PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY
REGISTRY OF THE NEPHROLOGY, DIALYSIS AND TRANSPLANTATION IN TURKEY
REGISTRY 2004
Central Registry Committee
Ekrem EREK Kamil SERDENGEÇTİ Chairman President of Turkish Society of Nephrology Gültekin SÜLEYMANLAR General Secretary of Turkish Society of Nephrology
İstanbul - 2005 PUBLISHED BY THE TURKISH SOCIETY OF NEPHROLOGY
Important Note
All copyrights are reserved for Turkish Society of Nephrology. Articles and figures might not be published without reference.
Contents and Design: OMEGA Contract Research Organization Printing: Art Ofset Printing date: June 2005
INTRODUCTION
15 Years in Turkish Nephrology Registry
Nephrology, Dialysis and Transplantation studies which are started in 1989 including solely Istanbul, are being performed in country wide since 1990 and published by Turkish Society of Nephrology, annually (except 1994). On the following two pages, you might see the names of the books and people who have worked throughout the publishing process. Till 1993 a lot of friends of us have taken place in Central Registry Committee. I am grateful to them. For efforts they spent in communicating with foreign and domestic nephrology centers and for supports in evaluating and commenting the collected data, I especially thankful to Kamil Serdengeçti, President of Turkish Society of Nephrology and to Gültekin Süleymanlar, General Secretary, who are the indispensable and permanent names of our society. Mehmet Rıza Altıparmak and Nurhan Seyahi, two young assistant members of Central Registry Committee have spent too much effort. Many thanks to them and to Lale Sever who has given her best support in evaluation of pediatric nephrology results. Registry studies which were performed with an amateur spirit till three years ago, are being executed by a professional company since 2002, under control, support and audition of our Central Registry Committee. You might see the graphics showing the now and then of the Turkish Registry for a period of 15 years. In recent years, Turkish Nephrology Registry has started to take place in two big registries as a result of contribution established with ERA-EDTA and USRDS. For the support they gave to Turkish Nephrology Registry, we are grateful to Kitty Jager, Director of the ERA- EDTA Nephrology Center and to Allan J. Collins, Director of the USRDS Coordinating Center. You might also find the figures of this two big registries and comparative graphics by USRDS, including Turkish results. Turkish Registry of 2004 is completed again with the extreme supports of the responsible persons of nephrology, dialysis and transplantation centers. We stated the names of both them and the centers at the back pages of this book. By this means we voice our gratitudes to them. We are also grateful to managers and the staff of Omega Contract Research Organization who have collected the data under the control and support of our Central Registry Committee and prepared the analysis report, and to Fresenius Medical Care, the company that has yet once more sponsored the printing of this book.
June 2005, Cerrahpaşa, Istanbul
Prof. Dr. Ekrem EREK
Turkish Society of Nephrology, Chairman to Central Registry Committee
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 i TURKISH SOCIETY OF NEPHROLOGY REGISTRY GENERAL COMMITTEE General Coordinator: Prof. Dr. Kamil SERDENGEÇTİ President of Turkish Society of Nephrology EDTA-ERA Registry Coordinator for Turkey Assistant Coordinator: Prof. Dr. Gültekin SÜLEYMANLAR General Secretary of Turkish Society of Nephrology Assistant Members to Central Registry Committee: Assoc. Prof. Mehmet Rıza ALTIPARMAK, Dr. Nurhan SEYAHİ Coordinator for Pediatric Nephrology: Prof. Dr. Lale SEVER Regional Coordinators for Ankara and Mid-Turkey: Şali ÇAĞLAR, Mehmet HABERAL, Enver HASANOĞLU, Şükrü SİNDEL, Neval DUMAN, Ayşın BAKKALOĞLU, Oğuz SÖYLEMEZOĞLU, Ayşe ÖNER, Haluk KİPER, Cengiz UTAŞ, Süleyman TÜRK, Necmettin GÜVENCE Regional Coordinators for Istanbul and Thrace Region: Emel AKOĞLU, Mehmet SEVER, Rezzan ATAMAN, Mine BESLER, Funda TÜRKMEN, Uluğ ELDEGEZ, Muzaffer SARIYAR, Saniye ŞEN, Metin ERMAN, Nedim SARSMAZ Hülya Karadayı ERGİN Regional Coordinators for Bursa and Marmara Region: Mustafa YURTKURAN, Kamil DİLEK, Mustafa GÜLLÜLÜ, Nilay OKTAY, Betül KALENDER Regional Coordinators for Izmir and Aegean Region: Ali BAŞÇI, Sevgi MİR, Taner ÇAMSARI, Fehmi AKÇİÇEK Cüneyt HOŞCOŞKUN, Adam USLU Regional Coordinators for Black Sea Region: Tekin AKPOLAT, Nurol ARIK, Şükrü ULUSOY Regional Coordinators for Eastern Turkey: Yılmaz SELÇUK, Reha ERKOÇ Regional Coordinators for Southeastern Turkey: Bünyamin IŞIKOĞLU, Emin YILMAZ, Asım GÖYMEN Regional Coordinators for Adana and Çukurova Region: Yahya SAĞLIKER, Uğur EKREN, Zeki GÜLOĞLU, Saime PAYDAŞ Regional Coordinators for Antalya and Mediterranean Region: Gülşen YAKUPOĞLU, Fevzi ERSOY, Alper DEMİRBAŞ Communication and Assistance in Data Collection: Executive Secretary: Mübeccel AKYÜZ Central Registry Committee Secretary: Şükran AKPINAR Project Management: Omega Contract Research Organization Project Managers: Ebru MUTLU, Hakan YILMAZ Assistant Project Manager Kartal ÇETİNTÜRK Regional Project Managers: Öznur BİÇEROĞLU, Yeşim KOÇ (Ankara), Güliz ÖZGEN (İstanbul), Buket ÜNAK (İzmir), Mesut BAHAR (Samsun) Data Analysis and Reporting: Oktay ÖZDEMİR, Ferit ÜN, Bülent SAKAOĞLU Database Management and Software Development: Berk ÖZDEMİR, Taner SUNDU, Taner VAROL Data Entry Officers: Fatih ELİTOĞ, Emre ÖZKAN Review of Forms: Hakan YILMAZ, Kartal ÇETİNTÜRK, Serpil ÇOBAN Graphics and Translation: Murat KİRTİŞ
ii Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 The Registry Books Published in Last 15 Years
1. Today of Hemodialysis in Istanbul, Istanbul 1989 Publishing Committee: Ekrem Erek, Serhat Perk. Publisher: Turkish Society of Nephrology, number of pages: 48 2. Today of Nephrology, Dialysis and Transplantation in Turkey, 1990 Publishing Committee: Ekrem Erek, Serhan Dalmak. Publisher: Turkish Society of Nephrology, number of pages: 97. 3. Nephrology, Dialysis and Transplantation in Turkey, Registry 1991 Publishing Committee: Ekrem Erek, Rezzan Ataman, Serran Dalmak, Süheyla Apaydın. Publisher: Turkish Society of Nephrology, number of pages: 49. 4. Nephrology, Dialysis and Transplantation in Turkey, Registry 1992-1993 Publishing Committee: Ekrem Erek, Kamil Serdengeçti, Rezzan Ataman, Süheyla Apaydın. Publisher: Turkish Society of Nephrology, number of pages: 55. 5. Nephrology, Dialysis and Transplantation in Turkey, Registry 1995 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 80. 6. Nephrology, Dialysis and Transplantation in Turkey, Registry 1996 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 48. 7. Nephrology, Dialysis and Transplantation in Turkey, Registry 1997 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 50. 8. Nephrology, Dialysis and Transplantation in Turkey, Registry 1998 Publishing Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 94. 9. Nephrology, Dialysis and Transplantation in Turkey, Registry 1999 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 82. 10. Nephrology, Dialysis and Transplantation in Turkey, Registry 2000 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 119. 11. Nephrology, Dialysis and Transplantation in Turkey, Registry 2001 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 74. 12. Nephrology, Dialysis and Transplantation in Turkey, Registry 2002 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 71. 13. Nephrology, Dialysis and Transplantation in Turkey, Registry 2003 (including English version) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 74. 14. Nephrology, Dialysis and Transplantation in Turkey, Registry 2004 (English) Central Registry Committee: Ekrem Erek, Gültekin Süleymanlar, Kamil Serdengeçti. Publisher: Turkish Society of Nephrology, number of pages: 91.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 iii DEMOGRAPHICS OF TURKEY
Background : Modern Turkey was founded in 1923 by Kemal ATATÜRK after a war of independence, following the fall of the 620-years-old Ottoman Empire. Under his leadership, the country adopted wide-ranging social, legal, and political reforms.
Location : Southeastern Europe and southwestern Asia
Area : Total: 780.580 sq km
Population : 73.330.000
Age structure : 0-14 years: 26% (male 9.232.439/female 8.897.135) 15-64 years: 67.3% (male 23.806.367/female 23.053.536) 65 years and over: 6.7% (male 2.140.242/female 2.530.840) (2005 est.)
Median age : Total: 27.7 years
Population growth rate : 1.8% (2005 est.)
Life expectancy at birth : Total population: 72.36 years Male: 69.94 years Female: 74.91 years (2005 est.)
Total fertility rate : 1.94 children born/woman (2005 est.)
Number of medical faculties : 35 state, 6 private (January 2001)
Number of physicians : 95.192 (2002) specialists : 43.662 general practitioners : 51.530
Number of nurses : 70.270 (4020 private)
Per capita income : 4250 $/year (2004)
iv Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 CONTENTS Page 2004 Registry...... 1 Clinical Nephrology ...... 3 Renal Replacement Therapies ...... 7 Hemodialysis ...... 7 Peritoneal Dialysis...... 29 Renal Transplantation ...... 43 Pediatric Nephrology ...... 53 Pediatric Hemodialysis ...... 55 Pediatric Peritoneal Dialysis ...... 59 Pediatric Renal Transplantation ...... 63 Comparative Figures from World and Turkey ...... 65 Centers Included in the Registry...... 75
ABBREVIATIONS
APD ...... Automated peritoneal dialysis BP ...... Blood pressure CAPD ...... Continuous ambulatory peritoneal dialysis CGN ...... Chronic glomerulonephritis CRF ...... Chronic renal failure DM...... Diabetes mellitus EPO ...... Erythropoietin ESRD ...... End stage renal disease GFR ...... Glomerular filtration rate HD ...... Hemodialysis HT ...... Hypertension PD ...... Peritoneal dialysis pmp ...... Per million population RRT ...... Renal replacement therapy RTx ...... Renal transplantation TIN ...... Tubulointerstitial nephritis TSN ...... Turkish Society of Nephrology
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 v
2004 REGISTRY
Number of centers invited to Registry (including pediatric nephrology centers) ...... 459 Number of centers that do not fit Registry inclusion criteria ...... 9 Number of centers without HD unit...... 3 Number of centers where HD units were closed in 2004...... 5 Number of centers that could not be reached ...... 1 Number of centers that fit Registry inclusion criteria ...... 450 Number of non-responding centers ...... 10 Number of responding centers and response rate...... 440 (97.8%) Number of centers per million population ...... 6.2
HD centers Number of specialist physicians ...... 439 Number of general practitioners ...... 699 Total number of physicians ...... 1138 Number of nurses ...... 2827 Number of HD equipments...... 5964
PD centers Number of specialist physicians ...... 85 Number of general practitioners ...... 38 Total number of physicians ...... 123 Number of nurses ...... 124
Pediatric nephrology centers Number of centers invited to Registry ...... 32 Number of responding centers and response rate...... 32 (100%) Number of centers with HD units ...... 23 Number of centers with PD units ...... 30 Number of centers where RTx is performed ...... 15
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 1
CLINICAL NEPHROLOGY
Incident ESRD* patients in 2004 Pre-dialysis patients...... 30.8% HD patients ...... 58.9% PD patients ...... 8.0% Tx patients ...... 2.3%
Prevalent ESRD patients, as of the end of 2004 Pre-dialysis patients...... 25.5% HD patients ...... 58.4% PD patients ...... 10.0% Tx patients ...... 6.1%
Primary renal diseases in incident ESRD patients in 2004 Diabetes mellitus ...... 25.3% Hypertensive renal disease ...... 17.2% Chronic glomerulonephritis ...... 13.4% Other diseases ...... 20.5% Etiology unknown ...... 23.6%
Primary renal diseases in prevalent ESRD patients, as of the end of 2004 Diabetes mellitus ...... 23.1% Hypertensive renal disease ...... 19.8% Chronic glomerulonephritis ...... 16.3% Other diseases ...... 22.5% Etiology unknown ...... 18.3%
* GFR less than 15 mL/min for non-diabetic patients and GFR less than 20 mL/min for diabetic patients are accepted as ESRD.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 3 Response rate by years
96.2 97.6 100 94.1 94.4
90
80 77.5 Percent 70
60 2000 2001 2002 2003 2004
Treatment modalities in incident RRT patients (2004)
100 84.1 80
60
40 % of pts. 20 11.6 3.3 0 HD PD Tx
Treatment modalities in prevalent RRT patients (2004)
100 78.4 80
60
40 % of pts. 13.4 20 8.2 0 HD PD Tx
4 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Etiology of incident ESRD patients (2004)
Diabetes mellitus 25.3
Hypertensive renal disease 17.2
Chronic glomerulonephritis 13.4
Urologic disease 5.8
Chronic interstitial nephritis 4.0
Cystic renal disease 3.9
Miscellaneous 6.8
Etiology unknown 23.6
0 10 20 30 % of pts.
