlmektedir.

2009 ylnda Trkiyede renal replasman tedavisi gerektiren son dnem kronik bbrek yetmezlii nokta prevalans milyon nfus bana 819 olarak saptanmtr (bu sayya ocuk hastalar dahildir).

2009 ylnda Trkiyede RRT insidans 197 olarak hesaplanmtr (bu sayya ocuk hastalar dahildir) (yeni transplant yaplan vakalarda yalnzca preemptif olanlar hesaba dahil edilmitir).

Evaluation is performed based on the results provided by 839 instutions. Of these, 802 institutions have answered via internet, while other 37 have used conventional methods. Percentage of institutions responding via internet (96%) is slightly higher than the last year. We can say that online data collection method has gained wide acception.

For the year 2009, the point prevalence of end stage renal disease needing renal replacement therapy is found as 819 in Turkey (including pediatric patients).

For the year 2009, the incidence of renal replacement therapy is found as 197 in Turkey (including pediatric patients) (from new transplanted cases only the preemptive ones are included).


TRKYEDE RENAL REPLASMAN TEDAVS (RRT): GENEL BLGLER RENAL REPLACEMENT THERAPY (RRT) IN TURKEY: GENERAL CONSIDERATIONS 2009 yl sonu itibariyle prevalan (mevcut) erikin SDBY hastalarnda RRT tipleri (n=58468) RRT modalities in prevalent adult ESRD patients, as of the end of 2009 (n=58468)

HD hastalar HD patients ...................................................................................................... %79.6 PD hastalar PD patients ......................................................................................................... %8.3 Tx hastalar Tx patients ......................................................................................................... %12.1

nsidans ve Prevalans Incidence and Prevalence Genel nsidans General Incidence TABLO 1. 2009 yl iinde ilk kez RRTne balanan hastalardan 90 gnden daha uzun sre izlenenlerin (ocuk hastalar dahil) uygulanan RRT tipine gre dalm. TABLE 1. Distribution of incident RRT patients followed for longer than 90 days, according to RRT type (including pediatric patients), in 2009.

Merkez says Number of centers

Erikin Adult ocuk Pediatricn %

HD 789 20 12599 83.8

PD 97 40 1454 9.7

Tx 41 16 976 6.5

Toplam Total 927 76 15029 100.0 Genel Prevalans General Prevalence TABLO 2. 31 Aralk 2009 itibaryla kronik HD/PD programnda izlenmekte olan veya fonksiyone greftle izlenmekte olan tm hastalarn (ocuk hastalar dahil) RRT tipine gre dalm. TABLE 2. Distribution of chronic HD/PD patients or patients followed with functioning graft (including pediatric patients), according to RRT type, as of the end of 2009.

Merkez says Number of centers

Erikin Adult ocuk Pediatricn %

HD 789 20 46650 78.5

PD 94 40 5418 9.1

Tx 41 16 7375 12.4

Toplam Total 924 76 59443 100.0



HEMODYALZ HEMODIALYSIS Hemodiyaliz nsidans Incidence of Hemodialysis TABLO 1. 2009 yl iinde ilk RRT olarak HDe balanan ve kronik HD programna alnan hastalarn ya ve cinsiyet dalm (738 merkez). TABLE 1. Age and gender distribution of incident chronic HD patients, in 2009 (738 centers).

Erkek Male Kadn Female Toplam Total

Ya Age n % n % n %

019 124 1.0 94 0.7 218 1.7

2044 1422 11.0 933 7.2 2355 18.2

4564 3083 23.9 2132 16.5 5215 40.4

6574 1787 13.8 1510 11.7 3297 25.5

75+ 924 7.2 898 7.0 1822 14.1

Toplam Total 7340 56.9 5567 43.1 12907 100.0 TABLO 2. 2009 yl iinde ilk RRT olarak HDe balanp kronik HD programna alnan ve 90 gnden uzun sre izlenen hastalarn ya ve cinsiyet dalm (738 merkez). TABLE 2. Age and gender distribution of incident chronic HD patients followed for longer than 90 days, in 2009 (738 centers).


Ya Age n % n % n %

019 97 1.0 78 0.8 175 1.7

2044 1138 11.3 746 7.4 1884 18.6

4564 2425 24.0 1705 16.9 4130 40.9

6574 1371 13.6 1218 12.1 2589 25.6

75+ 689 6.8 634 6.3 1323 13.1

Toplam Total 5721 56.6 4381 43.4 10102 100.0 TABLO 3. 2009 yl iinde ilk RRT olarak HDe balanp kronik HD programna alnan diyabetik nefropatili hastalarn ya ve cinsiyet dalm (738 merkez). TABLE 3. Age and gender distribution of incident chronic HD patients with diabetic nephropathy, in 2009 (738 centers).


Ya Age n % n % n %

019 6 0.1 11 0.2 17 0.4

2044 266 5.8 175 3.8 441 9.7

4564 1247 27.4 956 21.0 2203 48.4

6574 693 15.2 639 14.0 1332 29.3

75+ 283 6.2 276 6.1 559 12.3

Toplam diyabetik hasta says Total number of diabetic patients

2495 54.8 2057 45.2 4552 100.0


TABLO 4. 2009 yl iinde ilk RRT olarak HDe balanan ve kronik HD programna alnan hastalarn altta yatan etyolojik nedenlere gre dalm (737 merkez). TABLE 4. Distribution of incident chronic HD patients according to etiology, in 2009 (737 centers).

Tm HD hastalar All HD patients

90 gnden uzun sre izlenenler

Followed for longer than 90 days

n % n %

Diabetes mellitus Diabetes mellitus 4597 32.7 4126 37.3

Tip 1 DM Type 1 DM 850 6.4 806 7.3

Tip 2 DM Type 2 DM 3747 28.3 3320 30.0

Hipertansiyon* Hypertension* 3488 26.3 3055 27.6

Glomerlonefrit Glomerulonephritis 957 7.2 800 7.2

Polikistik bbrek hastalklar Polycystic kidney diseases 407 3.1 291 2.6

Piyelonefrit Pyelonephritis 317 2.4 291 2.6

Amiloidoz Amyloidosis 250 1.9 203 1.8

Renal vaskler hastalk Renal vascular disease 184 1.4 142 1.3

Dier Other 966 7.3 699 6.3

Etyoloji bilinmiyor Unknown etiology 1936 14.6 1275 11.5

Kayp (bilgi yok) Missing data 146 1.1 101 0.9

Toplam Total 13248 100.0 11073 100.0 * Hipertansiyonun tr olarak primer deil, kronik bbrek yetmezliine bal oluan sekonder hipertansiyon olduuna dair kuvvetli pheler vardr. * There are strong suspects that hypertension mentioned here is not primary but secondary which has occured due to chronic renal failure. Hemodiyaliz Prevalans Prevalence of Hemodialysis TABLO 5. 2009 yl sonu itibaryla kronik HD programnda izlemde olan hastalarn ya ve cinsiyet dalm (732 merkez). TABLE 5. Age and gender distribution of chronic HD patients, as of the end of 2009 (732 centers).


Ya Age n % n % n %

019 246 0.6 218 0.5 464 1.1

2044 5178 12.1 3853 9.0 9031 21.1

4564 10241 24.0 7849 18.4 18090 42.4

6574 5392 12.6 4775 11.2 10167 23.8

75+ 2589 6.1 2366 5.5 4955 11.6

Toplam Total 23646 55.4 19061 44.6 42707 100


TABLO 6. 2009 yl sonu itibaryla kronik HD programnda izlemde olan hastalarn etyolojik nedenlere gre dalm (735 merkez). TABLE 6. Distribution of chronic HD patients followed, according to etiology, as of the end of 2009 (735 centers).

n %

Diabetes mellitus Diabetes mellitus 12857 30.6 Tip 1 DM Type 1 DM 2126 5.1 Tip 2 DM Type 2 DM 10731 25.5

Hipertansiyon* Hypertension* 11597 27.6 Glomerlonefrit Glomerulonephritis 3440 8.2 Polikistik bbrek hastalklar Polycystic kidney diseases 1976 4.7 Piyelonefrit Pyelonephritis 1443 3.4 Amiloidoz Amyloidosis 835 2.0 Renal vaskler hastalk Renal vascular disease 409 1.0 Dier Other 3031 7.2 Etyoloji bilinmiyor Unknown etiology 6210 16.1 Kayp (bilgi yok) Missing data 514 1.3 Toplam Total 38604 100.0

Hemodiyaliz ve lmler Hemodialysis and Deaths TABLO 7. Kronik HD programnda izlenmekte olan hastalardan 2009 ylnda lenlerin ya ve cinsiyet dalm (712 merkez). TABLE 8. Age and gender distribution of chronic HD patients died in 2009 (712 centers).


