Objectives: There is a saying that, to evaluate the level of medicine in a country, one should pay attention to its level of uronephrology service – specifically, the level of renal replacement therapy, hemodialysis, peritoneal dialysis, and transplant. With the increasing number of patients requiring renal replacement therapy, it is the utmost duty of modern medicine to structure and organize it. Since its establishment in 2000, MedServis Private Medical Centre has dedicated its main services to hemodialysis, renal replacement therapy, health care in other branches of medicine, follow-ups, and preparing patients for transplant.

Materials and Methods: We compared statistical indicators of the patients who have been enlisted in reports of Azerbaijan, MedServis Private Medical Centre, which is in Azerbaijan, and European Renal Association-European Dialysis and Transplant Association between 2000 and 2013. The statistics of the patients reported in MedServis Private Medical Centre’s account for the past 14 years were categorized with respect to several factors.

Results: During its activity in the past 14 years, we received 5894 new patients at MedServis Private Medical Centre (male, 58.9%; female, 41.1%). Of all the patients received, children were 1.6% patients. In all patients, 9% patients had acute kidney failure and 91% had chronic kidney disease.

Conclusions: MedServis Private Medical Centre has contributed importantly to nephrology in Azerbaijan, with its first-in-the-country services in remote hemodialysis, hemodialysis of children, close-up control of the pregnancy of a woman with 6 years of hemodialysis, and successful delivery of the first permanent catheter during 14 years of activities.

Key words : End-stage renal failure, Hemodialysis, Peritoneal dialysis, Transplant

Introduction

There is a concept in the medical literature that, to evaluate a country's health care, one should be paying attention to its uronephrology services. To be more precise, one should evaluate the level of renal replacement therapy, hemodialysis, peritoneal dialysis, and transplant in the country.¹ Forming a well established structure of renal replacement therapy is one of the key elements of modern medicine.² When patients with terminal kidney insufficiency are not under a renal replacement therapy regimen, their morbidity and mortality indicators escalate. With application of renal replacement therapy, life expectancy of such patients increases by decades.³

According to statistical indicators, the number of patients who have terminal kidney insufficiency and are in need of renal replacement therapy has been increasing markedly. According to the World Health Organization 2011 reports, there are 2 786 000 people around the world who are under renal replacement therapy, and this number is steadily increasing. Prevalence varies between different countries. In 2009, prevalence in Europe was 730 patients per million population (pmp), Ukraine was 101 pmp, Russia was 170 pmp, Belgium was 1193 pmp, Spain was 1507 pmp, and Turkey was 828 pmp.

In 1970, the first hemodialysis center in Azerbaijan and the second hemodialysis center in the Union of Soviet Socialist Republics was created at the Republican Clinic Urological Hospital named after M. Javadzade, and the first kidney transplant surgery was performed later in that hospital by academic M. Javadzade. The second hemodialysis center was created in 1985 under the IV Medical Office of Cabinet Ministers (then known as medical commission). In 1995, a hemodialysis department was started with activities in Central Hospital of Oil Workers, which provided care for 40 patients.

In the year that MedServis Private Medical Centre was founded, there were only 10 to 15 hemodialysis machines that served 40 to 60 hemodialysis patients nationwide in a country of 8 000 000 people. Starting its activities under such conditions, our center was recognized and valued by Azerbaijan's health care society for its successful work within a short time. Since then, more than 6500 patients have had hemodialysis therapy due to chronic and acute kidney insufficiency. It is worthwhile mentioning that most hemodialysis patients who have applied for therapy at Medservis Private Medical Centre were in bad health condition, and as a result of a well programmed therapy regimen, their situation recovered and became better and stable. Most patients are continuing their therapy in various hemodialysis centers that have been opened in different regions of Azerbaijan. During these years, our center organized personnel education abroad, and people were sent to professional development trainings in leading medical institutions in Turkey, Iran, and Commonwealth of Independent States countries. Staff members who have improved their skills as doctors, midlevel medical providers, and technical service personnel currently are working at Medservis Private Medical Centre and other leading medical centers in Azerbaijan.

