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Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults.

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Malnutrition, inflammation, and anemia are common in peritoneal dialysis (PD) patients. In this study, correlations between Malnutrition Inflammation Score (MIS), laboratory and anthropometric parameters, and anemia indices in Croatian PD patients were analyzed. One hundred and one PD patients (males/females 54/47, age 58.71 ± 14.68 years, mean PD duration 21.82 ± 21.71 months) were included. Clinical, laboratory, and anthropometric parameters were measured. Statistically significant correlations between MIS and erythropoietin weekly dose per kg of body weight (ESA weekly dose), hemoglobin (Hb), and erythrocytes were found ( r = 0.439, p < 0.001; r = -0.032, p < 0.001; r = -0.435, p < 0.001), respectively. Also, statistically significant correlations were found between MIS and mean corpuscular volume ( r = 0.344, p < 0.001), iron ( r = -0.229, p = 0.021), and total iron binding capacity (TIBC) ( r = -0.362, p < 0.001), respectively. Furthermore, statistically significant correlations between ESA weekly dose and serum albumin level and body mass index (BMI) were found ( r = -0.272, p = 0.006; r = -0.269, p = 0.006), respectively. When we divided PD patients into 2 groups according Hb level (Hb ≥ 110 [ N = 60, 59.41 %]) and Hb < 110 [ N = 41, 40.59%]), statistically significant differences were found in MIS score (3.02 ± 2.54 vs 4.54 ± 3.54, p = 0.014), C-reactive protein (CRP) (3.52 ± 6.36 vs 7.85 ± 7.96, p = 0.005), and serum albumin level (44.22 ± 8.54 vs 39.94 ± 8.56, p = 0.003), respectively. Our findings suggest that anemia is correlated with malnutrition and inflammation in Croatian PD patients. Further studies are needed to assess whether modulating inflammatory or nutritional processes can improve anemia management in PD patients., (Copyright © 2017 International Society for Peritoneal Dialysis.)

Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease (CKD) which uses the patient's peritoneum as a membrane across which fluids and dissolved substances are exchanged from the blood. Implementation of this method begun in the seventies, with approximately 7000 patients treated in the year 1981. That same year, we started using this method in our center and to date we have a total of 167 patients. Years of experience and improvement of the technique made this method equivalent to hemodialysis and often even a first method of choice when treating patients with CKD. Data from all patients treated in our center were prospectively collected from year 1981 to 2010. A total of 167 patients (83 women and 84 men) between the ages 28 and 79 (median of 59) were treated by this method. The number of patients enrolled in the program of PD decreased from 64 in the first 10 year period (1981-1990) to 40 in the last 10 year period (2001-2010). 30-year average of PD treatment was 34 months (range from 1 to 110 months). Average duration of treatment per patient increased during the years up to 42 months per patient. The most common reason for termination of PD treatment was fatal outcome (48%), failure of peritoneal membrane (35%) and kidney transplantation (2.4%). Overall rate of peritonitis during the observed peritonitis was 1 every 15 months of treatment. Comparing the rates of peritonitis between the first and the last ten year period, a significant decrease from 1 every 10 months to 1 every 39 months was observed. Overall share of patients with diabetes was 19%. The total number of diabetic patients increased during years according to the increasing rates of diabetic patients worldwide. The decrease in number of patients enrolled in the program in our center is probably due to further development of transplantation program and opening of new dialysis centers in Croatia. The decrease of the peritonitis rate and consequent increase of duration of PD treatment per patient is explained by the improvement of techniques, solutions and better education of the patients and medical staff. 30 years of existence the Centre enabled us to gain experience in treating patients with CKD. Along with experience came the improvement of quality of life of our patients. Our goal is to further develop PD as it is the method of choice in terms of better physical and psychical rehabilitation of the patient with CKD waiting for the transplantation treatment.

Anemia is highly prevalent among chronic kidney disease (CKD) patients and patients receiving renal replacement therapy. In this paper we will outline the prevention and treatment of anemia in patients treated with peritoneal dialysis (PD). PD patients are less anemic and more sensitive to erythropoesis-stimulating agent (ESA) than their hemodialysis (HD) counterparts and, in general, dosages required for achieving similar hemoglobin levels to those achieved in HD patients are remarkably less. Before starting with ESA treatment we have to evaluate the degree of anemia and excluded other causes which are not connected with CKD and method of treatment. Patient's compliance is crucial for a successful therapy and it can be improved by decreasing frequency of administration of ESA. Since ESAare expensive, "cost-effectivnes" studies represent an important factor in choosing a distinct drug. Subcutaneous administration provides better long-term utilization of ESA in comparison to intravenous administration and is therefore preferred in PD patients. Intraperitoneal administration is not recommended due to poor bioavailability. In some patients we can observe the reduced response to ESA therapy. The definition of reduced response is generally regarded as a failure to achieve target hemoglobin concentration of >11 g/dL. Identification of underlying cause is not always easy but every attempt should be made to investigate every patient with resistance to therapy because some causes are easily corrected. Since 2005 particular ESA drugs have been approved by Croatian Institute for Health Insurance and registered for use in Croatia. For PD patients the ESAcan be prescribed by general practitioner. The list of available drugs is available in the official government newspaper Nardone novine No.27, March 2nd, 2009.