Ya Age n % n % n %

019 15 0.3 9 0.2 24 0.5 2044 151 3.2 105 2.2 256 5.4 4564 792 16.6 525 11.0 1317 27.7 6574 984 20.7 834 17.5 1818 38.2 75+ 752 15.8 590 12.4 1342 28.2 Toplam len hasta says Total number of deaths

2694 56.6 2063 43.4 4757 100.0


TABLO 8. 2009 ylnda len HD hastalarnn lm nedenlerine gre dalm (710 merkez). TABLE 8. Distribution of patients died in 2009, according to the cause of death (710 centers).

len hasta says

Number of death

Tm lmlere

oran Rate among all deaths (%)

Kardiyovaskler Cardiovascular 2376 52.1

Malignite Malignancy 556 12.2

Serebrovaskler aksidan Cerebrovascular accidents 516 11.3

nfeksiyon Infection 390 8.5

GS kanamas GIS bleeding 95 2.1

Karacier yetmezlii Liver failure 71 1.6

Akcier embolisi Pulmonary emboli 59 1.3

Diyalize girmeyi reddetme Refusal of dialysis treatment 24 0.5

Dier Other 476 10.4

Toplam Total 4563 100.0 TABLO 9. 2009 ylnda kardiyovaskler nedenlerle len HD hastalarnda lm nedenleri (710 merkez). TABLE 9. Causes of death in HD patients died due to cardiovascular events, in 2009 (710 centers).

Kardiyovaskler nedenle len hasta says Number of

patients died due to a CV events

Tm KV nedenli

lmlere oran Rate among all deaths due to CV events (%)

Kalp yetersizlii Heart failure 880 38.0

skemik kalp hastal Ischemic heart disease 837 36.1

Ani lm Sudden death 528 22.8

Dier Other 72 3.1

Toplam Total 2317 100.0 Hemodiyaliz Hastalarnda Prediyaliz Dnemi Predialysis Period of HD Patients TABLO 10. 2009 yl iinde yeni kronik HD hastalarnn prediyaliz dneminde dzenli takip, nefrolog takibi ve eitim alma durumlarna gre dalm. TABLE 10. Distribution of incident chronic HD patients according to training, regular follow-up and follow-up by nephrologist during predialysis period, in 2009.

n %

Dzenli takip yaplanlar (546 merkez) Regular follow-up (546 centers) 5334 59.0

Dzenli takip yaplmayanlar (546 merkez) No regular follow-up (546 centers) 3704 41.0

Nefrolog takibinde olanlar (536 merkez) Follow-up by a nephrologist (536 centers) 4608 53.0

Nefrolog takibinde olmayanlar (536 merkez) No follow-up by a nephrologist (536 centers) 4082 47.0

Eitim alanlar (488 centers) Training (488 centers) 4331 53.3

Eitim almayanlar (488centers) No training (488 centers) 3800 46.7


TABLO 11. 2009 yl iinde yeni kronik HD hastalarnn hemodiyalize balang durumlarna gre dalm (622 merkez). TABLE 11. Distribution of incident chronic HD patients according to their initial approach of RRT, in 2009 (622 centers).

n %

Acil Urgent 3926 35.1

Programl Scheduled 7272 64.9

Toplam Total 11198 100.0 TABLO 12. 2009 yl iinde yeni kronik HD hastalarndan hemodiyalize acil olarak balanan hastalarn balang endikasyonlarna gre dalm (360 merkez). TABLE 12. Distribution of incident chronic HD patients who have urgently started hemodialysis, according to indications (360 centers).

n %

Hipervolemi Akcier demi Hypervolemia Pulmonary edema 1411 37.8

nat bulant, kusma, itahszlk Persistent nausea, vomiting, anorexia 703 18.9

Tedaviye yant vermeyen hipertansiyon Hypertension not responding to treatment 437 11.7

remik ensefalopati Uremic encephalopathy 218 5.8

Hiperkalemi Hyperkalemia 339 9.1

Kontrolsz asidoz Uncontrolled acidosis 254 6.8

Perikardit Pericarditis 101 2.7

remiye bal kanama diyatezi Bleeding diathesis due to uremia 41 1.1

Dier Other 224 6.0

Toplam Total 3728 100.0 TABLO 13. 2009 yl iinde yeni kronik HD hastalarnn balang srasnda elik eden / komorbid durumlara gre dalm (674 merkez). TABLE 13. Distribution of incident chronic HD patients according to concomitant / comorbid conditions, in 2009 (674 centers).

n %

Diabetes mellitus Diabetes mellitus 3518 34.4


Konjestif kalp yetmezlii Congestive heart failure 1088 10.6

Kronik akcier hastal (KOAH vb) Chronic pulmonary disease (COPD, etc.) 674 6.6

Periferik damar hastal Peripheral vascular disease 597 5.8


Serebrovaskler hastalk Cerebrovascular disease 487 4.8

Kronik karacier hastal Chronic liver disease 197 1.9

Dier Other 1498 14.6

Toplam hasta says Total number of patients 10231 100.0


TABLO 14. 2009 yl iinde yeni kronik HD hastalarnn hemodiyalize balang srasndaki laboratuvar bulgularna gre dalm (518 merkez). TABLE 14. Distribution of incident chronic HD patients according to the initial laboratory findings, in 2009 (518 centers).

% % % % Toplam Total

=10.0 mg/dL

Serum kreatinin Serum creatinine 608 merkez centers

10.8 29.1 45.1 15.0 10845

=250 mg/dL

Serum re Serum urea 603 merkez centers

15.9 39.6 36.5 7.9 10841

=4.5 g/dL

Serum albmin Serum albumin 600 merkez centers

31.9 40.2 24.0 3.9 10749

=12.0 g/L

Hemoglobin Hemoglobin 508 merkez centers

16.6 37.2 36.5 9.7 10645

=7.5 mMol/L

Serum potasyum Serum potassium 601 merkez centers

6.1 59.9 30.8 3.2 10708

=12.0 mg/dL

Serum kalsiyum Serum calcium 598 merkez centers

31.0 58.2 9.9 0.9 10611

=7.5 mg/dL

Serum fosfor Serum phosphorus 603 merkez centers

10.3 46.6 34.9 8.1 10681


Hemodiyaliz Hastalarnda Diyaliz Uygulamalar Dialysis Application in Hemodialysis Patients

TABLO 15. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn diyaliz srelerine gre dalm (674 merkez). TABLE 15. Distribution of chronic HD patients according to dialysis duration, as of the end of 2009 (674 centers).

n %

0-5 yl years 24101 60.3

6-10 yl years 10935 27.4

11-15 yl years 3608 9.0

16-20 yl years 1029 2.6

>20 yl years 300 0.8

Toplam Total 39973 100.0 TABLO 16. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn HDe giri sklna gre dalm (689 merkez). TABLE 16. Distribution of chronic HD patients according to HD frequency, as of the end of 2009 (689 centers).

n %

Haftada 1 kez Once weekly 371 0.9

Haftada 2 kez Twice weekly 2939 7.2

Haftada 3 kez 3 times weekly 36667 90.1

> Haftada 3 kez veya noktrnal HD > 3 times weekly or nocturnal HD

735 1.8

Toplam Total 40712 100.0 TABLO 17. 2009 yl iinde kronik HD hastalarnn tketilen diyalizer membran tipine gre dalm (581 merkez). TABLE 17. Distribution of chronic HD patients according to the dialyser type, in 2009 (581 centers).

n %

Kuprofan Cuprophane 247 0.0

Semisentetik (Selloz asetat, hemofan vs) Semisynthetic (Cellulose acetate, hemophan, etc.)

434.425 13.9

Sentetik (Polislfon, PAN, PMMA vs) Synthetic (Polysulfone, PAM, PMMA, etc.)

2.039.795 65.3

High-flux High-flux 647.925 20.8

Toplam Total 3.122.392 100.0


TABLO 18. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn re azalma oran (URR) deerine gre dalm (665 merkez). TABLE 18. Distribution of chronic HD patients according to the urea reduction rate (URR),as of the end of 2009 (665 centers).

n %

0.65 6731 17.1

>0.65 32538 82.9

Toplam Total 39269 100.0 TABLO 19. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn Kt/V deerlerine gre dalm (483 merkez). TABLE 19. Distribution of chronic HD patients according to Kt/V values, as of the end of 2009 (483 centers).

n %

1.21 3209 10.2

1.21-1.40 12758 40.6

>1.40 15465 49.2

Toplam Total 31432 100.0 Hemodiyaliz Hastalarnda Damara Eriim Yolu Route of Vascular Access in Hemodialysis Patients

TABLO 20. 2009 yl iinde yeni kronik HD hastalarnn HD balangcndaki damar eriim yoluna gre dalm (652 merkez). TABLE 20. Distribution of incident chronic HD patients according to route of vascular access (652 centers).

n %

AV fistl (nativ) AV fistula (native) 5751 47.5

Geici (tnelsiz) kateter Temporary (untunnelled) catheter 4492 37.1

Kalc (tnelli) kateter Permanent (tunnelled) catheter 1710 14.1

AV greft (protez) AV graft (prothesis) 157 1.3

Toplam Total 12110 100.0 TABLO 21. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn halen kullanlmakta olan damar eriim yoluna gre dalm (682 merkez). TABLE 21. Distribution of chronic HD patients according to route of vascular access still being used, as of the end of 2009 (682 centers).

n %

AV fistl (nativ) AV fistula (native) 33904 84.0

Kalc (tnelli) kateter Permanent (tunnelled) catheter 3760 9.3

Geici (tnelsiz) kateter Temporary (untunnelled) catheter 1611 4.0

AV greft (protez) AV graft (prothesis) 1105 2.7

Toplam Total 34994 100.0


TABLO 22. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarndan kateterle hemodiyalize girenlerin kateterle hemodiyalize girme nedenine gre dalm (576 merkez). TABLE 22. Distribution of chronic HD patients according to the cause of entering HD with catheter, as of the end of 2009 (576 centers).

