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This report provides a summary of the 2013 Slovenian renal replacement therapy (RRT) data, obtained from 24 renal centers: 23 dialysis and one transplant center, referring from 31 December 2013, with 100% response rate to individual patient questionnaires. Slovenia had a population of 2 061 085 on 1 January 2014. The total number of patients treated by RRT was 2077, i.e. 1008.3 per million of population (pmp); 1349 (65%) were treated by hemodialysis, 52 (2.5%) by peritoneal dialysis, and 676 (32.5%) had a functioning kidney graft. A total of 260 incident patients, 126.2 pmp (at day one), started RRT, their median age was 69 years, 59.8% were men,. 58.5% of hemodialysis patients were treated with on-line hemodiafiltration. Vascular access was arteriovenous fistula in 79%, polytetrafluoroethylene graft in 8%, and catheter in 13% of patients, mean blood flow 276 ± 41 mL/min, 5.5% dialyzed in a single-needle mode. The crude death rate was 11.4% in all RRT patients (incident patients day 1 included, 15.9% in hemodialysis, 12.3% in peritoneal dialysis, 2.1% in transplant recipients). 60 kidney transplantations were performed in 2013, from deceased donors.

This report provides a summary of the 2011 Slovenian renal replacement therapy (RRT) data. Data were obtained from 24 renal centers: 23 dialysis and one transplant center, referred as of 31 December 2011, with 100% response rate to individual patient questionnaires. Slovenia has a population of approximately 2 million (2 052 496 in 2011). The total number of patients treated by RRT was 2011,that is, 980 per million of population (pmp); 0.4% decrease compared to 2010. 1347 (67.0%) were treated by hemodialysis, 60 (3.0%) by peritoneal dialysis, and 604 (30.0%) had a functioning kidney graft. A total of 236 incident patients, 115 pmp (at day one), started RRT, their median age was 68 years, 64.8% were men, 36.4% were diabetics. Regarding hemodialysis patients, 59.3% were treated with on-line hemodiafiltration, 86% with ultrapure dialysis fluid. Median weekly duration of hemodialysis was 12.5 h, median dry body weight 70 kg, mean blood flow 275 ± 46 mL/min, 7.1% were dialyzed in a single-needle mode. Vascular accesses were native arteriovenous fistula in 79%, polytetrafluoroethylene graft in 6%, and catheter in 15%. The crude death rate was 15.9% in dialysis patients, 1.9% in transplant recipients, and 12.0% in all RRT patients (both dialysis and transplant, incident patients at day 1 included). Slovenia has been a member of Eurotransplant since 2000. Forty-six kidney transplantations were performed in 2011, all from deceased donors. A slight decrease in prevalent number of RRT patients was observed in 2011, for the first time in 40 years. The number and proportion of patients with functioning kidney grafts is increasing, reaching 30% in 2011.

Anemia is a common and important complication of chronic kidney disease. Treatment includes the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation. However, the optimal schedule of iron supplementation remains to be defined. Thirty-one long-term hemodialysis patients were treated for 1 year (period 1) with ESAs and an intermittent pulse regimen consisting of 100 mg of iron sucrose administered after different dialysis sessions depending on serum ferritin and other laboratory values, but no more than once per week. During the next 3 years (period 2), patients were treated with ESAs and need-based, continuous, low-dose iron. Iron doses were determined on the basis of values and changes of serum ferritin and transferrin saturation every fourth week after the longest interdialysis time interval. Iron doses ranged from 10 to 60 mg of iron sucrose and were given 1-3 times per week. If grounded, we gradually reduced or even abolished the iron doses. A significant increase in the hemoglobin concentration and hematocrit during period 2 in comparison with period 1 was observed. The use of ESAs did not change significantly during period 2 in comparison with period 1, while the use of iron was significantly lower in period 2. Significantly lower values were obtained for serum ferritin, saturation of transferrin, serum iron, and total serum iron-binding capacity during period 2. A better response to ESA therapy (increase in hemoglobin and hematocrit) is achieved with need-based, continuous, low-dose iron replacement.