Etiology of prevalent ESRD patients (2004)
Diabetes mellitus 23.1
Hypertensive renal disease 19.8
Chronic glomerulonephritis 16.3
Urologic disease 5.7
Cystic renal disease 5.3
Chronic interstitial nephritis 4.9
Miscellaneous 6.6
Etiology unknown 18.3
0 10 20 30 % of pts.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 5 TRENDS IN CLINICAL NEPHROLOGY BY YEARS
RRT patients with diabetic nephropathy by years
30 25.3 25.3 22.8
18.1 20 16.9 15.3 16.4 15.8 13.6
% of pts. 10 4.5 4.6
0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2003 2004
RRT patients with cystic renal disease by years
15
10
6.6 6.0 5.8
% of pts. 4.5 5 4.1 4.2 3.9 2.5 2.8
0 1991 1996 1997 1998 1999 2000 2001 2003 2004
Discussion
Evaluation is performed based on the results provided by 440 centers (number of pediatric nephrology centers: 32). In the year 2004, the point prevalence and incidence rates of ESRD treated with RRT are found as 444 pmp and 123 pmp, respectively. There is an increase in both point prevalence and incidence rates as compared to last year. First three etiologic diseases causing chronic renal disease among incident ESRD patients in 2004 are found as diabetes mellitus (25.3%), hypertension (17.2%) and chronic glomerulonephritis (13.4%), respectively. First three etiologic diseases causing chronic renal disease among prevalent ESRD patients as of the end of 2004 are found as diabetes mellitus (23.1%), hypertension (19.8%) and chronic glomerulonephritis (16.3%), respectively.
6 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 RENAL REPLACEMENT THERAPIES
HEMODIALYSIS
Incident regular HD patients in 2004 Male ...... 54.9% Female ...... 45.1% 0-15 years of age ...... 0.4% 16-19 years of age ...... 1.3% 20-44 years of age ...... 21.7% 45-64 years of age ...... 48.9% 65-74 years of age ...... 20.8% 75+ years of age ...... 6.8%
Prevalent regular HD patients as of the end of 2004 ...... 25.321 Male ...... 56.2% Female ...... 43.8% 0-15 years of age ...... 0.3% 16-19 years of age ...... 1.4% 20-44 years of age ...... 28.8% 45-64 years of age ...... 42.9% 65-74 years of age ...... 20.7% 75+ years of age ...... 5.8%
Frequency of HD sessions in regular HD patients, as of the end of 2004 Once weekly ...... 1.6% Twice weekly ...... 13.6% Three times weekly ...... 84.8%
Duration of dialysis in regular HD patients, as of the end of 2004 0-5 years ...... 69.6% 6-10 years ...... 22.4% 11-15 years ...... 6.2% 16-20 years ...... 1.5% 20+ years ...... 0.2%
Number of dialysers consumed in 2004 ...... 3.234.687 Synthetic ...... 54.0% Semi-synthetic ...... 35.8% High-flux ...... 8.9% Cuprophane...... 1.3%
Percentage of regular HD patients with urea reduction rate higher than 0.65, as of the end of 2004 ...... 68.1%
Percentage of HD centers where urea kinetics model is used in 2004 ...... 62.2%
Kt/V values in regular HD patients, as of the end of 2004 <0.80 ...... 2.2% 0.81-1.00 ...... 8.5% 1.10-1.20 ...... 25.6% 1.21-1.80 ...... 58.7% >1.80 ...... 50%
Types of vascular access in regular HD patients, as of the end of 2004 AV fistula (native) ...... 90.1% Persistent (tunnel) catheter ...... 3.5% AV graft (prosthesis) ...... 2.6% Miscellaneous ...... 3.7%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 7
AV fistula localization in regular HD patients, as of the end of 2004 Forearm 1/3 distal region ...... 42.0% Forearm 1/3 mid-region ...... 25.0% Arm 1/3 distal ...... 23.7% Snuff-box ...... 8.5% Femoral ...... 0.8%
Anticoagulation method in regular HD patients, as of the end of 2004 Standard heparinization ...... 56.5% Low-molecular weight heparinization ...... 42.5% Regional heparinization ...... 0.1% Miscellaneous ...... 0.9%
Hypertension in regular HD patients, as of the end of 2004 Hypertensive ...... 40.7% BP >140/90 mmHg, on antihypertensive treatment ...... 13.5% BP >140/90 mmHg, not on antihypertensive treatment ...... 6.9% BP <140/90 mmHg, on antihypertensive treatment ...... 20.3% Normotensive (BP <140/90 mmHg, not on antihypertensive treatment) ...... 59.3%
Cardiovascular diseases in regular HD patients, as of the end of 2004 Left ventricular hypertrophy...... 19.3% Coronary heart disease...... 9.5% Heart failure ...... 6.8% Arrythmia ...... 5.5% Miscellaneous ...... 5.2%
Percentage of regular HD patients with hypoalbuminemia (less than 3.5 g/dL), as of the end of 2004 ...... 12.9%
Erythropoietin treatment in regular HD patients, as of the end of 2004 Percentage of HD patients on erythropoietin treatment ...... 62.8% Percentage of HD patients with erythropoietin resistance ...... 7.7%
Iron treatment in regular HD patients, as of the end of 2004 HD patients on iron treatment ...... 58.9% Oral iron treatment ...... 5.0% Parenteral iron treatment ...... 53.9%
Serum intact PTH levels (pg/mL) in regular HD patients, as of the end of 2004 <100 ...... 26.7% 100-300 ...... 36.6% 300-500 ...... 17.7% 500-1000 ...... 11.7% >1000 ...... 6.1%
Phosphate-binding treatment in regular HD patients, as of the end of 2004 HD patients on phosphate-binding treatment ...... 87.3% Calcium acetate ...... 66.7% Calcium carbonate ...... 13.3% Aluminium hydroxide ...... 4.7% Sevelamer ...... 2.0% Miscellaneous ...... 0.7%
Active vitamin D treatment in regular HD patients, as of the end of 2004 HD patients on vitamin D treatment ...... 41.3% Oral vitamin D treatment ...... 14.3% IV vitamin D treatment ...... 27.0%
8 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004
Hepatitis serology in regular HD patients, as of the end of 2004 HBsAg (+)...... 4.9% Anti-HCV Ab (+) ...... 19.3% Both HBsAg and Anti-HCV Ab (+) ...... 1.5%
Deaths in regular HD patients, in 2004 Deaths due to any cause ...... 3.441 (14.4%) within the first 90 days of dialysis ...... 4.5% after 90 days of dialysis ...... 9.9% Causes of death Deaths due to cardiovascular causes ...... 46.7% Deaths due to cerebrovascular accidents ...... 12.6% Deaths due to malignancies...... 10.4% Deaths due to infections ...... 9.7% Deaths due to other causes ...... 20.4%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 9 Age distribution of incident regular HD patients (2004)
80
60 48.9
40 21.7 20.8 % of pts. 20 6.8 0.4 1.3 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Mean age of incident regular HD patients (2004)
60 53.2 54.4 53.8
40
20 Years Years of age
0 Male Female Total
Age distribution of incident regular HD patients with diabetic nephropathy (2004)
60 51.8
40 29.0
20 11.9 % of pts. 6.7 0.3 0.3 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
10 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Age distribution of prevalent regular HD patients (2004)
60 42.9 40 28.8 20.7 20 % of pts. 5.8 0.3 1.4 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Age distribution of prevalent regular HD patients with diabetic nephropathy (2004)
60 52.3
40 28.6
20 13.0 % of pts. 6.0 0.0 0.2 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Frequency of HD sessions in regular HD patients (2004)
90 84.8
60
% of pts. 30 13.6 1.6 0 1/week 2/week 3/week
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 11 Distribution of dialyser membranes in regular HD patients (2004)
60 54.0
40 35.8
% pts. of 20 8.9 1.3 0 Synthetic Semisynthetic High-flux Cuprophane
Urea Reduction Rate (URR) in regular HD patients (2004)
80 68.1
60
40 31.9 % of pts. 20
0 ≤0.65 >0.65
Urea kinetics model usage in HD centers (2004)
80 62.2 60 37.8 40
% of centers 20
0 Yes No
12 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Kt/V ratios in regular HD patients (2004)
80
60 60.2 47.1 3/week 40
28.7 2/week 25.2 % of pts. 20 12.8 7.9 7.9 4.7 3.6 2.0 0 ≤0.80 0.81-1.00 1.01-1.20 1.21-1.80 >1.80
Types of vascular access in regular HD patients (2004)
100 90.1 80 60 40 % of pts. 20 3.5 2.6 3.7 0 AV fistula Persistent AV graft Misc. (native) (tunnel) catheter (prosthesis)
AV fistula localization in regular HD patients (2004)
100 73.4
80 70.7 70.7 70.7 60 61.3 Right 38.7
40 29.3 29.3 29.3 Left 26.6 % of pts. 20 0 Forearm Forearm Arm 1/3 Femoral Snuff-box 1/3 distal 1/3 mid distal region region region region
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 13 AV fistula localization in regular HD patients (2004)
60 42.0 40 25.0 23.7
% of pts. 20 8.5 0.8 0 Forearm 1/3 Forearm 1/3 Arm 1/3 Snuff-box Femoral distal region mid region distal region region
Anticoagulation methods used in regular HD patients (2004)
56.5 60 42.5 40
20 % of pts. 0.1 0.9 0 Standard Low molecular Regional Misc. heparinization weight heparinization heparinization
Blood pressure status in regular HD patients (2004)
80 59.3 60
40 20.3 % of pts. 13.5 20 6.9 0 BP <140/90 mmHg BP <140/90 mmHg BP >140/90 mmHg BP >140/90 mmHg untreated treated untreated treated
14 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Cardiovascular diseases in regular HD patients (2004)
Left ventricle hypertrophy 19.3
Heart failure 6.8
Arrythmia 5.5
Angina pectoris 5.5
Peripheral arterial disease 2.9
Coronary by-pass surgery 1.7
Acute myocardial infarction 1.2
Cerebrovascular accident 1.1
Coronary angioplasty / stent 1.1
Pericarditis 0.7
Infective endocarditis 0.5
0 5 10 15 20 % of pts.