n %

Diyalize kateterle balayp devam edenler Started with catheter and continue

1670 46.9

AV fistl veya AV greftinde sorun nedeniyle katetere geilenler Switched to catheter due to problem in AV graft or AV fistula

1891 53.1

Toplam Total 3561 100.0 TABLO 23. 2009 yl iinde geici (tnelsiz) kateter yerletirilen kronik HD hastalarnn kateter yerletirme yerine gre dalm (488 merkez). TABLE 23. Distribution of chronic HD patients with catheter according to the place of the catheter, as of the end of 2009 (488 centers).

n %

nternal juguler ven Internal jugular vein 3200 50.1

Subklavyan ven Subclavian vein 1539 10.4

Femoral ven Femoral verin 969 24.1

Eksternal juguler ven External jugular vein 664 15.2

nferior vena kava (translomber kateter) Inferior vena cava (translumbar catheter)

18 0.3

Toplam Total 6390 100.0 TABLO 24. Venz kateterleri takan hekimlerin branlara gre dalm. TABLE 24. Distribution of physicians placing the catheters, according to their speciality.

n (merkez center)

%

Kalp-damar cerrah Cardiovascular surgeon 321 68.6

Anestezi uzman Anesthesiologist 181 38.7

Genel cerrah General surgeon 66 14.1

Nefrolog Nephrologist 116 24.8

Giriimsel radyolog Interventional radiologist 77 16.5

Sertifikal dahiliye uzman Certificated internist 25 5.3

Sertifikal pratisyen Certificated practitioner 29 6.2


TABLO 25. 2009 yl iinde izlenen kronik HD hastalarnn santral venz kateterizasyondan sonra gelien komplikasyonlara gre dalm (638 merkez). TABLE 25. Distribution of chronic HD patients according to the complications developed after central venous catheterization, in 2009 (638 centers).

Erken komplikasyonlar Early complications n %

Arter ponksiyonu Artery punction 206 68.4

Pnmotoraks Pneumothorax 34 11.3

Hemotoraks Hemothorax 25 8.3

Ciddi aritmi Serious arrythmia 22 7.3

Ven veya atrium perforasyonu Vein or atrium perforation 5 1.7

Hava embolisi Air embolism 5 1.7

Perikard tamponad Pericarditis tamponade 4 1.3

Toplam komplikasyon says Total number of complications 301 100.0

Ge komplikasyonlar Late complications n %

Lokalize k yeri infeksiyonu Localised exit site infection 1219 40.6

Tromboz Thrombosis 833 27.7

Tnel infeksiyonu Tunnel infection 373 12.4

Vaskler darlk Vascular stenosis 289 9.6

Sistemik infeksiyon (Sepsis, infektif endokardit) Systemic infection (Sepsis, infective endocarditis)

239 8.0

Arteriyovenz fistl Arteriovenous fistula 51 1.7

Toplam komplikasyon says Total number of complications 3004 100.0 TABLO 26. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn uygulanan antikoaglasyon (heparinizasyon) yntemlerine gre dalm (681 merkez). TABLE 26. Distribution of chronic HD patients according to anticoagulation (heparinization) methods, as of the end of 2009 (681 centers).

n %

Standart heparinizasyon Standard heparinization 31814 78.5

Dk mol arlkl heparinizasyon Low mol weight heparinization 8037 19.8

Regional heparinizasyon Regional heparinization 51 0.1

Dier Other 610 1.5



Hemodiyaliz Hastalarnda Hipertansiyon Hypertension in Hemodialysis Patients

TABLO 27. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn diyaliz seans ncesi hipertansiyon durumuna gre dalm (654 merkez). TABLE 27. Distribution of chronic HD patients according to hypertension level before the dialysis session, as of the end of 2009 (654 centers).

n %

la YOK, KB < 140/90 mmHg Untreated, BP < 140/90 mmHg 22350 58.5

la VAR, KB < 140/90 mmHg Treated BP < 140/90 mmHg 8159 21.4

la YOK, KB 140/90 mmHg Untreated, BP 140/90 mmHg 3373 8.8

la VAR, KB 140/90 mmHg Treated BP 140/90 mmHg 4314 11.3

Toplam Total 38196 100.0 Hemodiyaliz Hastalarnda Serum Albmin Dzeyi Serum Albumin Level in Hemodialysis Patients

TABLO 28. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn serum albmin dzeyine (son 3 ayn ortalamas) gre dalm (657 merkez). TABLE 28. Distribution of chronic HD patients according to serum albumin level (mean value of last 3 months), as of the end of 2009 (657 centers).

n %

4 g/dL 15181 38.8

Toplam Total 39171 100.0 Hemodiyaliz Hastalarnda ESA (EPO) ve Anemi ESA (EPO) and Anemia in Hemodialysis Patients

31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn ortalama hemoglobin dzeyi (son 3 ayn ortalamas) (641 merkez) Distribution of chronic HD patients according to hemoglobin level (mean value of last 3 months), as of the end of 2009 (641 centers) .....................................................................................................................10.9 gr/dL TABLO 29. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn ESA tedavisine gre dalm (658 merkez). TABLE 29. Distribution of chronic HD patients according to ESA therapy, as of the end of 2009 (658 centers).

n %

Daha nce ESA kullanm, ancak halen kullanmyor Have recieved before, but not using currently

10981 28.4

Halen ESA kullanyor Using currently 24097 62.4

Hi ESA kullanmam Never used ESA 3553 9.2



TABLO 30. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnn ESA tedavisi, hedefe ulam (Hb>11 g/dL, Htc >%33) ve ESAya diren (668 merkez, 39790 hasta).* TABLE 30. ESA treatment, reaching the target and ESA resistance* in chronic HD patients (Hb>11 g/dL, Htc >%33), as of the end of 2009 (668 centers, 39790 patients).

n %

Hi ESA verilmeksizin hedefte At target without ESA 5777 14.5

ESA ile hedefte At target with ESA 17462 43.9

ESAya diren ESA resistance 4484 11.3

* Son 3 ayda 150 U/kg/hafta veya 0.75 mcgkg/hafta SC ESA uygulanmasna karn Htc dzeyi


Hemodiyaliz Hastalarnda Kalsiyum Fosfor Metabolizmas Calcium and Phosphorus Metabolism in Hemodialysis Patients

TABLO 33. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnda son 3 ayda en uzun sreli kullanlan fosfor balayc ila (653 merkez). TABLE 33. The most long lasting phosphorus binding agents in the last 3 months among chronic HD patients, as of the end of 2009 (653 centers).

n %

Kalsiyum asetat Calcium acetate 20964 54.6

Sevelamer Sevelamer 6034 15.7

Kalsiyum karbonat Calcium carbonate 4944 12.9

Aluminyum hidroksit Aluminium hydroxide 783 2.0

Dier Other 433 1.1

Kullanmayan Not using 5263 13.7

Toplam Total 38421 100.0 TABLO 34. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnda sekonder hiperparatiroidi tedavisinde kullanlan ilalar (649 merkez). TABLE 34. Seconder hyperparathyroid drug use among chronic HD patients, as of the end of 2009 (649 centers).

n

D vitamini / kalsimimetik kullananlara oran Rate among the patients using

vitamin D / calcimimetics (%

Tm hastalara oran Rate among all

patients (%)

Oral D vitamini Oral vitamin D 1826 10.8 4.9

IV D vitamini IV vitamin D 12508 73.8 33.2

D vitamini analogu Vitamin D analog 2267 13.4 6.0

Kalsimimetik Calcimimetics 351 2.1 0.9

Toplam tedavi kullanan Total use 16952 100.0 45.0

Toplam hasta says Total number of patients 37627 100.0 Hemodiyaliz Hastalarnda Hepatit Hepatitis in Hemodialysis Patients

TABLO 35. 31 Aralk 2009 tarihi itibariyle kronik HD hastalarnda hepatit serolojisi (659 merkez). TABLE 35. Hepatitis serology in chronic HD patients, as of the end of 2009 (659 centers).

n %

HbsAg (+) 1653 4.4

Anti-HCV (+) 3711 9.8

Hem HbsAg (+), hem Anti-HCV (+) HbsAg (+) and Anti-HCV (+)

230 0.6

Hem HbsAg (-), hem Anti-HCV (-) HbsAg (-) and Anti-HCV (-)

32361 85.3

HBV-DNA (+) 882 2.3

HCV-RNA (+) 278 0.7



Deerlendirme Discussion Hemodiyaliz, lkemizde en sk uygulanan

RRT yntemidir. Hemodiyalizde alan toplam hekim says 1932, hemire says 4919dur. Hekim ve hemire saysnda geen yla gre art vardr.

Son dnem bbrek yetmezlii etyolojisinde diabetes mellitus en sk rastlanan nedendir. Skl geen yllara gre artmaya devam etmektedir. Etyolojide yksek oranda bulunan hipertansiyonun primer mi, yoksa tespit edilmemi baka bir sonuca gre gelien renal yetersizlie bal sekonder hipertansiyon mu olduu tartmaldr.