One of the major problems that our center had when it started its activities was the lack of medical working protocols that were consistent with global standards. These protocols regulate processes such as the beginning of hemodialysis therapy¹, adequacy of hemodialysis,³ viral hepatitis, anemia, and renal osteodystrophy.⁴ We organized our activities with the therapist-prophylactic office of Azerbaijan Republic Health Ministry, based on protocols that were developed by the National Kidney Foundation-Disease Outcomes Quality Initiative, European Renal Association-European Dialysis and Transplant Association, and Baskent University.

Based on exact statistics, we have received 6500 new patients within 14 years of our activity, including 3729 adult males (58.9%), 2675 adult females (41.1%), and 96 pediatric patients (1.6%). Of all patients, 5919 patients (91%) had chronic kidney disease stage 5 and 581 patients (9%) had acute kidney injury. Causes of acute kidney injury were obstetric, gynecologic, and obstructive issues.

With respect to etiologic factors, 1917 patients (29.5%) had diabetic nephropathy, 1852 patients (28.5%) had chronic glomerulonephritis, 1137 patients (17.5%) had chronic pyelonephritis, 903 patients (13.9%) had hypertonic nephrosclerosis, 338 patients (5.2%) had polycystic kidney disease, 39 patients (0.6%) had amyloidosis, 130 patients (2%) had other causes of kidney disease, and 184 patients (2.8%) had kidney diseases of unknown cause.

When patients presented for the first time, catheters were inserted into central veins as the main venous line, including the internal jugular vein in 5765 patients (88%), subclavian vein in 650 patients (10%), and femoral vein in 65 patients (1%). There were 49 patients (1%) who had a previously placed arteriovenous fistula. In children and patients who could not have an arteriovenous fistula placed, permanent catheters were placed for the first time in Azerbaijan. During these years, 825 patients had permanent catheters placed, and 5 patients had vascular prostheses placed in veins.

Due to viral hepatitis prophylaxis, which is a major problem for dialysis centers, the hepatitis profile was identified on all evaluated patients at Medservis Private Medical Centre. There were 226 patients (4.52%) who had hepatitis B surface antigen, 259 patients (5.18%) who had antihepatitis C virus antibodies, 5 patients (0.1%) who had antihepatitis D virus antibodies, and 23 patients (0.46%) who had mixed infection. We also had a patient who had human immunodeficiency virus. In addition, liver function tests were evaluated monthly and hepatitis markers were evaluated every 3 months. Hepatitis patients and hepatitis carriers had hemodialysis in separate rooms. We have been performing vac­cination for our medical personnel and regular patients since the center was founded.

When evaluating for bone mineral disease prophylaxis, parathyroid hormone level was tested on all patients and was > 400 pg/mL in 4430 patients (88.6%).

Detailed information about kidney transplant was given to our patients who had chronic kidney disease stage 5 and who did not have any contraindications for transplant. During this time all our patients who applied to our clinics were prepared for kidney transplant and their health status was followed regularly according to the modern protocols mentioned earlier. Our patients have had successful kidney transplant surgery in Iran, Turkey, Russia, and Azerbaijan. We currently have information about 285 patients. Among all patients who had transplant, 1.72% patients were children, 39.65% were female, 60.35% were male, and 1.8% patients had transplant even before preemptive hemodialysis.

In conclusion, compared with the year 2000 when we started, better centers currently operate in Azerbaijan that follow modern standards. The level of nephrology services has increased, and there currently are hemodialysis centers in almost every region of Azerbaijan. Kidney transplant is successfully performed at Republican Clinic Urological Hospital Named After Academic Dr. Javadzade and at the Central Hospital of Oil Workers. Peritoneal dialysis services are being established. At Medservis Private Medical Centre, we consider that our contribution is to improve the level of nephrology services to the current stage.

References:

1. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5):895-904.
2. NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis. 1997;30(4 suppl 3): S192-S240.
3. Vascular Access in Vascular Access in Hemodialysis Hemodialysis: the 2006 KDOQI Guidelines Update. http://www2.kidney. org/professionals/KDOQI/guideline_upHD_PD_VA/. Accessed December 8, 2014.
4. Brenner BM. Brenner and Rector’s The Kidney. 8th ed. Saunders; 2007.