Serum albumin levels in regular HD patients (2004)
87.1 90
60
% of pts. 30 12.9
0 <3.5 g/dL >3.5 g/dL
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 15 Erythropoietin usage in regular HD patients (2004)
80 62.8 60 37.2 40 % of pts. 20
0 Yes No
Regular serum ferritin measurement in HD centers (2004) 79.5 80
60
40 20.5
% of centers 20
0 Yes No
Iron treatment in regular HD patients (2004)
60 53.9
41.1 40
% of pts. 20 5.0 0 Oral Parenteral None
16 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Renal bone disease tests performed in HD centers (2004)
Routine biochemical tests 97.5
Bone X-rays 74.7
Serum intact parathormone 70.2
Parathyroid scintigraphy 27.5
Bone-specific alkaline phosphatase 21.6
Serum aluminium 13.4
Serum Vit-D metabolites 8.2
Deferoxamine test 6.0
Bone biopsy 4.2
Serum osteocalcin 3.7
0 20 40 60 80 100 % of centers
Serum intact parathormone levels in regular HD patients (2004)
40 36.6 26.7 17.7 20 11.7 6.1 % of pts.
0 <100 100-300 300-500 500-1000 >1000 pg/mL
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 17 Phosphorus binding agents used in regular HD patients (2004)
Calcium acetate 66.7
Calcium carbonate 13.3
Aluminium hydroxide 4.7
Sevelamer 2.0
Misc. 0.7
None 12.7
0 20 40 60 80 % of pts.
Active vitamin D used in regular HD patients (2004) 58.7 60
40 27.0
% of pts. 20 14.3
0 Oral IV None
18 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Hepatitis serology in regular HD patients (2004)
19.3 20
10
% of pts. 4.9
1.5
0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+)
Duration of dialysis in regular HD patients (2004)
80 69.6
60
40 22.4 % of pts. 20 6.2 1.5 0.2 0 ≤5 6-10 11-15 16-20 >20 Years
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 19 Causes of death in regular HD patients (2004)
Cardiovascular 46.7
Cerebrovascular 12.6 accident
Malignancy 10.4
Infection 9.7
Hepatic failure 1.9
Pulmonary emboli 1.2
Misc. 17.3
0 10 20 30 40 50 % of total deaths
Deaths due to cardiovascular diseases in regular HD patients (2004)
60 45.6 44.3 40
20 7.2 2.5 0 Heart failure Ischemic heart Arrythmia Misc. % of cardiovascular % deaths of cardiovascular disease
Discussion
Evaluation is performed based on the results provided by 395 hemodialysis (HD) centers. The number of the centers contributed (n: 388), the number of HD equipments (n: 5964), and the number of HD patients (n: 25321) are increased by 13.0% compared to last year. The proportion of patients who are 15 years old or younger is 0.3%. With a percentage of 79.0%, HD is the most commonly used RRT method in Turkey. The total number of physicians and nurses are 1138 and 2829, respectively. There are some differences in numbers as compared to the numbers from Ministry of Health. There are several reasons of this: unlike the report of Ministry of Health, this report does not include; o the incident HD patients of 2005, o the numbers of died HD patients, o the potential HD patients of the centers newly established their HD equipments.
20 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 The proportion of diabetic patients among the HD patients is increased from 19.2% to %23.0 and this fact shows that diabetes mellitus, as a cause of ESRD, has an increasing rate in Turkey as well. The age range of HD patients: 49.8% of all patients and 52.4% of diabetic patients are in the age range of 45 and 64. Frequency of HD sessions: three times weekly for 84.8%, twice weekly for 13.6%, and once weekly for 1.6%. There is an increase in the frequency of 3 sessions/week compared to last year. A total of 3.235.000 dialysers are used in 385 centers in the year 2004. Decrease in cuprophane usage (1.3%) continues while there is a significant increase in synthetic membrane usage. Synthetic membranes are the most commonly prescribed membranes (54%) in the year 2004. High-flux membrane usage is 8.9%. There is an increase in urea kinetics model usage in the evaluation of dialysis sufficiency; it is used by 62.2% of the centers. Urea Reduction Rate is lower than 0.65 in 68.1% of chronic HD patients. Kt/V is higher than 1.2 in 63.7% of the patients. AV fistula is the vascular access route in 90.1% of HD patients and is opened on left arm with a proportion of over 70%. In 57.1% of the patients, dialysis is continued with the initial AV fistula. In 42.5% of the HD patients, low molecular weight heparine is used for anticoagulation. The frequency of hypertension in HD patients is found as 40.7%. Serum albumin level which is one of the reliable indicators of nutrition is lower than 3.5 g/dL in 12.9% of the HD patients. Results are better as compared to last year. The proportion of the patients whose serum albumin level is higher than 4.0 g/dL is 33.6%. The frequency of EPO usage in HD patients is 62.8% and there is a decrease when compared to last year. Target HB level (>11 g/dL) is reached in only 58.3% of the patients receiving EPO. EPO resistance is found in 7.7% of HD patients. This figure shows decrease as compared to last year (10.6%). Iron treatment is administered in 58.9% of HD patients (oral: 5.0%, parenteral: 53.9%). Routine serum ferritin tests are performed in 79.5% of the centers. Routine biochemical tests (97.5%), bone X-rays (74.7%), and parathyroid scintigraphy (70.2%) are the most commonly used tests for renal bone disease in HD patients. The proportions of patients with iPTH level <100 pg/mL and >1000 pg/mL are 26.7% and 6.1%, respectively. Calcium acetate (66.7%), calcium carbonate (13.3%), and sevelamer (2.0%) are used as phosphorus binding agents in HD patients. There is a decrease in the rates of oral (14.3%) and IV (27%) active vitamin D usage compared to last year. Parathyroidectomy is performed in 226 patients. Venous bicarbonate level test is practiced in only 6.6% of the centers, for acidose follow up. There found no change in the frequency of HBV infection in HD patients compared to last year. The frequency of anti-HCV (+) patients continues to decrease (from 24.6% to 19.3%). Dialysis duration is longer than 6 years in more than 30% of HD patients. 31.0% of the HD patients died within the first 3 months, which is same as last year. With a rate of 46.7%, cardiovascular diseases are the most common cause of death in HD patients. Cerebrovascular accident, malignancy and infection come after it, respectively. HD is the most commonly used RRT method in ESRD patients in Turkey (79%). While the number of patients keeps increasing, improvements in HD conditions and efforts to provide a more qualified dialysis are being carried on.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 21 TRENDS IN REGULAR HEMODIALYSIS THERAPY BY YEARS
Number of regular HD patients by years
30000 25321
25000 23387 20600
20000 18815
15000 14086 12196 11339 Count 10000 9658 7014 6527 5400
5000 3494 3069
0 1990 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Frequency of HD sesions in regular HD patients by years
100 80 60 40 % of pts. 20 0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
1/week 2/week 3/week
Types of dialysate used in regular HD patients by years
100 80 60 40 % of pts. 20 0 1995 1997 1998 1999 2000 2001 2002
Bicarbonate Acetate
22 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Types of vascular access in regular HD patients by years
100 90.1 88.4 87.5 83.0 80
60
40 % of pts.
20 14.1 9.1 5.5 3.8 3.5 3.5 3.5 2.9 2.5 2.6 0 1998 1999 2003 2004
AV fistula Catheter Graft Other
Hypoalbuminemia (<3.5 g/dL) in regular HD patients by years
40 34.5
30 23.0 19.8 18.3 19.2 20 17.3 16.2 14.7 15.4 12.9 % of pts. 10
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Erythropoietin usage in regular HD patients by years
80 69.5 69.5 67.6 69.3 66.5 63.4 65.5 62.8 60 55.0 44.2 38.0 40 % of pts. 20
0 1991 1993 1996 1997 1998 1999 2000 2001 2002 2003 2004
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 23 Erythropoietin resistance in regular HD patients by years 12 10.6 9.5 9 7.7
6
% of pts. 3
0 2002 2003 2004
Iron treatment in regular HD patients by years
80 73.5
60.4 58.9 60
40 % of pts. 20
0 1995 2003 2004
Active vitamin D usage in regular HD patients by years
90 85.0 73.6 70.6 62.2 60 50.5 45.2 40.4 41.3
% of pts. 30
0 1995 1998 1999 2000 2001 2002 2003 2004
24 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Frequency of HBsAg (+) regular HD patients by years 15.0 15 12.7 11.1 10.0 10.5 10 8.1 7.5 7.9 7.6 6.5 5.9 6.4
% pts. of 5
0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Frequency of Anti-HCV (+) regular HD patients by years
60 54.6
41.7 40 36.2 29.6 28.8 26.3 23.2 20.8 % of pts. 20
0 1997 1998 1999 2000 2001 2002 2003 2004
Deaths due to cardiovascular disease in regular HD patients by years
60 50.6 51.9 50.0 49.0 48.4 45.5 45.0 46.4 46.7 40
20
% deaths of total 0 1995 1996 1997 1998 1999 2000 2002 2003 2004
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 25 Deaths due to cerebrovascular accident in regular HD patients by years
20 15.0 15 13.1 12.9 13.4 12.6 12.6 10.6 11.2 10
5
% deaths of total 0 1995 1996 1997 1998 1999 2002 2003 2004
Deaths due to infections in regular HD patients by years
15 11.6 11.6 10.4 9.3 10.0 9.9 9.7 10 7.8 8.0
5
% deaths of total 0 1996 1997 1998 1999 2000 2001 2002 2003 2004
Deaths due to malignancies in regular HD patients by years
12 10.4 9.1 9.1 8.9 9 6.0 6.5 6
3
% deaths of total 0 1998 1999 2001 2002 2003 2004
26 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Deaths due to hepatic failure in regular HD patients by years
10 8 6 4.8 3.5 4 2.8 3.0 2.8 3.1 2.4 1.9 2 % deaths of total 0 1996 1997 1998 1999 2001 2002 2003 2004
Discussion
The proportion of regular HD patients is increased by 15-20% in the last 15 years. The increase in the weekly HD sessions is more significant for 3 sessions/week. Hygienic conditions have provided the significant decrease in the percentage of HBsAg (+) regular HD patients through years. The decrease in the proportion of anti-HCV (+) patients can be prevented by hygienic conditions, too. Acetate usage as a dialysate has almost left its place to bicarbonate. In Turkey, the most commonly preferred vascular access route is native AV fistula. Unlike USA the proportion of graft is too small. The percentage of EPO usage has showed no significant change through years, while there is an decrease in vitamin D usage, which is a result of . This decrease is a result of strict follow-up of patients. Hypolbuminemia is decreased to 12.9% in 2004. This result is very satisfactory as a matter of nutrition. Decrease in iron treatment is observed through 15 years. Through 15 years there observed no significant change in the percentage of deaths due to cardiovascular, cerebrovascular accident or infection. There is a slight increase in the proportion of deaths due to malignancy. Preventing the factors causing resistance, the frequency of EPO resistance is decreased.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 27