Haftalk hemodiyaliz seans says hastalarn %90.1sinde , %7.2inde iki, %0.9unda bir seansdr. Bu oranlar geen yla benzer seviyededir.

2009 ylnda dzenli HD tedavisine yeni balayan hastalarda damara ulam yolu olarak %1.3 hastada AV greft, %37,1 hastada tnelsiz (geici), %14.1 hastada tnelli (kalc) kateterizasyon, %47.5 hastada ise AV fistl kullanlmtr. Hastalarn byk ksmnda hemodiyaliz balangcndan itibaren AV fistl kullanlmas olumlu bir durumdur. Ancak geen yla gre (%54.9dan %47.5e d) bu oranda azalma dikkat ekmitir. 2009 yl sonu itibariyle izlemde olan dzenli HD hastalarnda ise en sk kullanlan damara eriim yolu AV fistldr (%84.0). Takipte olan hastalarda kateter (tnelli ve tnelsiz) kullanm oran %13.3dir. Takipdeki hastalarda yksek oranda AV fistl kullanm lkemizdeki hemodiyaliz tedavisi asndan olumlu ve istenilen bir bulgudur. Ancak yllar iinde az da olsa kateter kullanm orannda art varl dikkat ekmektedir. Bu, damar eriim yolu problemli olan diyabetik hastalarn artna bal olabilir.

2009 yl sonu itibariyle izlemde olan dzenli HD hastalarnn %78.5inde standart heparinizasyon, %19.8sinde dk molekl arlkl heparinizasyon, %0.2sinde regional heparinizasyon uygulanmtr. lkemizde diyaliz hastalarnda uygulanan antikoaglasyon tedavisinde dk molekl arlkl heparin kullanm oran hem Avrupa, hem de Amerikadan yksektir. Standart heparinizasyon dk molekl arlkl heparinizasyona gre ekonomik adan daha avantajl olduu unutulmamaldr.

HD hastalarnda hipertansiyon oran %41.5 bulunmutur. Bu oran geen ylki orana gre daha dktr. Bu hastalarn yaklak yarsnda kan basnc kontrol altnda deildir.

Beslenmenin gvenilir gstergelerinden biri olan serum albmin dzeyi hemodiyaliz hastalarnn %88.9unda 3.5 g/dLnin zerindedir.

Hemodiyaliz hasta poplasyonumuzda ESA kullanm oran %62.4dr ve geen yla gre

Hemodialysis is the most commonly used RRT method in Turkey. There are 1932 physicians and 4919 nurses working in hemodialysis centers. There is an increase in the number of both physicians and nurses.

Diabetes mellitus is the most common seen etiology of end stage renal disease and keeps increasing by years pass. The relationship of hypertension, which is noted to be highly prevalent, with end-stage renal failure is to be discussed with regards to the cause-and-effect sequence of hypertension and renal failure.

The number of hemodialysis session per week is three times for 90.1% of the patients while it is twice for 7.2% and once for 0.9% of them. These figures are similar to last year.

Route of vascular access in HD patients newly started routine HD treatment in the year 2009 are AV graft by 1.3%, untunnelled (temporary) catheterization by 37.1%, tunnelled (permanent) catheterization by 14.1% and AV fistula by 47.5%. AV fistula use from the beginning of hemodialysis is a desired development but there is a decrease when compared to last year (from 54.9% to 47.5%). Main IV route in routine HD patients as of the end of 2009 is AV fistula by 84.0%. Catheter use rate (tunnelled or untunnelled) in patients under follow-up is found as 13.3%. High rate of AV fistula use in patients under follow-up is a positive and desired figure by means of hemodialysis treatment in our country. The increase in catheter use may depend to the increase in the number of patients with vascular access problem.

Standard heparinization is performed in 78.5% of the patients who are under follow-up as of the end of 2009, while the rate of low molecular weight heparin anticoagulation is 19.8% and the rate of regional heparinization is 0.2%. The rate of using low molecular weight heparin for anticoagulation is higher than the rates in Europe and USA. Compared to low molecular heparinization, standart heparinization is reasonably economical.

The rate of hypertension among HD patients is found as 41.5% and this is lower than last years rate. Blood pressure is not under control in half of these patients

Serum albumin level, which is a reliable indicator of nutrition, is over 3.5 g/dL in 88.9% of HD patients.

There is no significant increase in the rate of ESA usage (62.4%) when compared to last year (62.7%). ESA resistence is found as 11.3%. Generally we can say that anemia treatment have being performed as desired (mean Hb values of patients are 10.9 gr/dL).

With a rate of 54.6%, calcium acetate is the most common phosphate binding agent in routine HD patients. The rate of Vit D usage


(%62.7) ok farkl deildir. ESA direnci %11.3 olarak saptanmtr. Hastalarn ortalama Hb deerleri 10.9 gr/dL olup genel olarak HD hastalarnda anemi tedavisinin uygun ekilde yapld sylenebilir.

Dzenli HD tedavisi gren hastalarda fosfat balayc seiminde kalsiyum asetat ilk srada (%54.6.) yer almtr. D vitamini kullanm %44.2 olup geen yla gre artmtr. Fosforun zellikle 7 mg/dLnin zerinde olduu vakalarda kullanlmas nerilen alminyum hidroksit nemli bir fosfat balaycdr Alminyum hidroksit ile dier kalsiyum iermeyen fosfor balayclar arasndaki ekonomik fark azmsanmayacak derecede byktr.

Yeni hemodiyaliz hastalarnn %35.1inde hemodiyalize acil artlarda balanmaktadr. Bbrek hastalklarnn erken tehisi, nefroloa erken ynlendirme, hasta eitimi gibi faktrlerle bu oran drlebilir.

Yeni hemodiyaliz hastalarnn yaklak %60nda hemodiyalize balama srasnda kreatinin 6 mg/dL veya stndedir. Bu MDRD formlne gre 50 yandaki beyaz rktan bir erkek iin yaklak 11ml/dk/1.73m2lik bir GFR deerine tekabl etmektedir.

Yeni hemodiyalizhastalarnda geici kateterizasyon yolu olarak subklavian venin kullanm orannda azalma (%19dan %10.4e) dikkat ekmektedir bu sevindirici bir bulgudur. Uzun dnemde yol aaca damar eriim yolu problemleri nedeniyle, kronik hemodiyaliz hastalarnda subklavian kateterizasyon tercih edilmemelidir.

Venz kateterizasyon sklkla kalp damar cerrahlar ve anestezi uzmanlar tarafndan yaplmaktadr. Burada nefrologlarn rolnn artrlmas uygun katerterizasyon yolunun seimi iin yararl olabilir.

Hemodiyaliz hastalarndaki en sk rastlanan lm nedeni kardiyovaskler hastalklardr (%52.1). Bu durum kardiyovaskler ve renal patolojiler arasndaki ilikinin bir sonucu olarak kabul edilebilir. Bunu malignite, serebrovaskler hastalk,ve infeksiyonlar izlemektedir.

is 44.2% which is higher than last year. Aluminium hydroxide is a very important phosphorus binding agent in especially the cases with phosphorus higher than 7 mg/dL. The cost of aluminium hydroxide is significantly less than other non-calcium containing phosphate binding agents.

In 35.1% of patients hemodialysis has been started urgently. Early diagnosis of the renal diseases, referring patients to a nephrologist in an early phase and patient training may decrease this figure.

Creatinine level is 6 mg/dL in approximately 60% of the incident HD patients. According to MDRD formula this number corresponds to approximately 11 ml/min/1.73 m2 GFR for a 50 years old white male.

Temporary catheters are placed to subclavian vein in approximately in 10.4% of the incident HD patients. Decrease when compared to the last year is pleasing. Subclavian catheterization can cause to various vascular access problems in long term, therefore subclavian catheterization shouldnt be preferred in chronic HD patients.

Venous catheterization are mostly performed by cardiovascular surgeons and anesthesiologists. Increasing the role of nephrologists may be helpful in choosing the appropriate catheterization route.

With a rate of 52.1%, cardiovascular diseases are the most common death causes in HD patients. This finding might be considered as a result of close relationship between cardiovascular and renal pathologies. Cerebrovascular diseases, malignancies and infections are the following causes.


PERTON DYALZ PERITONEAL DIALYSIS Periton Diyalizi nsidans Incidence of Peritoneal Dialysis

TABLO 1. 2009 yl iinde ilk RRT olarak PD (SAPD/APD)ne balanp kronik SAPD/APD programna alnan hastalarn ya ve cinsiyet dalm (95 merkez). TABLE 1. Age and gender distribution of incident chronic PD (CAPD/APD) patients, in 2009 (95 centers)


Ya Age n % n % n %

019 20 1.5 19 1.4 39 2.9

2044 229 17 224 16.7 453 33.7

4564 333 24.8 260 19.3 593 44.1

6574 121 9 83 6.2 204 15.2

75+ 29 2.2 27 2 56 4.2

Toplam Total 732 54.4 613 45.6 1345 100 TABLO 2. 2009 yl iinde ilk RRT olarak PDne balanp kronik PD programna alnan ve 90 gnden uzun sre izlenen hastalar (95 merkez). TABLE 2. Age and gender distribution of incident chronic PD patients followed for longer than 90 days, in 2009 (95 centers).