The aim of our study was to evaluate vascular access in patients treated with chronic hemodialysis for 30 years or more. Patients who had started dialysis in 1978 or earlier were identified from the Slovenian Renal Replacement Therapy Registry. The data on vascular access on April 2008 are presented. Sixteen patients were still alive, seven men and nine women aged 62 +/- 12 years (46-84), and they had been treated for 32 +/- 1.7 years (30-35), mainly with chronic HD. They had started HD at the age of 30 +/- 12 years (13-50), and none had diabetes. The vascular access in nine was a native arteriovenous (AV) fistula, on the forearm in eight patients, and a brachiobasilic fistula in one patient. Four patients had their primary AV fistulas still in use (maximum 35 years). In the remaining five patients, multiple salvage procedures had been performed or new AV fistulas created. The vascular access in four patients was the polytetrafluoroethylene (PTFE) graft, functioning for 1-8 years. In three patients, a non-cuffed, single-lumen hemodialysis catheter (a precurved jugular in two patients and a subclavian in one) locked with 30% citrate, with mupirocin at the exit site, was used for 5-12 years. The catheters were exchanged approximately once every two years over a guide-wire because of mechanical damage. None of these three patients had had catheter-related sepsis or exit-site infection. Before catheters, these patients had had multiple AV fistulas and PTFE grafts. Although native AV fistula is the predominant type of vascular access, a greater than 30-year survival on hemodialysis is possible with the combined use of AV fistula, PTFE graft, and a non-cuffed hemodialysis catheter locked with citrate.

Adsorption onto the dialyzer membrane is a contributing factor to the elimination of beta2-microglobulin (beta2M) from the sera of uremic patients. The purpose of this prospective study was to ascertain the influence of the blood flow rate on adsorption of beta2M onto the polyacrylonitrile (AN69) hollow-fiber dialyzer membrane in 8 patients during regular hemodialysis (HD). Blood first passed through a low-flux polysulfone dialyzer and then through an AN69 dialyzer, which was not in contact with the dialysis fluid. During the investigation period (first hour of the HD session), the blood flow rate was 100 ml/ min (first part of the study), 200 ml/min (second part of the study), and 300 ml/min (third part of the study). Ultrafiltration was not performed during the investigation period. At the start of the HD sessions, the serum concentration of beta2M in the afferent blood line did not differ significantly among the 3 parts of the study. Serum beta2M was measured in samples taken from the afferent and efferent blood lines of the AN69 dialyzer at 5, 10, 15, 30, 45, and 60 min. The serum beta2M concentration decreased significantly in blood that had passed through the AN69 dialyzer. This decrease, indicating membrane adsorption, was maximal during the first part and minimal during the third part of study. The decrease in the contact time between the blood and the AN69 could be the underlying cause. The calculated quantities of beta2M adsorbed onto the AN69 membrane (44.2 +/- 10.2, 43.2 +/- 12.1, and 42.6 +/- 17.3 mg) did not differ significantly among the 3 parts of the study. These results suggest that an increase in blood flow rate from 100 to 300 ml/min did not significantly affect the quantity of beta2M adsorbed onto the AN69 membrane.

Patients presenting for initial access evaluation in contemporary practice are less likely to have arteries and veins suitable for native fistula (AVF) formation in the classic location. Physical examination of the upper extremity alone may be inadequate for selection of arteries and veins that will mature into a functioning AF. The purpose of this paper is to determine how duplex ultrasonography can be used as an effective modality for the preoperative evaluation of vessels before construction of arteriovenous fistula for hemodialysis. The author have used duplex ultrasound (DU) to assess upper-extremity vasculature for planning of dialysis access procedures. Criteria for selection of arteries and veins and a detailed description of DU examination protocol are reviewed. Routine use of upper-extremity DU has identified many patients with veins that are suitable for use and determined arteries with optimal arterial inflow for successful AFV creation.

