Dialysis countries

Maintenance hemodialysis has grown and expanded beyond the expectations of even the most enthusiastic of its eadiest proponents. Figure 7 is a plot of the overall estimated dialysis population by year siace 1970. The population at the end of 1992 exceeded 475,000 another 500,000 patients or so have received therapy at one time but have siace died or had transplants. Maintenance dialysis is now available to some extent ia all but the poorest nations ia economically advanced countries, excepting the United Kingdom, it is rendered as a virtual entitlement. The current worldwide mean cost of a single dialysis patient is about 30,000 per year (47) the aggregate economic magnitude of the medical appHcation of hemodialysis thus approaches 15 biUion. 

International travelers who plan to spend >6 months in countries with high rates of HBV infection and who will have close contact with the local population Recipients of clotting-factor concentrates Sexually transmitted disease clinic patients HIV patienVHIV - testi ng patients Drug-abuse treatment and prevention clinic patients Correctional facilities inmates Chronic dialysis/ESRD patients... 

Finally, in countries where is it available, renal dialysis presents other challenges as many drugs are lost from the body in the course of peritoneal or haemodialysis. 

Rhabdomyolysis is a problem with several lipid-lowering drugs (SEDA-13, 1325 SEDA-13, 1328 SEDA-13, 1330 SEDA-19, 409), especially when they are used in combination (37). In individuals with pre-existing renal insufficiency this can lead to an earlier need for chronic dialysis (38). All statins can cause myopathy and rhabdomyolysis, but not all statins are alike. For example, the evidence to date, based on almost 2 decades of experience, points to an extremely low risk of myopathy and rhabdomyolysis with lovastatin, and lovastatin 20 mg tablets are being considered for non-prescription availability in several countries (39). Furthermore, muscle adverse effects do not necessarily occur after a change from one statin to another (40). Interactions between various hypolipidemic drugs and other drugs also sometimes cause rhabdomyolysis (SEDA-18, 426). For instance, itraconazole markedly increases plasma concentrations of lovastatin, and in one subject plasma creatine kinase was increased 10-fold within 24 hours of administration of this combination (41). 

True geographic differences cannot be proven from such figures, since the variation from country to country is largely due to inconsistent classification and differences in the selection of patients for dialysis and transplantation (46). 

Strontium levels are increased in plasma of renal failure patients. In dialysis patients the accumulation of the element has been reported to be strongly centre and country-dependent and values up to 50 times those noted in subjects with normal renal function have been reported within the latter population [20]. In addition to the renal failure, accumulation of the element turned out to be due to the use of strontium-contaminated dialysis fluids secondary to the addition of contaminated acetate-based concentrates. To which other factors such as age, medication, treatment modalities etc. .. also contribute to the increased levels is not yet fully understood. 

Of the 39% who survived ARF, 41% had residual renal insufficiency and 10% required chronic dialysis. Residual renal impairment was more frequent in older and oliguric patients, in those with previous chronic renal insufficiency, those who received antibiotics, and those whose ARF period was prolonged. The percentage of residual renal impairment is higher than that reported in the series of Davidman et al. [14] or Pru et al. [15], but is in accordance with that found 5 years later in the same country [16] and is supported by an earlier report from the European Dialysis and Transplant Association [17]. 

Detailed information concerning the extent of the problem in analgesic nephropathy is limited, particularly for recent years. National annual data are collected in Austraha/New Zealand by the Austrahan and New Zealand Dialysis and Transplant Registry (ANZDATA) [51] and in the United States by the United States Renal Data System (USRDS) [52]. In Europe, the registration system of the European Dialysis and Transplant Association (EDTA) [53] pubUshed regularly incidence and prevalence data of analgesic nephropathy for all European countries in the past. 

The normative lithium requirement of humans is assessed at < 100 tg per day, as all German test subjects of both genders took in between < 100 and > 3500 tg Li per day without showing deficiency symptoms, even at the lowest intake amounts (Anke etal. 1995, 1997b). However, deficiency symptoms may occur in dialysis patients, in kidney failure and in parenteral nutrition. Based on intake data in different countries, Schrauzer (2002) suggested a provisional recommended dietary allowance (RDA) of 1 mg Li per day for a 70-kg adult. Compared with the above intake data, therapeutic effectiveness in the treatment of manic-depressive disorders is achieved at doses of 140 to 280 mg Li per day - about 100 to 300 times higher than RDA (Schou... 

Because it is soluble in water, thiamine is not stored in the body. A person must include the compound in his or her daily diet on a regular basis. Most people ingest adequate amounts of vitamin Bx in their ordinary diets, and beriberi is very rare in developed countries of the world. It may occur, however, in alcoholics, pregnant women, and people who must undergo kidney dialysis. In all of these cases, a person does not receive adequate amounts of the vitamin for the body s needs. In the case of alcoholics, for example, alcohol replaces the calories they would be getting from food if they were not drinking so much. As a result, they do not get enough vitamin Bx and other nutrients needed to stay healthy. 

It is interesting to observe that although there is as yet no country in the world where PVC has been banned, in certain countries strong anti-PVC lobbies do exist. Paradoxically, PVC is heavily used in the health sector, even for blood bags and tubing for dialysis equipment, and although the details of this debate are beyond the scope of this book, by considering the fact that the production and consumption of PVC increases every year it is not difficult to predict that PVC will continue to be one of the basic plastics for the years to come. 

With online haemo(dia)filtration the dialysis machine produces the diluent solution near the patient, so-called online . In some countries the pharmacist is responsible for the quality of the solutions, because health inspectorate regards this as the preparation of a medicine. 

We are grateful that so many authors from different countries have contributed to this book. They give us a diversified insight into important concepts and technical tricks, which are essential to create and maintain a functional dialysis access. With checklists in our mind, we can be more precise in the timing and in the process of dialysis access creation. Besides simulation training, we also need a better focus on interdisciplinary and interprofessional communication. We are convinced that these efforts lead to more satisfaction amongst health care professionals and result in an improved medical outcome for our patients. 

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