Ya Age n % n % n %

019 17 1.6 15 1.4 32 3

2044 184 17.2 185 17.3 369 34.5

4564 268 25.1 200 18.7 468 43.8

6574 97 9.1 67 6.3 164 15.3

75+ 19 1.8 17 1.6 36 3.4

Toplam Total 585 54.7 484 45.3 1069 100 TABLO 3. 2009 yl iinde ilk RRT olarak PDne balanp kronik PD programna alnan diyabetik nefropatili hastalarn ya ve cinsiyet dalm (95 merkez). TABLE 3. Age and gender distribution of incident chronic PD patients with diabetic nephropathy, in 2009 (95 centers).


Ya Age n % n % n %

019 0 0 0 0 0 0

2044 56 13.1 43 10.1 99 23.2

4564 150 35.2 92 21.6 242 56.8

6574 41 9.6 32 7.5 73 17.1

75+ 7 1.6 5 1.2 12 2.8

Toplam diyabetik hasta says Total number of diabetic patients

254 59.6 172 40.4 426 100


TABLO 4. 2009 yl iinde ilk RRT olarak PDne balanp kronik PD programna alnan hastalarn altta yatan etyolojik nedenlere gre dalm (95 merkez). TABLE 4. Distribution of incident chronic PD patients according to etiology, in 2009 (95 centers).

Tm PD hastalar All HD patients

90 gnden uzun sre izlenenler

Followed for longer than 90 days

n % n %

Hipertansiyon* Hypertension* 416 32.0 350 32.2

Diabetes mellitus Diabetes mellitus 398 30.6 327 30.1

Tip 1 DM Type 1 DM 78 6.0 65 6.0

Tip 2 DM Type 2 DM 320 24.6 262 24.1

Glomerlonefrit Glomerulonephritis 104 8.0 97 8.9

Piyelonefrit Pyelonephritis 39 3.0 33 3.0

Polikistik bbrek hastalklar Polycystic renal diseases 36 2.8 33 3.0

Amiloidoz Amyloidosis 35 2.7 31 2.9

Renal vaskler hastalk Renal vascular disease 6 0.5 3 0.3

Dier Other 96 7.4 74 6.8

Etyoloji bilinmiyor Unknown etiology 167 12.9 135 12.4

Kayp (bilgi yok) Missing data 2 0.2 4 0.4

Toplam Total 1299 100.0 1087 100.0 * Hipertansiyonun tr olarak primer deil, kronik bbrek yetmezliine bal oluan sekonder hipertansiyon olduuna dair kuvvetli pheler vardr. * There are strong suspects that hypertension mentioned here is not primary but secondary which has occured due to chronic renal failure. Periton Diyalizi Prevalans Prevalence of Peritoneal Dialysis

TABLO 5. 2009 yl sonu itibaryla kronik PD programnda izlemde olan hastalarn ya ve cinsiyet dalm (94 merkez). TABLE 5. Age and gender distribution of chronic PD patients, as of the end of 2009 (94 centers).


Ya Age n % n % n %

019 39 0.8 42 0.9 81 1.8

2044 770 16.6 858 18.5 1628 35.2

4564 1205 26 1027 22.2 2232 48.2

6574 311 6.7 236 5.1 547 11.8

75+ 65 1.4 73 1.6 138 3

Toplam Total 2390 51.7 2236 48.3 4626 100


TABLO 6. 2009 yl sonu itibaryla kronik PD programnda izlemde olan hastalarn etyolojik nedenlere gre dalm (94 merkez). TABLE 6. Distribution of chronic PD patients have being followed, according to etiology, as of the end of 2009 (94 centers).

n %

Hipertansiyon* Hypertension* 1303 27.7


Tip 1 DM Type 1 DM 195 4.2


Glomerlonefrit Glomerulonephritis 557 11.9

Piyelonefrit Pyelonephritis 197 4.2

Polikistik bbrek hastalklar Polycystic kidney diseases 190 4.0

Amiloidoz Amyloidosis 118 2.5

Renal vaskler hastalk Renal vascular disease 26 0.6

Dier Other 335 7.1

Etyoloji bilinmiyor Unknown etiology 810 17.2

Kayp (bilgi yok) Missing data 36 0.8

Toplam Total 4698 100.0 * Hipertansiyonun tr olarak primer deil, kronik bbrek yetmezliine bal oluan sekonder hipertansiyon olduuna dair kuvvetli pheler vardr. * There are strong suspects that hypertension mentioned here is not primary but secondary which has occured due to chronic renal failure. Periton Diyalizi ve lmler Peritoneal Dialysis and Deaths TABLO 7. Kronik PD programnda izlenmekte olan hastalardan 2009 ylnda lenlerin ya ve cinsiyet dalm (94 merkez). TABLE 7. Age and gender distribution of chronic PD patients died in 2009 (94 centers).


Ya Age n % n % n %

019 1 0.2 2 0.5 3 0.7

2044 27 6.2 27 6.2 54 12.4

4564 106 24.4 92 21.2 198 45.6

6574 63 14.5 57 13.1 120 27.6

75+ 23 5.3 36 8.3 59 13.6

Toplam len hasta says Total number of deaths

220 50.7 214 49.3 434 100


TABLO 8. 2009 ylnda len PD hastalarnn lm nedenlerine gre dalm (91 merkez). TABLE 8. Distribution of PD patients died in 2009, according to cause of death (91 centers).

len hasta says

Number of death

Tm lmlere

oran Rate among all deaths (%)







Diyalize girmeyi reddetme Refusal of dialysis treatment 0 0.0


Dier Other 54 12.9

Toplam Total 420 100.0 TABLO 9. 2009 ylnda kardiyovaskler nedenlerle len PD hastalarnda lm nedenleri (94 merkez). TABLE 9. Causes of death in PD patients died due to cardiovascular events in 2009 (94 centers).

Kardiyovaskler nedenle len hasta says Number of

patients died due to CV events

Tm KV nedenli

lmlere oran Rate among all deaths due to CV events (%)

Kalp yetersizlii Heart failure 69 36.9


Ani lm Sudden death 52 27.8

Dier Other 6 3.2

Toplam Total 187 100.0 Periton Diyalizi Hastalarnda Diyaliz Uygulamalar Dialysis Application in Peritoneal Dialysis Patients

TABLO 10. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn diyaliz srelerine gre dalm (91 merkez). TABLE 10. Distribution of chronic PD patients according to dialysis duration, as of the end of 2009 (91 centers).

n %

0-5 yl years 3606 76.0 6-10 yl years 980 20.7 11-15 yl years 146 3.1 16-20 yl years 10 0.2 >20 yl years 1 0.0 Toplam Total 4743 100.0


TABLO 11. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn Kt/V deerlerine gre dalm (90 merkez). TABLE 11. Distribution of chronic PD patients according to Kt/V values, as of the end of 2009 (90 centers).

n %

2.0 1808 43.2

Toplam Total 4189 100 Periton Diyalizi Hastalarnda Hipertansiyon Hypertension in Peritoneal Dialysis Patients

TABLO 12. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn hipertansiyon durumuna gre dalm (91 merkez). TABLE 12. Distribution of chronic PD patients according to hypertension level, as of the end of 2009 (91 centers).

n %

la YOK, KB < 140/90 mmHg Untreated, BP < 140/90 mmHg 1584 33.5

la VAR, KB < 140/90 mmHg Treated BP < 140/90 mmHg 1828 38.7

la YOK, KB 140/90 mmHg Untreated, BP 140/90 mmHg 277 5.9

la VAR, KB 140/90 mmHg Treated BP 140/90 mmHg 1037 21.9

Toplam Total 4726 100.0 Periton Diyalizi Hastalarnda Serum Albmin Dzeyi Serum Albumin Level in Periton Dialysis Patients

TABLO 13. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn serum albmin dzeyine (son 3 ayn ortalamas) gre dalm (91 merkez). TABLE 13. Distribution of chronic PD patients according to serum albumin level, as of the end of 2009 (91 centers).

n %

4 g/dL 944 20.1

Toplam Total 4701 100.0 Periton Diyalizi Hastalarnda ESA (EPO) ve Anemi ESA (EPO) and Anemia in Peritoneal Dialysis

31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn ortalama hemoglobin dzeyi (son 3 ayn ortalamas) (88 merkez). Distribution of chronic PD patients according to hemoglobin level (mean value of last 3 months), as of the end of 2009 (88 centers) ................................................................................................11.17 (9.00-13.60) gr/dL


TABLO 14. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn ESA tedavisine gre dalm (91 merkez). TABLE 14. Distribution of chronic PD patients according to ESA therapy, as of the end of 2009 (91 centers).

n %

Daha nce ESA kullanm, ancak halen kullanmyor Have recieved before, but not using currently

1252 26.6

Halen ESA kullanyor Using currently 2506 53.3

Hi ESA kullanmam Never used ESA 940 20.0

Toplam Total 4698 100.0 TABLO 15. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnn ESA tedavisi ve hedefe ulam (Hb>11 g/dL, Htc >%33) (91 merkez). TABLE 15. Distribution of chronic PD patients according to ESA therapy, as of the end of 2009 (91 centers).