PERITONEAL DIALYSIS
Incident CAPD patients in 2004 ...... 1.230 Male ...... 52.1% Female ...... 47.9% 0-15 years of age ...... 1.9% 16-19 years of age ...... 2.1% 20-44 years of age ...... 34.1% 45-64 years of age ...... 42.4% 65-74 years of age ...... 15.9% 75+ years of age ...... 3.7%
Incident APD patients in 2004 ...... 271 Male ...... 57.6% Female ...... 42.4% 0-15 years of age ...... 1.5% 16-19 years of age ...... 1.8% 20-44 years of age ...... 46.1% 45-64 years of age ...... 38.0% 65-74 years of age ...... 10.3% 75+ years of age ...... 2.2%
Prevalent PD patients as of the end of 2004 ...... 3.320
Duration of dialysis in PD patients, as of the end of 2004 0-5 years ...... 87.8% 6-10 years ...... 11.7% 11-15 years ...... 0.5%
Hypertension in PD patients, as of the end of 2004 Hypertensive ...... 51.3% BP >140/90 mmHg, on antihypertensive treatment ...... 26.4% BP >140/90 mmHg, not on antihypertensive treatment ...... 6.3% BP <140/90 mmHg, on antihypertensive treatment ...... 28.6% Normotensive (BP < 140/90 mmHg, not on antihypertensive treatment) ...... 38.7%
Cardiovascular diseases in PD patients, as of the end of 2004 Left ventricular hypertrophy...... 12.8% Coronary heart disease...... 4.1% Heart failure ...... 3.8% Arrythmia ...... 3.1% Miscellaneous ...... 5.2%
Percentage of PD patients with hypoalbuminemia (less than 3.5 g/dL), as of the end of 2004 ...... 28.9%
Erythropoietin treatment in PD patients, as of the end of 2004 Percentage of PD patients on erythropoietin treatment ...... 56.7% Percentage of PD patients with erythropoietin resistance ...... 8.4%
Iron treatment in PD patients, as of the end of 2004 PD patients on iron treatment ...... 59.8% Oral iron treatment ...... 44.4% Parenteral iron treatment ...... 15.4%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 29
Serum intact PTH levels (pg/mL) in PD patients, as of the end of 2004 <100 ...... 25.8% 100-300 ...... 33.0% 300-500 ...... 22.2% 500-1000 ...... 11.8% > 1000 ...... 7.2%
Phosphate-binding treatment in PD patients, as of the end of 2004 PD patients on phosphate-binding treatment ...... 86.2% Calcium acetate ...... 56.4% Calcium carbonate ...... 20.0% Aluminium hydroxide ...... 6.1% Sevelamer ...... 2.5% Miscellaneous ...... 1.2%
Active vitamin D treatment in PD patients, as of the end of 2004 PD patients on vitamin D treatment ...... 40.2% Oral vitamin D treatment ...... 37.8% IV vitamin D treatment ...... 2.4%
Hepatitis serology in PD patients, as of the end of 2004 HBsAg (+)...... 4.8% Anti-HCV Ab (+) ...... 8.9% Both HBsAg and Anti-HCV Ab (+) ...... 0.7%
Complications in PD patients, in 2004 Percentage of PD patients who experienced peritonitis ...... 29.3% Rate of peritonitis ...... 1/29.7 months Other complications Hyperlipidemia ...... 23.4% Obesity ...... 8.4% Hernia ...... 7.2% Psychological problems ...... 6.0% Insufficient dialysis ...... 5.6% Hyperglycemia ...... 3.1%
Causes of deaths in PD patients, in 2004 Deaths due to cardiovascular causes ...... 37.1% Deaths due to infections ...... 17.3% Deaths due to cerebrovascular accident ...... 8.2% Deaths due to malignancies ...... 3.3% Deaths due to other causes ...... 34.0%
30 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004
Age distribution of incident CAPD patients (2004)
50 42.4 40 34.1 30 20 15.9 % of pts. 10 1.9 2.1 3.7 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Age distribution of incident APD patients (2004)
50 46.1 38.0 40 30 20
% of pts. 10.3 10 1.5 1.8 2.2 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Mean age of incident PD patients (2004)
60 48.7 48.2 48.5
40
20 Years Years of age
0 Male Female Total
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 31 Age distribution of incident PD patients with diabetic nephropathy (2004)
60 54.4
40 22.3 18.0 20 % of pts. 4.6 0.0 0.6 0 0-15 16-19 20-44 45-64 65-74 75+ Years of age
Blood pressure status in PD patients (2004)
38.7 40 28.6 26.4
20
% of pts. 6.3
0 BP <140/90 mmHg BP <140/90 mmHg BP >140/90 mmHg BP >140/90 mmHg untreated treated untreated treated
32 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Cardiovascular diseases in PD patients (2004)
Left ventricle hypertrophy 12.8
Heart failure 3.8
Arrythmia 3.1
Peripheral arterial disease 2.3
Angina pectoris 2.1
Cerebrovascular accident 0.8
Coronary angioplasty / stent 0.8
Coronary by-pass surgery 0.7
Infective endocarditis 0.7
Acute myocardial infarction 0.5
Pericarditis 0.5
0 5 10 15 % of pts.
Serum albumin levels in PD patients (2004)
80 71.1
60
40 28.9 % pts. of 20
0 <3.5 g/dL >3.5 g/dL
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 33 Complications other than peritonitis in PD patients (2004)
Hyperlipidemia 23.4
Obesity 8.4
Hernia 7.2
Psychological 6.0 problems
Insufficient dialysis 5.6
Drainage dysfunction 4.4
Hyperglycemia 3.1
0 10 20 30 % of pts.
Erythropoietin usage in PD patients (2004)
60 56.7 43.3 40
% pts. of 20
0 Yes No
34 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Iron treatment in PD patients (2004)
50 44.4 40.2 40
30
20 15.4 % pts. of 10
0 Oral Parenteral None
Serum intact parathormone levels in PD patients (2004)
40 33.0 30 25.8 22.2 20 11.8
% of pts. 7.2 10
0 <100 100-300 300-500 500-1000 >1000 pg/mL
Phosphorus binding agents used in PD patients (2004)
Calcium acetate 56.4
Calcium carbonate 20.0
Aluminium hydroxide 6.1
Sevelamer 2.5
Misc. 1.2
None 13.8
0 20 40 60 % of pts.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 35 Active vitamin D used in PD patients (2004) 59.8 60
37.8 40
% pts. of 20 2.4 0 Oral IV None
Hepatitis serology in PD patients (2004)
10 8.9
8
6 4.8
4 % of pts.
2 0.7 0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+)
Duration of dialysis in PD patients (2004)
100 87.8 80 60 40 % of pts. 20 11.7 0.5 0.0 0 ≤5 6-10 11-15 >15 Years
36 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Causes of death in PD patients (2004)
Cardiovascular 37.1
Infection 17.3
Cerebrovascular 8.2 accident
Malignancy 3.3
Pulmonary emboli 2.2
Hepatic failure 0.5
Misc. 31.3
0 10 20 30 40 % of total deaths
Deaths due to cardiovascular diseases in PD patients (2004)
60 53.3
40 32.6
20 8.1 5.9 0
% of cardiovascular % deaths cardiovascular of Ischemic heart Heart failure Arrythmia Misc. disease
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 37 Discussion
Evaluation is performed based on the results provided by 51 centers performing chronic peritoneal dialysis. There are 48 certificated PD nurses working in these centers. There are 2683 CAPD patients and 637 APD patients as of the end of 2004. The proportion of pediatric patients in CAPD and APD are 1.9% and 1.5%, respectively. The frequency of peritonitis is found as 29.7 patient-months and there is a significant improvement compared to last year. Hypertension (61.3%) and hyperlipidemia (23.4%) are the most common non-infectious complications. Serum albumin level is lower than 3.5 g/dL in 28.9% of the PD patients. This figure is higher compared to last year. There is no difference in EPO usage (56.7%) in PD patients. Target HB level (<11 g/dL) is reached in only 64.6% of the patients receiving EPO. EPO resistance is found in 8.4% of PD patients. Iron treatment is administered in 59.8% of PD patients (oral: 44.4%, parenteral: 15.4%). Routine serum ferritin tests are performed in 79.5% of the centers. The proportion of patients with iPTH level <100 pg/mL and >1000 pg/mL are 25.8% and 7.2%, respectively. Calcium acetate (56.4%), calcium carbonate (20%), and sevelamer (2.5%) are used as phosphorus binding agents in PD patients. There is a decrease in the rates of oral (37.8%) and IV (2.4%) active vitamin D usage compared to last year. Parathyroidectomy is performed in 47 PD patients. When compared to last year, there found a decrease in the frequency of HBsAg (+) and Anti-HCV (+) patients; (4.8% and 8.9%, respectively). With a rate of 37.1%, cardiovascular disease is the most common cause of death in PD patients and infections and cerebrovascular accidents come after, respectively. Cause of death ranking is similar to the previous years.
38 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 TRENDS IN PERITONEAL DIALYSIS THERAPY BY YEARS
Number of PD patients by years
3500 3320 3000 2728 2556 2500 1903 1927 2000 1787
Count 1500 1194 1030 1124 1111 1000 500 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Hypoalbuminemia (<3.5 g/dL) in PD patients by years
60
40.2 40 36.0 36.7 34.9 30.4 30.8 28.9 25.3 22.7 23.5
% of pts. 20
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Erythropoietin usage in PD patients by years
80 62.3 56.7 60 55.2 55.8 53.1 49.8 43.8 43.0 42.5 40
% of pts. 23.4 20
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 39 Erythropoietin resistance in PD patients by years
20
15.3 15
10.0 10 8.4 % of pts. 5
0 2002 2003 2004
Iron treatment in PD patients by years
80 63.7 59.8 60
40 % of pts. 20
0 2003 2004
Active vitamin D usage in PD patients by years
80
56.8 56.9 60 53.7 47.2 47.4 42.8 38.7 40.2 40 % pts. of 20
0 1997 1998 1999 2000 2001 2002 2003 2004
40 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Frequency of HBsAg (+) PD patients by years
15 14.2
11.0 10.5 10 9.2 8.6 7.2 5.8 5.6 5.6 5.5
% pts. of 5
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Frequency of Anti-HCV (+) PD patients by years
25 21.3 21.3 20.8 21.3 20 16.7 15.1 15 13.8 11.3 9.6 10 7.3 % pts. of
5
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Deaths due to cardiovascular diseases in PD patients by years
49.2 46.3 50 42.4 41.7 42.7 42.4 39.5 37.1 40 31.9 30 20 10 % deaths of total 0 1995 1996 1997 1998 1999 2001 2002 2003 2004
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 41 Deaths due to cerebrovascular accident in PD patients by years
20 15.9 13.0 13.7 15 12.7 11.7 11.9 10.6 10.2 9.8 10 8.2
5
% deaths of total 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Deaths due to infections in PD patients by years
30 26.1 23.7 23.9 20.8 18.2 20 17.3 14.4 12.8 14.2 11.1 10
% deaths of total 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Deaths due to malignancies in PD patients by years
4.7 5 3.8 4 3.4 3.2 3.3 3 2.5 1.8 2 1 0.6 0.6 % deaths of total 0 1995 1996 1997 1998 1999 2000 2002 2003 2004
Discussion
Starting from 1995 number of the PD patients shows an increasing trend. The increase in the proportion of patients receiving EPO is significant. Cardiovascular diseases are the most significant cause of death for 15 years. The proportion of HBsAg (+) PD patients varies from year to year, while the frequency of anti-HCV (+) PD patients is higher between the years 1997-2000 as compared to last 5 years.