Background Regional citrate anticoagulation (RCA) during hemodialysis is alternative to heparin in patients at high risk of bleeding. It enables excellent antithrombotic effect in the circuit, but requires strict monitoring during the procedure. The aim of our retrospective clinical study is to evaluate safety and efficacy of RCA performed according to our unit protocol. Methods Data from 40 protocols for RCA performed between April and June 2004 were analyzed. Double-needle vascular access was obtained via either arteriovenous fistula or hemodialysis catheter. Hollow-fiber dialyzer Polyflux 14 S (Gambro, Lund, Sweden) was used in all dialysis sessions. Calcium-free dialysate was used and set to: Na 137 mEq/L, bicarbonate 28 mEq/L, magnesium 0.5 mEq/L, potassium 2.0 mEq/L, glucose 0 mEq/L. Potassium and glucose were added into the dialysate or intravenously if needed, respectively. Blood flow rate was maintained between 250–300 mL/min. 4% trisodium citrate was infused in the arterial line of the circuit, proximally from the arterial bubble trap, at the initial rate 300 mL/hour and adjusted accordingly to the blood flow rate and targeted clotting time (15–20 minutes in the circuit). One molar CaCl2 was infused in the venous line (distally from the venous bubble trap) at the initial rate 13 mL/h and was adjusted to maintain ionized calcium concentration (iCa) within normal range. Clotting time, iCa, Na, and bicarbonate were measured during hemodialysis. Clot formation in the dialyzer was estimated by counting the number of clotted fibers and assessment of clot presence in bubble traps. Results (see Table A26) Table A26. preHD At 60 min At 120 min At 180 min Post HD Clotting time (min) – 11.0 ± 3.4 11.0 ± 3.3 11.2 ± 3.0 11.2 ± 2.7 iCa (mmol/L) 1.15 ± 0.31 1.0 ± 0.12 1.03 ± 0.09 1.04 ± 0.10 1.07 ± 0.20 Sodium (mmol/L) 137 ± 4 139 ± 3 139 ± 4 140 ± 3 140 ± 3 Bicarbonate (mmol/L) 21.4 ± 3.0 – – – 25.02 ± 3.3 pH 7.39 ± 0.04 – – – 7.45 ± 0.07 At 60 min At 120 min At 180 min At 240 min Blood flow rate (mL/min) 268 ± 24 266 ± 25 267 ± 23 267 ± 23 Citrate infusion rate (mL/h) 297 ± 11 298 ± 23 297 ± 22 300 ± 15 1M CaCl2 inf. rate (mL/h) 12.95 ± 0.45 13.12 ± 1.4 13.17 ± 1.55 13.35 ± 1.1 Assessment of clotting in the circuit 23/40 dialyzers (57.5%) were estimated as excellent (

Introduction It was noticed that the decline of renal function was slower in patients (pts) with end stage renal disease (ESRD) after early arteriovenous fistula (AVF) construction. The aim of this prospective study was to find out the influence of AVF on the progression of renal failure. Patients and methods Sixty ESRD pts with serum creatinine level (SCL) between 400 and 500 µmol/L were included and randomized in two groups. One group of pts received AVF and the other did not. Serum creatinine level, creatinine clearance (CC), and mean arterial pressure (MAP) were followed every two months for one year. All pts were clinically evaluated for signs of cardiac insufficiency. Hemodialysis (HD) was started when SCL was 850 µmol/L or CC 10 mL/min or when signs of uremia were presented. Results In Group A, 30 ESRD pts, 17 males and 13 females, age 61 ± 7.3 years, mean SCL 446.4 ± 30.5 µmol/L, mean CC 29.3 ± 4.1 mL/min, native forearm AVFs were constructed. No AVFs were constructed in Group B, 30 pts, 12 males and 18 females, mean age 62.8 ± 8.2 years, mean SCL 447.6 ± 37.6 µmol/L, mean CC 29.1 ± 4.7 mL/min. Mean SCL during a 12 month period in both groups is shown in Table A20. Table A20. Serum creatinine in a 12 month period (µmol/L) Group A Group B * P