n %

Hi ESA verilmeksizin hedefte At target without ESA 1096 23.0

ESA ile hedefte At target with ESA 1714 36.0

ESAya diren ESA resistance 482 10.1 TABLO 16. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnda demir prepat kullanm (91 merkez). TABLE 16. Distribution of chronic PD patients according to iron therapy use, as of the end of 2009 (91 centers).

n

Demir kullananlara oran Rate

among patients recieving iron therapy (%)

Tm hastalara

oran Rate among all

patients (%)

Oral Oral 1603 65.7 34.6

Parenteral Parenteral 723 29.6 18.0

Toplam demir kullanan hasta says Total number of patients recieving iron treatment

2437 100.0 52.6

Toplam hasta says Total number of patients

4630 100.0


Periton Diyalizi Hastalarnda Kalsiyum Fosfor Metabolizmas Calcium and Phosphorus Metabolism in Peritoneal Dialysis Patients

TABLO 17. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnda son 3 ayda en uzun sreli kullanlan fosfor balayc ila (91 merkez). TABLE 17. The most long lasting phosphorus binding agents in the last 3 months among chronic PD patients, as of the end of 2009 (91 centers).

n %

Kalsiyum asetat Calcium acetate 2014 42.8

Kalsiyum karbonat Calcium carbonate 850 18.1

Sevelamer Sevelamer 565 12.0

Aluminyum hidroksit Aluminium hydroxide 66 1.4

Dier Other 73 1.6

Kullanmayan Not using 1137 24.2

Toplam Total 4705 100.0 TABLO 18. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnda sekonder hiperparatiroidi tedavisinde kullanlan ilalar (91 merkez). TABLE 18. Seconder hyperparathyroid drug use among chronic PD patients, as of the end of 2009 (91 centers).

n

D vitamini / kalsimimetik kullananlara oran Rate among the patients using

vitamin D / calcimimetics (%)

Tm hastalara oran Rate among all

patients (%)

Oral D vitamini Oral vitamin D 2403 77.5 44.0

IV D vitamini IV vitamin D 63 2.4 1.4

D vitamini analogu Vitamin D analog 144 5.5 3.1

Kalsimimetik Calcimimetics 26 1.0 0.6

Toplam tedavi kullanan Total use 2636 100.0 49.0

Toplam hasta says Total number of patients 4648 100.0 Periton Diyalizi Hastalarnda Hepatit Hepatitis in Peritoneal Dialysis Patients

TABLO 19. 31 Aralk 2009 tarihi itibariyle kronik PD hastalarnda hepatit serolojisi (91 merkez). TABLE 19. Hepatitis serology in chronic PD patients, as of the end of 2009 (91 centers).

n %

HbsAg (+) 223 5.0

Anti-HCV (+) 212 4.7

Hem HbsAg (+), hem Anti-HCV (+) HbsAg (+) and Anti-HCV (+) 60 1.3

Hem HbsAg (-), hem Anti-HCV (-) HbsAg (-) and Anti-HCV (-) 3987 89.0

HBV-DNA (+) 32 0.7

HCV-RNA (+) 38 0.8



Periton Diyalizi Hastalarnda Komplikasyonlar Complications in Peritoneal Dialysis Patients

Peritonit skl: 89 merkezden elde edilen bilgilere gre peritonit skl 29.9 ay/epizoddur. Peritonitis frequency: Peritonitis frequency is 29.9 months/episode. TABLO 20. 2009 ylnda kronik PD hastalarnda peritonit dndaki dier komplikasyonlar (90 merkez). TABLE 20. Complications in chronic PD patients other than peritonitiz, in 2009 (90 centers).

n %

Herni Hernia 370 9.9

Hiperlipidemi Hyperlipidemia 779 20.9

Hiperglisemi (PD ncesi AK normal) Hyperglycemia (FBG is normal before PD) 134 3.6


Obezite (VK>30) Obesity (BMI>30) 229 6.1

Drenaj bozukluu Drenage problem 203 5.4

Diyaliz yetersizlii Insufficent dialysis 253 6.8

Diyalizat kaa Dialysate loss 147 3.9

Sklerozan enkapsle peritonit Sclerosant encapsulated peritonitis 16 0.4

Hipervolemi Hypervolemia 548 14.7

Psikolojik sorunlar Psychological problems 463 12.4

Ultrafiltrasyon yetersizlii Ultrafiltration failure 276 7.4



2009 yl sonu itibariyle periton diyalizi hasta says 5418dir. Bu sayya ocuk hastalar da dahildir. Geen yla gre periton diyalizi hasta saysnda azalma dikkat ekmektedir.

Diyaliz sresi 6-10 yl olan PD hastalarnn oran (%20.7), diyaliz sresi 0-5 yl olan HD hastalarnn oranndan (%76.0) daha azdr.

PDndeki hipoalbminemili hasta oran HDdekinden daha yksektir; PDdeki hipoalbminemi %30.8 olmasna karn HDde %11.1dir.

PD peritonit skl ortalama olarak 29.9 hasta aynda bir olarak bulunmutur. Peritonit nemli bir sorun olma zelliini korumaktadr.

PD hastalarnda non-infeksiyz komplikasyonlarn banda hiperlipidemi gelmektedir.

PD hasta poplasyonumuzda ESA kullanm oran %53.3dr HD ile karlatrldnda ESA kullanm daha azdr.

Dzenli PD tedavisi gren hastalarda fosfat balayc seiminde kalsiyum asetat (%42.8) ve kalsiyum karbonat (%18.1) ilk iki srada yer almtr. Vit D kullanm %48.4 olup

As of the end of 2009, there were 5418 PD patients. Pediatric patients are included in this number. There is a remarkable decrease in the number of the peritoneal dialysis patients when compared to last year.

The proportion of PD patients with dialysis duration of 6-10 years (20.7%) is lower than the proportion of HD patients with dialysis duration of 0-5 years (76.0%).

The proportion of patients with hypoalbuminemia is higher in PD compared to HD patients (PD: 30.8%, HD: 11.1%).

The frequency of peritonitis is found as one in 29.9 patient-months and is still a problem.

The most common non-infectious complication in PD patients is hyperlipidemia.

The rate of ESA usage is 53.3% and lower than that of HD treatment.

With a rate of 42.8%, calcium acetate is the most common phosphate binding agent in routine PD patients and followed by calcium carbonate (18.1%). The proportion of Vit D usage is 48.4% which is higher than last years figure. Vit D is used orally in most of the PD patients (77.5%).


geen yla gre artmtr. PD hastalarnn ounda D vitamini oral yoldan (%77.5) kullanlmaktadr.

PD hastalarndaki en nemli lm nedeni kardiyovaskler hastalklar (%46.7) olup bunu infeksiyonlar ve serebrovaskler hastalklarizlemektedir. lm nedenleri sralamas geen yllara benzemektedir.

With a rate of 46.7% cardiovascular diseases are the most common death causes among PD patients and followed by infections and cerebrovascular diseases. The ranking of the most common death causes are similar to the previous years.


BBREK TRANSPLANTASYONU KIDNEY TRANSPLANTATION Transplantasyon nsidans Incidence of Transplantation

TABLO 1. 2009 yl iinde bbrek Tx (BTx) yaplan hastalarn ya ve cinsiyet dalm (41 merkez). TABLE 1. Age and gender distribution of Tx (KTx) patients, in 2009 (41 centers).


Ya Age n % n % n %

019 88 4.9 77 4.3 165 9.2

2044 608 34.0 402 22.5 1010 56.4

4564 352 19.7 215 12.0 567 31.7

6574 31 1.7 15 0.8 46 2.6

75+ 2 0.1 0 0.0 2 0.1

Toplam Total 1081 60.4 709 39.6 1790 100.0 TABLO 2. 2009 yl iinde BTx hastalarnn ya ve donor kaynana gre dalm (41 merkez). TABLE 2. Distribution of KTx patients according to age and donor source, in 2009 (41 centers).

Canl Living Kadavra Deceased Toplam Total

Ya Age n % n % n %

019 141 7.9 24 1.3 165 9.2

2044 809 45.2 199 11.1 1008 56.3

4564 425 23.7 143 8 568 31.7

6574 35 2 12 0.7 47 2.6

75+ 2 0.1 0.0 0.0 2 0.1

Toplam Total 1412 78.9 378 21.1 1790 100.0 TABLO 3. 2009 yl iinde BTx yaplan hastalarda doku uyumu (33 merkez). TABLE 3. HLA matching in KTx patients, in 2009 (33 centers).

n %

En az 1 haplotip uyum ile BTx KTx with at least 1 haplotype matching 627 42.1

ABO uyumsuz BTx KTx with ABO incompatibility 5 0.3

Doku uyumu olmayan (6MM) BTx KTx with no tissue matching 107 7.2


TABLO 4. 2009 yl iinde canl vericiden yaplan BTx dalm (38 merkez). TABLE 4. Distribution KTx from living donors, in 2009 (38 centers).

n %

Akrabadan From living related 783 64.5 Anne Mother 319 26.3 Baba Father 172 14.2 Karde Sister-Brother 179 14.7 ocuk Child 37 3.0 Dier akraba Other related 76 6.3

Akraba d Living unrelated 429 35.3 E Spouse 244 20.1 Dier Other 185 15.2

TABLO 5. 2009 yl iinde BTx yaplan diyabetik nefropatili hastalarn ya dalm (38 merkez). TABLE 5. Age distribution of KTx patients with diabetic nephropathy, in 2009 (38 centers).

n %

019 4 2.0

2044 111 54.7

4564 80 39.4

6574 8 3.9

75+ 0 0.0

Toplam Total 203 100.0 TABLO 6. 2009 yl iinde BTx yaplan hastalarda etyolojik nedenlere gre dalm (38 merkez). TABLE 6. Distribution of KTx patients according to etiology, in 2009 (38 centers).

n %










Dier Other 164 10.4





Transplantasyon Prevalans Prevalence of Transplantation

TABLO 7. 31 Aralk 2009 itibariyle fonksiyone greftle izlenmekte olan BTx hastalar (37 merkez). TABLE 7. Age and gender distribution of KTx patients with functioning graft, as of the end of 2009 (37 centers).