42 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 RENAL TRANSPLANTATION
Incident RTx patients in 2004 ...... 665 Male ...... 68.0% Female ...... 32.0% 0-15 years of age ...... 4.1% 16-19 years of age ...... 5.6% 20-44 years of age ...... 73.7% 45-64 years of age ...... 16.7% 65+ years of age ...... none Living donor ...... 72.1% Related ...... 85.6% Spouse ...... 12.9% Non-related ...... 1.5% Cadaver...... 27.9%
Prevalent RTx patients as of the end of 2004 ...... 3.395
Hypertension in RTx patients, as of the end of 2004 Hypertensive ...... 71.8% BP >140/90 mmHg, on antihypertensive treatment ...... 9.5% BP >140/90 mmHg, not on antihypertensive treatment ...... 1.1% BP <140/90 mmHg, on antihypertensive treatment ...... 61.2% Normotensive (BP <140/90 mmHg, not on antihypertensive treatment) ...... 28.2%
Cardiovascular diseases in RTx patients, as of the end of 2004 Left ventricular hypertrophy...... 11.0% Coronary heart disease...... 2.2% Arrythmia ...... 0.9% Heart failure ...... 0.5% Miscellaneous ...... 0.7%
Hepatitis serology in RTx patients, as of the end of 2004 HBsAg (+)...... 1.4% Anti-HCV Ab (+) ...... 7.9% Both HBsAg and Anti-HCV Ab (+) ...... 0.2%
Status of the incident RTx patients, as of the end of 2004 Functioning graft ...... 80.3% Allograft dysfunction ...... 12.6% Returned to HD...... 3.8% Died ...... 3.3%
Causes of graft loss in RTx patients, as of the end of 2004 Chronic rejection...... 48.9% Death ...... 38.4% Relapse of the primary disease ...... 4.7% Acute rejection ...... 4.1% Primary non-functioning ...... 2.8% Misc...... 1.1%
Causes of deaths in RTx patients, in 2004 Deaths due to infections ...... 51.1% Deaths due to cardiovascular causes ...... 25.5% Deaths due to cerebrovascular accident ...... 6.4% Deaths due to malignancies ...... 4.3% Deaths due to other causes ...... 12.7%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 43 Age distribution of incident RTx patients (2004)
80 73.7
60
40
% of pts. 16.7 20 5.6 4.1 0.0 0 0-15 16-19 20-44 45-64 65+ Years of age
Age distribution of incident RTx patients by donor type (2004)
80 69.2 69.7 60 Living 40
22.8 Cadaver
% of pts. 20 15.7 8.1 6.5 4.2 2.7 0 0.0 0.0 0-15 16-19 20-44 45-64 65+ Years of age
Mean age of incident RTx patients (2004)
40 36.3 34.5 32.9 32.8 34.0
20 Years Years of age
0 Male Female Living Cadaver Total
44 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Hepatitis serology in RTx patients (2004)
10 7.9 8
6
4 % of pts.
2 1.4 0.2 0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+)
Blood pressure status in RTx patients (2004)
80 61.2 60
40 28.2 % of pts. 20 9.5 1.1 0 BP <140/90 mmHg BP <140/90 mmHg BP >140/90 mmHg BP >140/90 mmHg untreated treated untreated treated
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 45 Cardiovascular diseases in RTx patients (2004)
Left ventricle hypertrophy 11.0
Angina pectoris 1.1
Arrythmia 0.9
Coronary angioplasty / stent 0.6
Heart failure 0.5
Peripheral arterial disease 0.4
Acute myocardial infarction 0.3
Cerebrovascular accident 0.2
Coronary by-pass surgery 0.2
Infective endocarditis 0.1
0 3 6 9 12 % of pts.
Status of incident RTx patients (2004)
90 80.3
60
% pts. of 30 12.6 3.8 3.3 0 Functioning graft Allograft Returned to HD Died dysfunction
46 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Causes of graft loss in prevalent RTx patients (2004)
Chronic rejection 48.9
Death 38.4
Relapse of the 4.7 primary disease
Acute rejection 4.1
Primary 2.8 non-functioning
Misc. 1.1
0 10 20 30 40 50 % of pts. with graft loss
Causes of death in prevalent RTx patients (2004)
Infection 51.1
Cardiovascular 25.5
Cerebrovascular 6.4 accident
Malignancy 4.3
Pulmonary emboli 2.1
Misc. 10.6
0 20 40 60 % of total deaths
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 47 Discussion
Evaluation is performed based on the results provided by 25 centers. The number of the RTx patients on follow up is found as 3395 as of the end of 2004. The annual number of RTx is increased by 21.7% (n: 665). The rate of cadaver donation is 27.8%. The rate of RTx patients younger than 15 years old is 4.1%. Living donations were 85.6% from relatives, 12.9% from spouse and 1.5% from non-relatives. The frequency of diabetic nephropathy is 3.6% in RTx patients in 2004 and diabetes mellitus is found as comorbidity in 0.8%. Only 12% of the 25 centers performed pancreas Tx in 2004. Synchronous kidney and pancreas Tx is performed in 22 patients. The number of the Tx patients in whom kidney is transplanted first is 10. The number of the centers performing laparoscopic nephrectomy in living donors is 2 (8%). Antibody treatment is preferred for induction therapy in 58.3% (n: 388) of the RTx patients, in 2004. In 42.5% of them basiliximab, in 35.3% ATG (horse), in 18.8% daclizumab, and in 3.4% thymoglobulin (rabbit) is administered. Increase in the prescribing of the new immunosuppresive agents (mycophenolate mofetil, tacrolimus, IL-2r monoclonal antibodies) will lead to more selective, efficient and safe treatment protocols. Hypertension is observed in 71.8% of the patients as of the end of 2004. Blood pressure is out of control in 9.5% of treated patients. The proportions of HBsAg (+) and Anti-HCV (+) patients are 1.4% and 7.5%, respectively, as of the end of 2004. 29.2% of the centers are performing RTx to HBsAg (+) patients, while 66.7% performs RTx to anti-HCV (+) patients. These figures are decreased compared to last year. Due to the mortality analysis of the year 2004, infections are the most common cause of death (51.1%) and significantly increased compared to last year (34.8%). The most commonly observed infection is sepsis. Cardiovascular diseases, cerebrovascular accident and malignancy come after infections, respectively. Chronic rejection (48.9%) and death (38.4%) are the most common causes of graft loss in 2004; there found a significant change compared to last year. Serum creatinin level is <2 mg/dL in 80.3% of the RTx patients while it is >2 mg/dL in 12.6% of them, in 2004. The proportion of RTx patients who returned to HD is 3.8%, and 19 patients (3.3%) died.
48 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 TRENDS IN RENAL TRANSPLANTATION BY YEARS
Number of RTx's performed by years
700 665 600 600 549 475 500 382 400 364 360 370
Count 300 215 193 200 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Distribution of RTx patients due to donor type by years
100 80 60 40 % of pts. 20 0 1991 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Living Cadaver
Frequency of HBsAg (+) RTx patients by years
4 3.2 2.9 3.0 3
2 1.6 % of pts. 1
0 1997 1998 1999 2004
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 49 Frequency of Anti-HCV (+) RTx patients by years
30 24.0 23.9 22.5
20
% of pts. 10 8.1
0 1997 1998 1999 2004
Deaths due to cardiovascular disease in RTx patients by years
40 30.4 25.5 20.0 15.7 20 13.3
% deaths of total 0 1996 1998 2000 2002 2004
Deaths due to cerebrovascular accident in RTx patients by years
30
20 11.6 8.7 10 6.4 4.1
% deaths of total 0 2000 2002 2003 2004
50 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Deaths due to infections in RTx patients by years
60 53.3 51.5 51.1 44.1 45.2 43.3 40.0 40 34.8 32.6
20
% deaths of total 0 1995 1996 1998 1999 2000 2001 2002 2003 2004
Deaths due to malignancies in RTx patients by years
30
20 11.6 8.6 10 6.7 6.7 7.2 6.1 2.9 4.3
% deaths of total 0 1995 1996 1998 2000 2001 2002 2003 2004
Discussion
The number of RTx patients has increased starting from 1995, it is still too low compared to Europe. We believe that this number will increase with the help of the efforts being spent by Ministry of Health in establishing a better organized Tx system. Through 15 years, there is no significant decrease in the proportion of HBsAg (+) patients while a significant decrease in the frequency of anti-HCV (+) patients is observed. Starting from 2000, there observed an increase in the percentage of the deaths due to cardiovascular diseases.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 51
PEDIATRIC NEPHROLOGY *
Primary renal diseases in incident pediatric RRT patients in 2004 ...... (n:174) Congenital urologic anomalies (including vesicoureteral reflux) ...... 25.9% Primary glomerulonephritis ...... 20.7% Neurogenic bladder ...... 5.7% Renal hypoplasia / dysplasia ...... 4.0% Secondary glomerulonephritis ...... 3.4% Other diseases ...... 14.3% Etiology unknown ...... 25.9%
* Comments on the results of Pediatric Nephrology, Dialysis and Transplantation are made by Prof. Dr. Lale SEVER (İstanbul University Cerrahpaşa Faculty of Medicine Departmant of Pediatrics Division of Clinical Nephrology)
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 53 Etiology of incident pediatric RRT patients (2004)
Congenital urologic anomalies 25.9
Primary glomerulonephritis 20.7
Neurogenic bladder 5.7
Renal hypoplasia/dysplasia 4.0
Urolithiasis 3.4
Secondary glomerulonephritis 3.4
Misc. 10.9
Etiology unknown 25.9
0 5 10 15 20 25 30 % of pts.
Discussion
Pediatric patient forms are sent to 33 pediatric nephrology centers and 32 of them have responded. In 30 of responding centers chronic PD patients, and in 23 of responding centers chronic HD patients are being followed-up as of the end of 2004. RTx is performed in 13 of pediatric nephrology centers, in 2004. The number of the centers with RTx patients is 15, as of the end of 2004. There are 61 pediatric nephrologists in 32 pediatric nephrology centers. There are 28 pediatricians continuing their education in pediatric nephrology, as of the end of 2004. There are more than 800 RRT patients in nephrology centers, as of the end of 2004. The percentages of PD and HD patients are 51% and 13%, respectively. The proportion of RTx patients is 36%. Primary renal disease is unknown in 1/4 of the incident RRT patients. Etiologic causes of ESRD congenital urologic anomalies in 1/4 and primary and secondary glomerulonephritis, each in 1/4.
54 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 PEDIATRIC HEMODIALYSIS
Prevalent pediatric regular HD patients, as of the end of 2004 ...... 116 Male ...... 50.0% Female ...... 50.0% 0-6 years of age...... 0.8% 7-10 years of age ...... 9.8% 11-15 years of age ...... 49.2% 15+ years of age ...... 40.2%
Frequency of HD sessions in pediatric regular HD patients, as of the end of 2004 Once weekly ...... 3.3% Twice weekly ...... 12.3% Three times weekly ...... 83.6% More than three times weekly ...... 0.8%
Duration of dialysis in pediatric regular HD patients, as of the end of 2004 0-6 months ...... 10.7% 7-12 months ...... 6.6% 13-24 months ...... 25.4% 25-60 months ...... 36.1% 60+ months ...... 21.3%
Types of vascular access in pediatric regular HD patients, as of the end of 2004 AV fistula ...... 77.0% Catheter ...... 15.6% AV graft ...... 7.4%
Percentage of pediatric regular HD patients under antihypertensive treatment ...... 52.5%
Hepatitis serology in pediatric regular HD patients, as of the end of 2004 HBsAg (+)...... 7.8% Anti-HCV Ab (+) ...... 17.6% Both HBsAg and Anti-HCV Ab (+) ...... 2.9%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 55 Age distribution of prevalent pediatric regular HD patients (2004)
60 49.2 40.2 40
% of pts. 20 9.8 0.8 0 0-6 >6-10 >10-15 >15 Years of age
Types of vascular access in pediatric regular HD patients (2004)
77.0 80
60
40 % of pts. 20 15.6 7.4
0 AV fistula Catheter AV graft
Hepatitis serology in pediatric regular HD patients (2004)
20 17.6
15
10 7.8 % of pts.