By the end of 2007 we had 160 patients on CAPD treatment in our centre (44% male, 56% female) aged between 29-78 years. Till 1994 13% of our patients were diabetics. In the last 10 years (1997-2007) the percentage of diabetics increased to 36%. During the 27 years period 44% of our patients died, 35% switched to haemodialysis and 3% have undergone renal transplantation. The survival rate after three years of treatment was 75%, after five years 63% and after 10 years 44%. Technique survival was 77%, 65% and 48% respectively. There were 309 episodes of peritonitis as the main complication of treatment (one episode on every 9, 4 months of treatment till 1994 and one episode on every 25, 8 months in the last ten years), out of which 58% was caused by Gram positive bacteria, 18% by Gram negative, 4% were fungal infections while the remaining 20% were culture negative. Regarding other complications we had 42 exit-site infections and 8 episodes of sclerosing peritonitis with 4 deaths. We found peritonitis to be the main reason of switching to haemodialysis (71%) and the main reason of death (39%) among the patients on CAPD. In the last 10 years (1997-2007) we analyzed the diabetics group separately and we found that the rate of CAPD dropout was not significantly different between diabetics and non-diabetics group. However, when analysing the causes of CAPD dropout, we found significant difference in mortality ate (50% among diabetics versus 26% among non-diabetics) and the rate of switching to haemodialysis (37% versus 55% respectively). In addition we established that the rate of CAPD survival was better after 1994 and we speculate that the main reason is the diminished peritonitis rate.

The prevalence and incidence of hepatitis B in hemodialysis patients in Croatia have been estimated to 1.3% and 0.03%, respectively. HBV infection in dialysis patients is usually asymptomatic, has a prolonged course, and progresses to chronic HBsAg hepatitis in 50% of cases. Some 15%-40% of HBsAg carriers on dialysis will develop cirrhosis, liver decompensation or hepatocellular carcinoma. Strict adherence to the standard infection prevention measures, continuous monitoring of HBV markers in patients on hemodialysis, patient and personnel immunization and hepatitis B treatment in hemodialyzed patients are mandatory. Each new patient in a dialysis center must be tested for HBV markers irrespective of prior immunization. All patients in the center should be routinely screened every 3-4 months. HBV immunization is mandatory for all patients on dialysis. In patients with uremia the anti-HBs antibody production is decreased (antibodies will develop in 50%-60% of cases after immunization). It is recommended to immunize all patients with progressive kidney disease, preferably in the preterminal stage. Hepatitis B therapy is recommended in all patients with biopsy proven chronic liver disease. Patients should be treated with standard interferon alpha and/or lamivudine, or peginterferon alpha monotherapy. Hepatitis B treatment is most important in kidney and/or liver transplant candidates. HBV immunization is obligatory for all hospital personnel who are in close contact with infected patients and infective materials.

Every year ever more and more patients in our country receive some form of dialysis, which provides life-saving renal replacement therapy for end-stage renal disease. In an effort to improve the quality and outcomes of dialysis care, the National Kidney Foundation--Dialysis Outcomes Quality Initiative (NKF-DOQI) have developed clinical practice guidelines for care of dialysis patients regarding hemodialysis adequacy, peritoneal dialysis adequacy, treatment of anemia, and vascular access. The morbidity and mortality of patients is strongly connected with dialysis adequacy and degree of anemia. We compared 180 patients on hemodialysis (HD) in 1998 and 177 patients in 2002, who are regularly treated in our Center with the use of DOQI guidelines. Dialysis adequacy was assessed by use of urea reduction ratio URR = 1-(post. urea/pre. urea), and overall wellbeing according to the degree of anemia, number of blood transfusions, presence of elevated blood pressure, and number of antihypertensives in therapy. In year 2002, 50% of the patients had adequate dialysis compared with 30% in 1998. The average duration on dialysis and the age of patients did not change. We recorded a rise in hemoglobin from 80 g/L to 92 g/L, and in the use of EPO (from 18% to 30%). No case of hypoalbuminemia was observed. The aim of dialysis is to improve the overall wellbeing of uremic patients. Comparing our results with DOQI-guidelines, we demonstrated that dialysis therapy could be improved to prevent complications and early mortality in dialysis patients.

From December 1993 to December 2000 at the Department of Surgery, General Hospital "Sveti Duh", and University, Hospitals Split and Osijek the catheter for peritoneal dialysis was placed in 128 patients, in 137 cases. Videoendoscopic procedure, with the trocar made precisely for that purpose, was used. All surgical procedures, performed in the completely equipped operation room and in general anesthesia, were done without any intraoperative or postoperative complications. The procedure showed to have all advantages of endoscopic or minimally invasive surgery. The patients recovered quickly with low consumption of analgesics, got out of the bed and started with feeding sooner. There were no wound complications. It was possible to start with the dialysis 2-3 days after the procedure. Most important, the results showed that using this approach in comparison to others, there were no more dialysis solution leakages, catheter drainage problems, or more tunnel, exit site or peritoneal infections. Along with placing the catheter, other surgical procedures could be also done without increasing the complication rate. Therefore, laparoscopic cholecystectomy was done in 12 cases, adhesiolysis in 25 cases, and right adnexectomy, open hernioplasty and umbilical hernioplasty in one case. Videoendoscopic approach of placing the catheter is a simple, short and patient convenient procedure, with quick recovery and without any increase in complication rate.