Ya Age n % n % n %

019 292 4.4 222 3.4 514 7.8

2044 2612 39.6 1581 24.0 4193 63.6

4564 1153 17.5 611 9.3 1764 26.7

6574 81 1.2 43 0.7 124 1.9

75+ 1 0.0 1 0.0 2 0.0

Toplam Total 4139 62.7 2458 37.3 6597 100.0 TABLO 8. 31 Aralk 2009 itibariyle fonksiyone greftle izlenmekte olan BTx hastalarn etyolojik nedenlere gre dalm (36 merkez). TABLE 8. Distribution of KTx patients with functioning graft, according to etiology,as of the end of 2009 (36 centers).

n %




Diabetes mellitus 508 7.8






Dier Other 437 6.7



Toplam Total 6388 100.0 * Hipertansiyonun tr olarak primer deil, kronik bbrek yetmezliine bal oluan sekonder hipertansiyon olduuna dair kuvvetli pheler vardr. * There are strong suspects that hypertension mentioned here is not primary but secondary which has occured due to chronic renal failure.


TABLO 9. 31 Aralk 2009 itibariyle BTx yaplm tm hastalarn ya ve donor kaynana gre dalm (28 merkez). TABLE 9. Distribution of all KTx patients accordingage and donor type, as of the end of 2009 (28 centers).


Ya Age n % n % n %

019 711 8.1 214 2.4 925 10.5

2044 3881 43.9 1547 17.5 5428 61.5

4564 1717 19.6 584 6.6 2301 26.1

6574 118 1.3 59 0.7 177 2.0

75+ 0 0.0 0 0.0 0 0.0

Toplam Total 6427 72.8 2404 27.2 8831 100.0 Transplantasyon ve lmler Transplantation and Deaths

TABLO 10. 2009 ylnda BTx yaplm hastalardan 2009 ylnda lenler (35 merkez). TABLE 10.Distribution of new KTx patients died in 2009, according to age and donor type, (35 centers).


Ya Age n % n % n %

019 1 1.5 0 0.0 1 1.5

2044 12 18.5 10 15.4 22 33.8

4564 15 23.1 18 27.7 33 50.8

6574 5 7.7 4 6.2 9 13.8

75+ 0 0.0 0 0.0 0 0.0

Toplam Total 32 49.2 33 50.8 65 100.0 TABLO 11. 2009 ylnda len BTxli hastalarn lm nedenlerine gre dalm (35 merkez). TABLE 11. Distribution of KTx patients died in 2009, according to cause of death (35 centers).

n %








Dier Other 8 13.8



Transplantasyon Hastalarnda Tx ncesi RRT ve Kadavra Kayna Deceased Source and PreTx RRT in Transplantation Patients

TABLO 12. 2009 ylnda yaplan BTxlerin Tx ncesi renal replasman tedavisine gre dalm (34 merkez). TABLE 12. Distribution of new KTx according to preTx RRT, in 2009 (34 centers).

n %

HD HD 1138 70.0

PD PD 267 16.4

Preemptif Tx Premptive Tx 218 13.4

nceki grefti yetmezlie giren ve dorudan re-Tx yaplan Directly re-Tx due to failure of prior graft

2 0.1

Toplam Total 1625 100.0 TABLO 13. 2009 ylnda kadavra vericiden yaplan BTxlerin kadavra kaynana gre dalm (34 merkez). TABLE 13. Distribution of KTx from deceased donor according to source, in 2009 (34 centers).

n %

Kendi merkezinizden kan kadavra bbrek says Number of deceased donors from patients center

74 21.0

Baka merkezden gelen kadavra bbrek says Deceased donors came from other centers

278 79.0

Toplam kadavra BTx says Total number of KTx from deceased donors

352 100.0

Transplantasyon Hastalarnda mmnosupresif Tedavi Immunosuppresive Treatment in Transplantation Patients

TABLO 14. 2009 ylnda yaplan BTxlerde indksiyonda kullanlan antikor tedavilerine gre dalm (33 merkez). TABLE 14. Distribution of KTx patients according to the antibody induction treatment used for induction, in 2009 (33 centers).

n %

Timogloblin (tavan kaynakl) Thymoglobulin (from rabbit) 169 15.6

ATG (at kaynakl) ATG (from horse) 394 36.3

OKT-3 OKT-3 1 0.1

Basiliksimab Basiliximab 496 45.7

Daklizumab Daclizumab 24 2.2

Dier Other 1 0.1



TABLO 15. 31 Aralk 2009 tarihi itibariyle fonksiyonel greftle izlenmekte olan hastalarda idame tedavide kullanlan immnospresif ilalara gre dalm (33 merkez). TABLE 15. Distribution of KTx patients with functioning graft, according to immunosuppressive drugs used for maintenance therapy, as of the end of 2009 (33 centers).

n %

Prednizolon Prednisolone 4374 90.8

Mikofenolat Mycophenolate 3233 67.1

Takrolimus Tacrolimus 2249 46.7

Siklosporin Cyclosporine 1764 36.6

Azatiyoprin Azathioprine 557 11.6

Sirolimus Sirolimus 377 7.8

Everolimus Everolimus 218 4.5

Dier Other 1 0.0 Transplantasyon Hastalarnda Hipertansiyon Hypertension in Transplantation Patients

TABLO 16. 31 Aralk 2009 tarihi itibariyle izlemde olan BTx hastalarnn hipertansiyon durumuna gre dalm (30 merkez). TABLE 16. Distribution of KTx patients on follow up, according to hypertension level, as of the end of 2009 (30 centers).

n %

la YOK, KB Untreated, BP < 140/90 mmHg 1575 36.2

la VAR, KB Treated BP < 140/90 mmHg 2262 52.1

la YOK, KB Untreated, BP > 140/90 mmHg 120 2.8

la VAR, KB Treated BP > 140/90 mmHg 388 8.9

Toplam Total 4345 100.0 Transplantasyon Hastalarnda Hepatit Hepatitis in Transplantation Patients

TABLO 17. 31 Aralk 2009 tarihi itibariyle fonksiyone transplante bbrekli hastalarda hepatit serolojisine gre dalm (30 merkez). TABLE 17. Hepatitis serology in KTx patients with functioning graft, as of the end of 2009 (30 centers).

n %

HbsAg (+) 186 2.9

Anti-HCV (+) 468 7.3

Hem HbsAg (+), hem Anti-HCV (+) HbsAg (+) and Anti-HCV (+)

115 1.8

Hem HbsAg (-), hem Anti-HCV (-) HbsAg (-) and Anti-HCV (-)

5671 88.1

HBV-DNA (+) 15 0.2

HCV-RNA (+) 53 0.8



Transplantasyon Hastalarnda Prognoz Prognosis in Transplantation Patients TABLO 18. 2009 yl iinde BTx yaplm hastalarda yl sonu itibariyle son duruma gre dalm (33 merkez). TABLE 18. Distribution of KTx patients transplanted in 2009, according to final situation, as of the end of 2009 (33 centers).

n %

Serum kreatinin


Deerlendirme Discussion Deerlendirme, yant alnan 41 merkezden

gelen sonulara gre yaplmtr. Tansplantasyon yapan merkezlerin saysnda geen yla gre (29 merkez) art olmas dikkat ekmektedir.

2009 ylnda yaplan BTx says toplam 1790 olarak bildirilmitir. Salk Bakanl verisine gre ise toplam 2362 nakil yaplmtr. Aradaki farkn sonularn bildirmeyen baz merkezlerden kaynakland dnlmektedir. Kadavra donr oran %21.1dir.

2009de canl donrlerden yaplan BTxlerin %64.5i kan ba olan akraba donrlerden yaplmtr. Geen yla gre kan ba olmayan donrlerden yaplan nakillerde art grlmektedir.

Infeksiyonlarn en nemli lm nedeni olduu (%37.9) saptanmtr. Dier nemli nedenler kardiyovaskler hastalklar, serebrovaskler hastalklar, pulmoner emboli ve malignitedir.

lkemizde greft kayplarnn en sk rastlanan nedenleri kronik rejeksiyon (%43.7) ve lmdr (%39.1).

2009 ylnda yaplan BTx says olmas gerekenin ok altndadr. En nemli potansiyel kaynak olan kadavra vericilerde istenilen artn olmamas dndrcdr.