5 2.9
0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+)
56 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Discussion
Only 10% of the regular HD patients are younger than 10 years old. Hemodialysis duration is longer than 2 years in approximately 60% of HD patients. AV fistula is being used for vascular access in the vast majority of HD patients (77%). Proportion of HBsAg (+) pediatric HD patients is 10%, while this figure is 20% for anti-HCV Ab (+) pediatric HD patients.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 57
PEDIATRIC PERITONEAL DIALYSIS
Prevalent pediatric PD patients, as of the end of 2004 ...... 421 Male ...... 47.1% Female ...... 52.9% 0-2 years of age...... 2.4% 3-6 years of age...... 9.9% 7-10 years of age ...... 22.4% 11-15 years of age ...... 33.9% 15+ years of age ...... 31.5%
Duration of dialysis in pediatric PD patients, as of the end of 2004 0-6 months ...... 12.1% 7-12 months ...... 17.9% 13-24 months ...... 21.2% 25-60 months ...... 30.8% 60+ months ...... 17.9%
PD treatment modality in pediatric PD patients, as of the end of 2004 CAPD ...... 53.4% APD ...... 46.6%
Percentage of pediatric PD patients under antihypertensive treatment ...... 63.5%
Hepatitis serology in pediatric PD patients, as of the end of 2004 HBsAg (+)...... 2.7% Anti-HCV Ab (+) ...... 1.9% Both HBsAg and Anti-HCV Ab (+) ...... 0.5%
Peritonitis in pediatric PD patients in 2004 Percentage of PD patients who experienced peritonitis ...... 33.9% Rate of peritonitis All PD patients ...... 1/25.7 months All CAPD patients ...... 1/35.5 months All APD patients ...... 1/24.3 months
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 59 PD treatment modality in pediatric PD patients as of the end of 2004
60 53.4 46.6
40
% of pts. 20
0 CAPD APD
Age distribution of prevalent pediatric PD patients (2004)
40 33.9 31.5 30 22.4 20
% of pts. 9.9 10 2.4 0 0-2 >2-6 >6-10 >10-15 >15 Years of age
Hepatitis serology in pediatric PD patients (2004)
4
3 2.7
1.9 2 % of pts. 1 0.5
0 HBsAg (+) Anti-HCV (+) HBsAg (+) and Anti-HCV (+)
60 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Peritonitis in pediatric PD patients (2004)
80 66.1 60
40 23.5 % of pts. 20 6.1 4.3 0 None 1 2 >2 Number of episodes
Discussion
One-third of the PD patients are younger than 10 years old, as of the end of 2004. PD duration is more than 2 years in nearly 50% of the patients. PD duration for 18% of the patients is more than 5 years. The proportion of APD patients is 47%. The proportions of positivity of hepatitis serology are lower than HD patients; HBsAg (+) 3.2% and anti-HCV Ab (+) 2.4%. Average peritonitis rate is found as 1/25.7 patient-months.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 61
PEDIATRIC RENAL TRANSPLANTATION
Incident pediatric RTx patients in 2004 ...... 59 Male ...... 50.8% Female ...... 49.2% 0-6 years of age...... 5.1% 7-10 years of age ...... 6.8% 11-15 years of age ...... 45.8% 15+ years of age ...... 42.4% Living donor ...... 50.8% Cadaver...... 49.2%
Prevalent pediatric RTx patients, as of the end of 2004 ...... 279
Duration of waiting of pediatric patients transplanted in 2004 Preemptive Tx ...... 12.7% <6 months ...... 20.8% 6-12 months ...... 5.5% 13-24 months ...... 25.5% 25-60 months ...... 29.1% >60 months ...... 7.3%
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 63 Age distribution of incident pediatric RTx patients (2004)
60 45.8 42.4 40
% of pts. 20 5.1 6.8
0 0-6 >6-10 >10-15 >15 Years of age
Duration of waiting of pediatric patients transplanted (2004)
40
29.1 25.5 20.8 20 12.7 % of pts. 7.3 5.5
0 Preemptive <6 months 6-12 13-24 25-60 >60 Tx months months months months
Discussion
The number of RTxs performed in 2004 is 59. This figure is similar to the last year. The donors in half of the RTxs are living related donors. The duration of waiting on dialysis is more than 2 years in 36% of pediatric RTx patients.
64 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004
Comparative Figures from World and Turkey
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 65
Figure 1. Worldwide incident rates (per million population)* (USRDS 2004).
* Data represent the most current information available (primarily 2002). Data from Israel, Japan, Luxembourg, & Taiwan represent dialysis only.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 67 Figure 2. European countries/regions contributing to ERA-EDTA Registry (ERA-EDTA registry newsletter, December 2004).
Registries contributing individual patient data to the ERA-EDTA Registry database Registries sending aggregated data to be included in the annual report No registry / no contribution / data not eligible for analysis
68 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 3. Incidence of ESRD in some countries in 2003 (USRDS 2004).
Taiw an
United States
Japan
Qatar
Israel
Germany
Belgium
Greece
Spain/Canary Islands
Spain/Valencia
Canada
Spain/Catalonia
Luxembourg
Uruguay
Austria
Korea (Repub of)
Denmark
Chile
Sw eden Turkey 122 Croatia
New Zealand
Scotland
Netherlands
Poland
Malaysia
Australia
Norw ay
Spain/Basque Country
Finland
Iceland
Latvia
Philippines
Russia
Bangladesh
0 100 200 300 400 Rate per million population
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 69 Figure 4. Prevalence of ESRD in some countries in 2003 (USRDS 2004).
Japan
Taiw an
United States
Spain/Valencia
Spain/Catalonia
Spain/Canary Islands
Germany
Canada
Spain/Basque Country
Belgium
Greece
Uruguay
Austria
Sw eden
Chile
Denmark
Korea, Republic of
Scotland
Croatia
New Zealand
Israel
Australia
Netherlands
Norw ay
Finland
Qatar
Luxembourg
Iceland
Malaysia
Poland Turkey 387.5 Latvia
Russia
Bangladesh
Philippines
0 300 600 900 1200 1500 1800 Rate per million population
70 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 5. Prevalent dialysis patients by modality in some countries in 2003 (USRDS 2004).
In-center HD Home HD PD
Bangledesh
Luxembourg
Japan
Chile
Spain/Catalonia
Germany
Uruguay
Russia
Taiw an
Spain/Valencia
Austria
United States
Croatia
Spain/Canary Islands
Qatar
Greece
Israel
Poland
Belgium
Malaysia
Turkey
Norw ay
Canada
Finland
Korea
Scotland
Denmark
Sw eden
Spain/Basque Country
Netherlands
Iceland
Australia
New Zealand
0 20 40 60 80 100 % of pts.
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 71 Figure 6. Transplant rates in some countries in 2003 (USRDS 2004).
Spain/Canary Islands
Spain/Catalonia
United States
Spain/Valencia
Norw ay
Austria
Qatar
Netherlands
Sw eden
Canada
Luxembourg
Finland
Denmark
Australia
New Zealand
Belgium
Germany
Scotland
Uruguay
Poland
Israel
Greece
Iceland
Taiw an
Chile
Korea, Republic of Turkey 8.1 Malaysia
Spain/Basque Country
Thailand
Philippines
Russia
Bangladesh
0 20 40 60 80 Rate per million population
72 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Figure 7. Prevalence of functioning graft in some countries in 2003 (USRDS 2004).
Spain/Canary Islands
Spain/Catalonia
Norw ay
United States
Spain/Valencia
Sw eden
Austria
Spain/Basque Country
Finland
Belgium
Canada
Netherlands
Scotland
Australia
New Zealand
Denmark
Qatar
Iceland
Germany
Chile
Korea, Republic of
Greece
Poland
Uruguay
Croatia
Malaysia
Turkey 37.9
Thailand
Russia
Bangladesh
Philippines
0 200 400 600 Rate per million population
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 73 Table 1. Total RRT expenses in Turkey, France, Germany, Japan and USA (Erek et al. Nephrology 2004; 9: 33-38).
Total RRT expenses ($)
Treatment modality Turkey France Germany Japan U.S.A. HD 22.759 78.947 44.500 46.000 46.000 CAPD 22.350 23.684 29.000 - 41.000 APD 25.714 - - - 35.545 RTx (first year) 23.393 29.605 40.000 50.000 60.000 RTx (second year) 10.028 - - 19.000 27.000
Table 2. Annual growth rate of world population and number of ESRD, HD, PD and RTx (ESRD patients, 2003, p. 4. Fresenius M.C.)
Approximate annual growth rates
World population 1.2%
ESRD 6%
HD 6%
PD 6%
RTx 5%
Table 3. World population and number of ESRD, HD, PD and RTx patients. (ESRD patients in 2003, p. 4. Fresenius M.C.)
ESRD patients 1.681.000
HD 1.158.000
PD 141.000
RTx 382.000
World population 6.3 billion
Table 4. Gross mortality rate in Turkey and world. (Nephrol Dial Transplant 2002; 17: 2092).
Expansion rate of Gross mortality rate of RRT stock (%) RRT patients (%)
USA (1999) 9 19.7 Japan (1997) 7.8 9.3 EU (15 countries) 8.2 (2.3-13) 10.4a TURKEY 17b 9.4
a Death range on RRT in Europe (pmp) is 35-89. b HD 18.5%, CAPD 6%, RTx 1.7%.