Introduction Renal anemia is a major problem of patients with chronic kidney disease (CKD). Target hemoglobin concentration (Hb) in these patients should be > 110 g/dL and hematocrit (Ht) > 0.33. Treatment of renal anemia with epoetin is a well established practice. The purpose of this review in one dialysis center was to analyze the quality of such treatment and to find which parameters could influence success of treatment Patients and Methods Patients (pts) on HD were included in this analysis. The properties Hb, Ht, epoetin (alpha or beta intravenously) dose (EPO), ferritin, transferrin saturation (TSAT), hypochromic red cells (HYPO), CRP, albumin, parathyroid hormone (PTH) Kt/V were followed during 10 months period. Results 58 pts, 29 female and 29 male, mean age 60.5 ± 12.5 (range 32–82) years, HD treatment mean 8.4 ± 7.8 (range 0.7–30.7) years were observed. Mean Hb was 119.9 g/L ± 2.1 (range 79–142), mean Ht 0.36 ± 0.01, mean EPO 6970 ± 456.7 IE/week. EPO 110.3 ± 7.9 IE/kgBW/week, ferritin 603.5 ± 46.2 µg/L, TSAT 25.8 ± 3.3%. HYPO 2.1 ± 0.1, CRP 7.4 ± 0.21, albumin 41.9 ± 0.37 g/L, PTH 281.5 ± 47.9, Kt/V 1.68 ± 0.34. The female and male groups were analyzed and compared (Table A23) Table A23. Female Male w, week; *P

Introduction Hyperparathyroidism continues to be a major problem in patients with chronic kidney disease (CKD). Hypocalcemia and hyperphosphatemia are crucial for the development of secondary hyperparathyroidism (SHP). Preventing hyperphosphatemia ameliorates the progression of SHP. Vitamin D analogs (Alpha D3) per oral after hemodialysis (HD) could be used in the therapy of SHP. The purpose of this review in one dialysis center was to analyze the quality of such treatment. Patients and methods Patients (pts) on HD in one dialysis center were included in this analysis. Calcium (Ca) and phosphate (P) were followed during a 10 month period every 3 weeks and intact parathyroid hormone (iPTH) every three months. Vitamin D was given after HD per oral under nurse control. Results Sixty-four pts, 34 female and 30 male, mean age 59.9 ± 11.5 (range 32–82) years, HD treatment length mean 8.8 ± 7.2 (range 0.7–30.7) years were observed. Mean Ca was 2.46 ± 0.04 mmol/L, (range from 1.06 to 2.72), mean P 1.52 ± 0.08 mmol/L (range from 0.62 to 3.53), mean iPTH 211.9 ± 36.7 ng/L (range from 1 to 699). Mean calcium concentration in dialysis fluid was 1.51 ± 0.02 mmol/L and mean dose of vitamin D was 0.35 ± 0.11 mg. Mean values of parameters during the 10 months observation are shown in Table A21. Table A21. December 2003 February 2004 April 2004 June 2004 Ca (mmol/L) 2.46 2.44 2.35 2.38 P (mmol/L/ 1.52 1.56 1.71 1.53 iPTH (ng/L) 204.8 173.1 272.3 196.5 Ca in fluid (mmol/L) 1.52 1.53 1.49 1.49 Dose of vitamin D (mg) 0.47 0.28 0.21 0.43 Conclusions Regular evaluation of Ca, P, iPTH and strict correction of calcium concentration in dialysis fluid, per oral vitamin D are very helpful in prevention of SHP. Critical elevation of iPTH was in pts with low compliance in hypophosphatemic diet and therapy. If concentration of phosphate is normal, elevated iPTH could be diminished very effective by titration of vitamin D.

Introduction There is strong evidence from randomized trials that subcutaneous (s.c.) epoetin is as effective as intravenous (i.v.) and may allow a lower dose to be used, thereby reducing costs. Dose requirements for s.c. are reported to be from 22–32% lower than those of i.v. epoetin. The purpose of these analyses was to find out what was increasing the epotein dose after the beginning of i.v. administration. Patients and methods Patients (pts) on HD treated with epoetin s.c. for 10 months (group A), and then with epoetin i.v. for 10 months (group B) were included in this analysis. Hemoglobin (Hb), epoetin (alpha or beta) dose (EPO), and ferritin were evaluated. Results 46 pts, 25 females and 21 males, mean age 58.2 ± 12.6 (range 30–80) years, HD treatment mean 9.1 ± 7.7 (range 0.2–29.2) years were observed. In Group A, mean Hb was 123.8 g/L ± 2.4 (range 119–127), mean EPO 6914 ± 810 IE/week, ferritin 603.5 ± 46.2 µg/L. In Group B mean Hb was 120.3 g/L ± 2.3 (range 117–125) (P