Etkinlik-maliyet asndan en uygun tedavi olan bbrek transplantasyonunun arttrlmas iin niversite, bakanlk ve toplum ilikilerinin gelitirilmesi ve etkin bir organizasyon kurulmas hastalarmzn sal ve lke ekonomisi asndan ok nemlidir. Kadavra vericilerinin yaknlarna devlet tarafndan eitli avantajlar salanmaldr.

This report is compiled through the data collected from 41 centers and the number of the transplantation centers is significantly increased compared to last year (29 centers).

Number of KTx performed in 2009 is 1790. According to the data of Ministry of Health 2362 transplantation was performed in 2009. The difference arises from nonresponding centers. The rate of deceased donation is 21.1%.

Living donations were 64.5% from living related donors in the year 2009. There is an increase in the number of transplantations performed from living unrelated donors.

It is found that the most common death causes are infections (37.9%). Cerebrovascular and cardiovascular diseases, pulmonary emboli and malignancies are the other most common causes.

The most common causes of graft loss are chronic rejection (43.7%) and death (39.1%) in Turkey.

KTx rate in 2009 is still lower than needed. The number of deceased donation, which is the most important source, is still low in our country.

In order to increase the number of KTx, which is the most convenient RRT method with regard to the cost-effectiveness, the interaction between academia, Ministry of Health and the society should be improved, and an efficient organization should be built. It is very important for wellbeing of our patients and the economy of our country. Government should provide some advantages to the relatives of deceased donors.


PEDATRK NEFROLOJ PEDIATRIC NEPHROLOGY Pediatrik verilerin deerlendirilmesi Prof. Dr. Ouz Sylemezolu tarafndan yaplmtr. Kendilerine teekkrlerimizi sunarz. The evaluation of pediatric data was performed by Prof. Dr. Ouz Sylemezolu. We tender our thanks to him. TABLO 1. 2009 ylnda hastanede yatan pediyatrik renal hastalarn ya dalm (17 merkez). TABLE 1. Age distribution of pediatric renal patients hospitalized in 2009 (17 centers).

n %

0-2 ya age 1270 24.5

>2-6 ya age 1056 20.4

>6-10 ya age 1028 19.8

>10-15 ya age 1167 22.5

>15 -18 ya age 659 12.7

Toplam Total 5180 100.0 TABLO 2. 2009 ylnda nativ bbrek biyopsisi yaplan hastalarn tanlar (17 merkez). TABLE 2. Diagnosis in patients to whom native renal biopsy was performed in 2009 (17 centers).

Diagnosis n %

Fokal segmental glomerloskleroz Focal segmental glomerulosclerosis 104 19.1

Minimal lezyon hastal Minimal lesion disease 65 11.9

Henoch Schnlein nefriti Henoch Schnlein nephritis 63 11.6

Sistemik lupus eritomatosus Systemic lupus erythematosus 39 7.2

IgA nefropatisi IgA nephropathy 38 7.0

Mezangioproliferatif glomerlonefrit Mesangioproliferative glomerulonephritis 33 6.1

Membranoproliferatif glomerlonefrit Membranoproliferative glomerulonephritis 31 5.7

Dier tubulointerstisyel hastalklar Other tubulointerstitial diseases 28 5.1

Akut eksdatif, proliferatif glomerlonefrit Acute exudative proliferative glomerulonephritis 27 5.0

Hemolitik remik sendrom Hemolitic uremic syndrome 12 2.2

Membranz nefropati Membranous nephropathy 12 2.2

Dier sistemik hastalk veya vasklitlerin bbrek tutulumu Other systemic disease or vasculitis with renal involvement

8 1.5

dyopatik kresentik glomerlonefrit Idiopathic cresentic glomerulonephritis 7 1.3

Akut tubuler nekroz Acute tubular necrosis 6 1.1


Dierleri Others 67 12.3



TABLO 3. 2009 ylnda ilk defa renal replasman tedavisine balanlan hastalarn kronik bbrek yetersizlii etyolojisi (17 merkez). TABLE 3. Etiology of chronic renal failure in new RRT patients, in 2009 (17 centers).

Diagnosis n %

VUR ve tekrarlayan YE VUR and recurrent UTI 79 26.3

Primer glomerlonefritler Primary glomerulonephritis 41 12.7

Doumsal rolojik anomaliler (VUR d) Congenital urologic anomalies (excluding VUR) 35 11.7

Ta hastal Stone disease 33 11.0

Renal hipoplazi / Displazi Renal hypoplasia / Dysplasia 28 9.3

Nrojen mesane nonnrojen nrojen mesane Neurogenic non-neurogenic bladder 19 6.3

Sekonder glomerlonefritler Secondary glomerulonephritis 17 5.7

AA Amiloidoz AA Amyloidosis 3 1.0

Bilinen dier nedenler Other known causes 29 9.7

Bilinmeyen Unknown 18 5.3



2009 ylnda ocuk nefroloji merkezlerinde toplam 545 bbrek biyopsisi yaplmtr. Fokal segmental glomerulosklerozis, Minimal lezyon hastal ve Henoch Schonlein nefriti en sk tanmlanan hastalklardr.

IgA nefropatisi cocukluk anda giderek daha fazla tanmlanmaktadr.

Hastalarn kronik bbrek yetersizlii etyolojileri incelendiinde ilk srada veziko uretral refl (VUR) nefropatisi ve primer glomerulopatiler yer almaktadr.

A total of 545 renal biopsies have been performed in pediatric nephrology centers in 2009. Focal segmental glomerulosclerosis, Henoch Schnlein nephritis and Minimal lesion disease are the most common histopathologic findings.

By years pass, more IgA nephropathy have being diagnosed in children.

Vesico ureteral reflux (VUR) nephropathy and primary glomerulopathies are the first line causes among chronic renal failure etiologies of patients.


PEDATRK HEMODYALZ PEDIATRIC HEMODIALYSIS Akut Hemodiyaliz Acute Hemodialysis Onsekiz merkezden gelen bilgilere gre 2009 yl iinde toplam 142 hastaya akut hemodiyaliz tedavisi uygulanmtr. Bu hastalarda kullanlan kateter tipleri srasyla yledir: femoral ven (%40.1), juguler ven (%31.7) ve subklavian ven (%28.2). Data from responding 18 centers show that acute hemodialysis treatment were performed in 142 renal pediatric patients, in 2009. Distribution of catheters according to their type is as follow: femoral vein (40.1%) jugular vein (31.7%) and subclavian vein (28.2%). Kronik Hemodiyaliz Chronic Hemodialysis 31 Aralk 2009 tarihi itibariyle kronik HD tedavisine alnan hasta says 1643dr. 2009 yl iinde toplam 66 yeni hastaya kronik HD tedavisi balanmtr. Total number of chronic HD patients is 1643, as of the end of 2009. Total number of new chronic HD patients is 66, in 2009. TABLO 1. 2009 yl iinde ilk RRT olarak HDe balanan ve kronik HD programna alnan hastalarn ya ve cinsiyet dalm (19 merkez). TABLE 1. Age and gender distribution of incident chronic HD patients, in 2009 (19 centers).

Erkek Male Kz Female Toplam Total

Ya Age n % n % n %

02 1 1.5 2 3.0 3 4.5

>26 3 4.5 2 3.0 5 7.6

>610 5 7.6 4 6.1 9 13.6

>1015 21 31.8 19 28.8 40 60.6

>1518 3 4.5 6 9.1 9 13.6

>18 0 0.0 0.0 0.0 0.0 0.0

Toplam Total 33 50.0 33 50.0 66 100.0 TABLO 2. 2009 yl iinde ilk RRT olarak HDe balanp kronik HD programna alnan ve 90 gnden uzun sre izlenen hastalarn ya ve cinsiyet dalm (19 merkez). TABLE 2. Age and gender distribution of incident chronic HD patients followed for longer than 90 days, in 2009 (19 centers).


Ya Age n % n % n %

02 0 0.0 0 0.0 0 0.0

>26 0 0.0 1 2.6 1 2.6

>610 4 10.5 5 13.2 9 23.7

>1015 10 26.3 10 26.3 20 52.6

>1518 2 5.3 3 7.9 5 13.2

>18 2 5.3 1 2.6 3 7.9

Toplam Total 19 50.0 19 50.0 38 100.0


TABLO 3. 2009 yl iinde ilk RRT olarak HDe balanp kronik HD programna alnan diyabetik nefropatili hastalarn ya ve cinsiyet dalm (19 merkez). TABLE 3. Age and gender distribution of incident chronic HD patients with diabetic nephropathy, in 2009 (19 centers).


Ya Age n % n % n %

02 0 0.0 0 0.0 0 0.0

>26 0 0.0 0 0.0 0 0.0

>610 0 0.0 0 0.0 0 0.0

>1015 0 0.0 1 100.0 1 100.0

>1518 0 0.0 0 0.0 0 0.0

>18 0 0.0 0 0.0 0 0.0

Toplam Total 0 0.0 1 100.0 1 100.0 TABLO 4. 2009 yl iinde ilk RRT olarak HDe balanan ve kronik HD programna alnan hastalarn altta yatan etyolojik

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