74 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004
CENTERS INCLUDED IN THE REGISTRY
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 75
CENTERS INCLUDED IN THE REGISTRY in alphabetical order by cities
Center No City Name of center Responsible person code 1 21EAA ADANA ADANA NUMUNE EĞİTİM VE ARŞ. HST. SIDDIG MOMİN ADAM 2 21BJA ADANA ADANA SSK HST. ELİF GÜRBÜZ KASIM YILDIZER 3 21SDA ADANA BAŞKENT Ü ADANA ARŞ. VE UYG. MERKEZİ PEDİYATRİ ÜMİT SAATÇİ 4 21DPA ADANA BAŞKENT ÜNİVERSİTESİ ADANA HST. DİLEK TORUN 5 21AKA ADANA ÇUKUROVA ÜTF MERKEZİ SAİME PAYDAŞ 6 21LVA ADANA ÇUKUROVA ÜTF PEDİYATRİ ALİ ANARAT 7 21MPA ADANA FRESENİUS ADANA DİYALİZ MERKEZİ SIDDIK MONİN ADAM 8 21WLA ADANA FRESENİUS GÜNEYDOĞU ADANA DİYALİZ MERKEZİ PINAR ERGİN 9 21BZA ADAPAZARI ÖZEL SAKARYA NEFROMED DİYALİZ MERKEZİ SEDAT AYDIN 10 21DLA ADAPAZARI SSK ADAPAZARI HST. BÜLENT KARAMAN 11 21CNA ADIYAMAN ADIYAMAN DEVLET HST. ABDULKADİR DEMİR 12 21RPA ADIYAMAN FRESENİUS ADIYAMAN DİYALİZ MERKEZİ 13 21UMA ADIYAMAN GÖLBAŞI DEVLET HST. HÜSEYİN ÖZTOP 14 21FSA AFYON AFYON DEVLET HST. A.KADİR ERÇOLAK 15 21MHA AFYON AFYON ÖZEL DİYALİZ MERKEZİ GÜLDANE ÇETİNKAYA 16 21PCA AFYON AFYON SKK HST. HASAN SUNGUR 17 21PUA AFYON BOLVADİN DEVLET HST. ALİ OSMAN AVCI 18 21SGA AFYON ÇAY DEVLET HST. ÖZCAN ÇELİK 19 21MNA AFYON DİNAR DEVLET HST. HÜLYA ÜNAL ŞENCAN 20 21LHA AFYON SANDIKLI DEVLET HST. BANU ERKALKAN 21 21KNA AĞRI AĞRI DEVLET HST. YASİN TAŞDEMİR 22 21EZA AKSARAY AKSARAY DEVLET HST. AHMET AYDOĞDU 23 21CBA AMASYA MERZİFON DEVLET HST. ALİ SEZGİN 24 21FTA AMASYA SABUNCUOĞLU ŞEREFEDDİN DEVLET HST. RUHİ KALAYCIOĞLU 25 21EYA ANKARA ANKARA ATATÜRK EĞİTİM VE ARŞ.HST. HÜLYA GÜVENCE 26 21KHA ANKARA ANKARA NEFROMED GÖRKEM TIP ALEV ÖZSARI 27 21AJA ANKARA ANKARA ÜTF İBN-İ SİNA HST. 28 21KDA ANKARA ANKARA ÜTF PEDİYATRİ MESİHA EKİM 29 21.Ara ANKARA BAŞKENT ÜTF NURHAN ÖZDEMİR 30 21NKA ANKARA BAŞKENT ÜTF PEDİYATRİ ÜMİT SAATÇİ 31 21RCA ANKARA BEYPAZARI DEVLET HST. SERDAR ŞİRİN 32 21NQA ANKARA ÇINAR DİYALİZ MERKEZİ MANSUR KAYATAŞ 33 21VNA ANKARA ÇUBUK DEVLET HST. RAHMAN SİYAHHAN 34 21EDA ANKARA DR. SAMİ ULUS ÇOCUK SAĞLIĞI VE HAST. HST. AYŞE ÖNER 35 21GRA ANKARA ECE DİYALİZ MELTEM AYLI 36 21VWA ANKARA FATİH ÜNİVERSİTESİ HST. TANJU İNANÇ 37 21GXA ANKARA FRESENİUS SAĞLIK HİZMETLERİ YAŞAM DİYALİZ M.DENİZ AVCI MERKEZİ 38 21GYA ANKARA GAMBRO DİYALİZ MERKEZİ CANAN VAR 39 21ADA ANKARA GATA NEFROLOJİ BD İZZET YAVUZ 40 21AUA ANKARA GAZİ ÜTF NEFROLOJİ BD ŞÜKRÜ SİNDEL 41 21NHA ANKARA GAZİ ÜTF PEDİYATRİ 42 21HDA ANKARA GÜNEŞLİ DİYALİZ MERKEZİ ABDÜLGAFFAR VURAL 43 21AFA ANKARA HACETTEPE ÜTF ÇETİN TURGAN 44 21LNA ANKARA HACETTEPE ÜTF PEDİYATRİ AYŞİN BAKKALOĞLU 45 21LQA ANKARA ÖZEL GÖNÜL DİYALİZ MERKEZİ MÜZEYYEN IŞIKMAN GÖNÜL ALTUN 46 21YDA ANKARA POLATLI DUATEPE DEVLET HST. DOĞAN ÇİFTÇİ CAHİT YALÇIN 47 21UXA ANKARA S. KOÇHİSAR DEVLET HST. AHMET NOYAN 48 21YMA ANKARA SAĞLIK BAKANLIĞI DIŞKAPI ÇOCUK HAST. EĞT. VE ARŞ. NİLGÜN ÇAKAR HST. NAZLI KARA 49 21BKA ANKARA SB. ETLİK İHTİSAS HST. TURGAY BAŞAY 50 21YCA ANKARA SEVGİ DİYALİZ MERKEZİ İZZET YAVUZ 51 21ZKA ANKARA SİNCAN KOÇ DİYALİZ MERKEZİ AHMET DİRİKOÇ
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 77 Center No City Name of center Responsible person code 52 21AHA ANKARA TÜRKİYE YÜKSEK İHTİSAS HST. MEDİHA BORAN 53 21YKA ANTAKYA ANTAKYA EMİR DİYALİZ MERKEZİ İDRİS EMİR 54 21YAA ANTALYA ADALİA DİYALİZ MERKEZİ HALİM YAVUZ 55 21KJA ANTALYA AKDENİZ ÜTF PEDİYATRİ AYŞE GÜR GÜVEN 56 21SHA ANTALYA ALANYA DEVLET HST. ERDEM BABACAN 57 21VVA ANTALYA ANTALYA BAŞKENT ÜNİVERSİTESİ HST. HÜSEYİN ÇELİK 58 21HPA ANTALYA ANTALYA DEVLET HST. METİN SARIKAYA 59 21PVA ANTALYA ANTALYA DEVLET HST. PEDİYATRİ 60 21GWA ANTALYA CAN DİYALİZ MERKEZİ MÜJDAT YENİCESU 61 21UUA ANTALYA ELMALI DEVLET HST. ÖZER YAZICI 62 21PKA ANTALYA FİNİKE DEVLET HST. ENVER AYAR 63 21GSA ANTALYA FRESENİUS ANTALYA TATİL DİYALİZ MERKEZİ METİN SARIKAYA 64 21VGA ANTALYA KORKUTELİ DEVLET HST. KEMAL ALADAĞLI 65 21VHA ANTALYA MANAVGAT DEVLET HST. SAİD ÖZER 66 21LBA ANTALYA NEFROTALYA NEFROLOJİ MERKEZİ GÜLTEKİN SÜLEYMANLAR 67 21PGA ANTALYA OLBİA DİYALİZ MERKEZİ MUZAFFER SAPAN 68 21BRA ANTALYA ÖZEL CAN HST. YAMAN ERSOY 69 21BYA ANTALYA SSK ANTALYA BÖLGE HST. NEVCAN AKTUĞ 70 21AZA ANTALYA AKDENİZ ÜTF HST. F.FEVZİ ERSOY 71 21JUA ARDAHAN ARDAĞAN DEVLET HST. NEJAT AKIN 72 21DDA ARTVİN ARTVİN DEVLET HST. ENVER AKBAŞ 73 21JYA ARTVİN HOPA DEVLET HST. EGEMEN ARIKAN 74 21UWA ARTVİN ŞAVŞAT DEVLET HST. YAVUZ AKALTUN 75 21PPA AYDIN ADNAN MENDERES ÜTF HARUN AKAR 76 21YVA AYDIN ADNAN MENDERES ÜTF PEDİYATRİ FERAH SÖNMEZ 77 21DHA AYDIN AYDIN DEVLET HST. ÜLGER AVCI 78 21BEA AYDIN AYDIN SSK HST. KADİR SARI 79 21RNA AYDIN GÜNEŞ ÖZEL DİYALİZ MERKEZİ OSMAN GÖK 80 21URA AYDIN KUŞADASI DEVLET HST. BÜLENT ILDIZ 81 21KFA AYDIN NAZİLLİ DEVLET HST. YAŞAR GÜNDOĞDU 82 21STA AYDIN ÖDEMİŞ İKİNCİ BAHAR DİYALİZ MERKEZİ GÜNAY ÖNDER 83 21GZA AYDIN ÖZEL AYDIN DİYALİZ MERKEZİ ÜLGER AVCI 84 21RDA AYDIN ÖZEL KUŞADASI HST. YUSUF TUNA 85 21VFA AYDIN SÖKE FEHİME KOCAGÖZ DEVLET HST. ORHAN YAVUZ 86 21ZPA AYDIN VOLAKA DİYALİZ MERKEZİ 87 21KKA BALIKESİR AYVALIK DEVLET HST. MEVLUT HAMAMCI 88 21HJA BALIKESİR BALIKESİR ATATÜRK DEVLET HST. O.NURİ TOPAL 89 21CXA BALIKESİR BALIKESİR DEVLET HST. SEZGİN ÇETİN 90 21FUA BALIKESİR BURHANİYE DEVLET HST. RIZA TOKSOY 91 21CZA BALIKESİR DR. M. GÜVEN KARAHAN BANDIRMA DEVLET HST. ERHAN ÇOLAK 92 21TPA BALIKESİR EDREMİT DEVLET HST. MEHMET TEMELLİ 93 21CHA BALIKESİR GÖNEN DEVLET HST. SEYFULLAH AKKILIÇ 94 21WWA BALIKESİR ÖZEL UMUT HEMODİYALİZ MERKEZİ AYHAN AĞAOĞLU 95 21CDA BARTIN BARTIN DEVLET HST. ŞAHİN ÇEÇEN 96 21GQA BATMAN BATMAN DEVLET HST. FADIL EDEBALİ 97 21KTA BAYBURT BAYBURT DEVLET HST. HÜSEYİN TÜRKER 98 21JGA BİLECİK BİLECİK DEVLET HST. BAHRİ GÜNDOĞAN 99 21VRA BİLECİK BOZÜYÜK ERTUĞRUL GAZİ DEVLET HST. SÜLEYMAN EKİZ 100 21LCA BİNGÖL BİNGÖL DEVLET HST. MEHMET YILDIRIM 101 21TQA BİTLİS BİTLİS DEVLET HST. FİKRET BAŞTIMAR 102 21FRA BOLU DÜZCE DEVLET HST. MUSTAFA EROĞLU 103 21FQA BOLU İZZET BAYSAL BOLU DEVLET HST. NATAY TUĞRUL 104 21WMA BOLU ÖZEL NEFRO BOLU HEMODİYALİZ GÜLDEHEN AKBAŞ 105 21MZA BURDUR BUCAK DEVLET HST. İBRAHİM AYDIN 106 21BNA BURDUR BURDUR DEVLET HST. MEHMET BÜLBÜL 107 21UZA BURDUR GÖLHİSAR DEVLET HST. TARKAN HAYDAROĞLU 108 21CTA BURSA BURSA DEVLET HST. MEHMET USTA 109 21LRA BURSA BURSA ULUDAĞ PEDİATRİ OSMAN DÖNMEZ 110 21VKA BURSA BURSA YÜKSEK İHTİSAS EĞİTİM VE ARŞ. HST. ALTAY TÜRKSÖZ 111 21DNA BURSA ÇEKİRGE DEVLET HST. ŞENİZ SEVİNİR
78 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Center No City Name of center Responsible person code 112 21JPA BURSA DİAMED ÖZEL DİYALİZ MERKEZİ UMUR DORA 113 21MCA BURSA İNEGÖL DEVLET HST. İ.HALİL SÖZMEN 114 21UNA BURSA İZNİK DEVLET HST. ÜMİT AYÇİÇEK 115 21WZA BURSA KARACABEY DEVLET HST. ARİF ÜNAL 116 21MSA BURSA MUSTAFA KEMAL PAŞA DEVLET HST. HÜSEYİN ERENER 117 21ZRA BURSA ÖZEL MUSTAFA KEMALPAŞA DİYALİZ MERKEZİ HÜSEYİN ERENER 118 21ZSA BURSA R. T. S. ÖZEL DİYALİZ ERDOĞAN GÜL 119 21HCA BURSA REN TIP ÖZEL DİYALİZ MERKEZİ N.İLAY OKTAY 120 21ALA BURSA ULUDAĞ ÜTF NEFROLOJİ BD MUSTAFA GÜLLÜLÜ 121 21MBA ÇANAKKALE ÇANAKKALE ÇAN DEVLET HST. SABRİ KÖSE RAMAZAN DOĞRU 122 21EBA ÇANAKKALE ÇANAKKALE DEVLET HST. ALİ DEĞİRMENCİ 123 21HUA ÇANAKKALE ÇANAKKALE DİYALİZ SAĞLIK YARDIM VE KÜLTÜR VAKFI SEMRA MENGÜ DİYALİZ MERKEZİ 124 21ZEA ÇANAKKALE ÖZEL ÇANAKKALE MİLLET DİYALİZ MERKEZİ KAYHAN TANGÖR 125 21ECA ÇANKIRI ÇANKIRI DEVLET HST. AYKUT BAŞER 126 21MKA ÇORUM ALACA DEVLET HST. YASİN CENGİZ 127 21FVA ÇORUM ÇORUM DEVLET HST. RECEP BURHANOĞLU 128 21TRA ÇORUM İSKİLİP DEVLET HST. ENGİN DEĞİRMENCİ 129 21FLA ÇORUM SSK ÇORUM HST. TİMUR HARZADIN 130 21LXA ÇORUM SUNGURLU DEVLET HST. SEZGİN BAŞKAN 131 21ULA DENİZLİ ÇİVRİL DEVLET HST. HAYRULLAH SERT 132 21CWA DENİZLİ DENİZLİ DEVLET HST. REMZİ DÜNDAR 133 21CLA DENİZLİ ERPA ÖZEL SAĞLIK HST. REMZİ DÜNDAR 134 21GTA DENİZLİ PAMUKKALE DİYALİZ MERKEZİ NECDET DOĞAN 135 21NYA DENİZLİ PAMUKKALE ÜTF NEFROLOJİ BD MURAT ÇOLAKOĞLU 136 21BDA DİYARBAKIR DİCLE ÜTF M.EMİN YILMAZ 137 21CJA DİYARBAKIR DİYARBAKIR DEVLET HST. HASAN TURAN 138 21PQA DİYARBAKIR ÖZEL DİYARBAKIR DİYALİZ MERKEZİ UĞUR NEDİM YÜCE 139 21FNA DİYARBAKIR SSK DİYARBAKIR HST. ŞENER CİHAN 140 21WAA DÜZCE ÖZEL DÜZCE DİYALİZ MERKEZİ RAMAZAN ATAGÜN 141 21KBA EDİRNE EDİRNE DEVLET HST. ASLAN SEFER 142 21KEA EDİRNE KEŞAN DEVLET HST. FİKRİ ŞENTÜRK 143 21ZAA EDİRNE SELİMİYE DEVLET HST. HÜSEYİN AKPINAR 144 21FFA EDİRNE TRAKYA ÜTF HST. SEDAT ÜSTÜNDAĞ 145 21VBA EDİRNE UZUNKÖPRÜ DEVLET HST. SAMİ AYDIN 146 21FXA ELAZIĞ ELAZIĞ DEVLET HST. ÖZLEM ERDİNÇ 147 21YHA ELAZIĞ ELAZIĞ HARPUT DEVLET HST. MEHMET ÇİNKILINÇ 148 21DQA ELAZIĞ FIRAT ÜNİVERSİTESİ FIRAT TIP MERKEZİ HÜSEYİN ÇELİKER 149 21CRA ERZİNCAN ERZİNCAN DEVLET HST. ADALET ÖZÇİÇEK 150 21LSA ERZİNCAN ERZİNCAN SSK HST. ÖZER TERZİOĞLU 151 21ATA ERZURUM ATATÜRK ÜTF ALİ RIZA ODABAŞ 152 21DGA ERZURUM ERZURUM NUMUNE HST. DEMET YİĞİT 153 21CFA ERZURUM ERZURUM SSK HST. SELİM ATAMAN 154 21EKA ESKİŞEHİR ESKİŞEHİR DEVLET HST. BÜLENT ÖZGÜR 155 21BWA ESKİŞEHİR ONYAK HEMODİYALİZ MERKEZİ İNCİ KİPER 156 21MDA ESKİŞEHİR RTS YAŞAM DİYALİZ MERKEZİ MEHMET EROL 157 21HFA ESKİŞEHİR SSK ESKİŞEHİR BÖLGE HST. NECDET ATALIK 158 21AYA ESKİŞEHİR OSMANGAZİ ÜTF HST. MEHMET SOYDAN 159 21EEA GAZİANTEP GAZİANTEP AV. CENGİZ GÖKÇEK DEVLET HST. NECATİ BİLGİN 160 21FPA GAZİANTEP GAZİANTEP SSK HST. GALİP AKSOY 161 21WYA GAZİANTEP GAZİANTEP ÜTF CELALETTİN USULAN 162 21UVA GAZİANTEP NİZİP DEVLET HST. VERDA ERBEKTE 163 21TUA GAZİANTEP ÖZEL GÜNEYDOĞU HEMODİYALİZ EMRKEZİ NECATİ BİLGİN 164 21YRA GAZİANTEP GAZİANTEP ÜTF PEDİYATRİ AYŞE BALAT 165 21EGA GİRESUN GİRESUN DEVLET HST. ALPER AK 166 21NMA GİRESUN GÖREK DEVLET HST. MEHMET ÖZKAN 167 21NPA GİRESUN TİREBOLU DEVLET HST. SELAHATTİN BOZKURT 168 21FWA GÜMÜŞHANE GÜMÜŞHANE DEVLET HST. ZEYNEL BAYRAKTAR 169 21SJA HAKKARİ HAKKARİ DEVLET HST. MEDENİ ŞERMET
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 79 Center No City Name of center Responsible person code 170 21FYA HATAY ANTAKYA DEVLET HST. İDRİS EMİR MUSA YÜKSEKGÖNÜL 171 21MMA HATAY BAŞKENT ÜNİVERSİTESİ İSKENDERUN DİYALİZ MERKEZİ ZEKİ GÖLOĞLU 172 21YEA HATAY FRESENİUS GÜNEYDOĞU DİYALİZ HİZM. LTD. ŞTİ. MUSA YÜKSEKGÖNÜL ANTAKYA ŞUBESİ 173 21JZA HATAY HATAY İSKENDERUN DEVLET HST. MUSTAFA ALÇIKAYA 174 21RUA HATAY İSKENDERUN RNC HEMODİYALİZ MERKEZİ MUSTAFA ALÇIKAYA 175 21KLA IĞDIR IĞDIR DEVLET HST. EMİN AKYILDIZ 176 21BPA ISPARTA ISPARTA DEVLET HST. TAHSİN MİNKAR 177 21MTA ISPARTA MEDİANT ISPARTA ÖZEL DİYALİZ MERKEZİ NEŞE TUNÇ 178 21KAA ISPARTA SÜLEYMAN DEMİREL ÜNİVERSİTESİ M. TUĞRUL SEZER 179 21WQA ISPARTA SÜLEYMAN DEMİREL ÜTF PEDİYATRİ FARUK ÖKTEM 180 21SKA ISPARTA YALVAÇ DEVLET HST. ERDOĞAN YAVUZ 181 21VQA İÇEL TARSUS DEVLET HST.SAĞLIK EĞİTİM VAKFI DİYALİZ MAHMUT AKGÖZ MERKEZİ 182 21HVA İSTANBUL AVCILAR HAYAT HST. TANER YÜCETÜRK 183 21AXA İSTANBUL BAŞKENT ÜNİVERSİTESİ İSTANBUL DİYALİZ MERKEZİ METİN ERMAN 184 21LAA İSTANBUL BAYRAKTAR DİYALİZ MERKEZİ KEMAL ÖNEN 185 21FBA İSTANBUL DİAMED A.Ş. YILDIZ BARUT 186 21YZA İSTANBUL DİAMED ŞİŞLİ DİYALİZ MERKEZİ T.RIFKI EVRENKAYA 187 21WSA İSTANBUL DİYALİSANS DİYALİZ VE SAĞLIK HİZMETLERİ A.Ş. NAİL SUAT ÜNVER 188 21SQA İSTANBUL DOĞAN HST. MURAT KUYUMCU 189 21MWA İSTANBUL DR. LÜTFÜ KIRDAR KARTAL EĞİTİM VE ARŞ.HST. MUSTAFA TEKÇE 190 21PSA İSTANBUL DR. SADİ KAVUK EĞİTİM ARŞ.HST. NURSEL KORKMAZ 191 21PRA İSTANBUL DUYGU HST. MURAT MIHÇIOĞLU 192 21FGA İSTANBUL FATİH SULTAN MEHMET EĞİTİM VE ARŞ.HST. SEHER RAHİME KEBAPCIOĞLU 193 21SNA İSTANBUL FRESENİUS EKOMED DİYALİZ MERKEZİ ELBİS AHBAP 194 21HWA İSTANBUL FRESENİUS SAĞLIK HİZMETLERİ A. Ş. AVCILAR ŞUBESİ A. HALİT EROL 195 21BBA İSTANBUL GATA HAYDARPAŞA EĞİTİM HST.NEFROLOJİ SERVİSİ SUAT ÜNVER 196 21TGA İSTANBUL GAZİEMİR DİYALİZ MERKEZİ PINAR ÜRETMEN 197 21TNA İSTANBUL GÖK HEMODİYALİZ MERKEZİ PINAR SEYMEN 198 21AQA İSTANBUL HAYDARPAŞA NUMUNE HST. YILDIZ BARUT FUNDA TÜRKMEN 199 21PTA İSTANBUL IŞIL SAĞLIK HİZMETLERİ-ÇAMLICA MEDİCAM DİYALİZ MEHMET ALİ TARIM 200 21ACA İSTANBUL İ. Ü.CERRAHPAŞA TIP FAKÜLTESİ DİYALİZ MERKEZİ EKREM EREK 201 21DBA İSTANBUL İNTERNATİONAL HOSPİTAL ALİ GÜRÇAY 202 21MQA İSTANBUL İSTANBUL ÖZEL MERTER VATAN DİYALİZ MERKEZİ YALÇIN ÖZBAHAR 203 21AWA İSTANBUL İSTANBUL REN-MED DİYALİZ MERKEZİ NEDİM SARSMAZ 204 21AAA İSTANBUL İSTANBUL TF PEDİYATRİ AYDAN ŞİRİN 205 21DVA İSTANBUL İSTANBUL Ü CERRAHPAŞA TF PEDİYATRİ LALE SEVER 206 21ABA İSTANBUL İSTANBUL ÜTF NİLGÜN AYSUNA 207 21PJA İSTANBUL İSTİNYE DEVLET HST. YALÇIN ÖZBAHAR 208 21KYA İSTANBUL KOŞUYOLU ATA HEMODİYALİZ MERKEZİ DAVİD ÇUKRAN 209 21PWA İSTANBUL KOZYATAĞI DİYALİZ MERKEZİ FUAD KARSLI 210 21LDA İSTANBUL KÜÇÜKYALI DİYALİZ MERKEZİ SALİH ÖNCEL 211 21DMA İSTANBUL MARMARA ÜNİVERSİTESİ KADİR HAS SERHAN TUĞLULAR 212 21TVA İSTANBUL MARMARA ÜTF PEDİYATRİ HARİKA ALPAY 213 21NAA İSTANBUL MEDİKARE DİYALİZ MERKEZİ HAKAN KAPTANOĞLU 214 21RLA İSTANBUL ÖZEL BAHÇELİEVLER DİYALİZ MERKEZİ MEHMET ŞÜKRÜ SEVER 215 21WBA İSTANBUL ÖZEL ÇAPA HST. MEHMET EMİN YILMAZ 216 21WNA İSTANBUL ÖZEL GAZİOSMANPAŞA HST. MUSTAFA CANBAKAN 217 21NWA İSTANBUL ÖZEL KARAMAN DİYALİZ MERKEZİ ENVER BERBER 218 21LTA İSTANBUL ÖZEL KARTAL HST. MEHMET ALİ ÇOBANOĞLU 219 21LZA İSTANBUL ÖZEL MALTEPE ONUR DİYALİZ MERKEZİ BİLGİN ÇAPANOĞLU 220 21PEA İSTANBUL ÖZEL RENİN DİYALİZ MERKEZİ ZERRİN EREN 221 21SSA İSTANBUL ÖZEL SİLİVRİ MİLLET HST. GÜNAY DOĞAN 222 21NNA İSTANBUL ÖZEL UMUT DİYALİZ MERKEZİ MUAZZEZ SEZER CAYMAZ 223 21JBA İSTANBUL ÖZEL YAŞAR HST. GÜRKAN YURTERİ 224 21NUA İSTANBUL ÖZEL ZEYTİNBURNU DAMLA DİYALİZ MERKEZİ AYDOĞAN ÖBEK 225 21BVA İSTANBUL ÖZGÖZÜKARA DİYALİZ MERKEZİ ABDULLAH ÖZGÖZÜKARA
80 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Center No City Name of center Responsible person code 226 21LYA İSTANBUL PENDİK DEVLET HST. GÜLÇİN KANTARCI 227 21BTA İSTANBUL RTS TRANSMED DİYALİZ MERKEZİ FATMA KARAKULLUKÇU 228 21YSA İSTANBUL S.B HASEKİ EĞİTİM VE ARŞ. HST. 229 21ANA İSTANBUL SAĞLIK BAKANLIĞI İSTANBUL EĞİTİM VE ARŞ.HST. MİNE BESLER 230 21JHA İSTANBUL SAĞLIKLI YAŞAM DİYALİZ MERKEZİ ERALP KUYUCU 231 21ZCA İSTANBUL SSK BAKIRKÖY DOĞUMEVİ VE ÇOCUK HST. GÖNÜL AYDOĞAN 232 21BAA İSTANBUL SSK GÖZTEPE EĞT. HST. HÜLYA ERGİN 233 21SMA İSTANBUL SSK GÖZTEPE EĞT. VE ARŞ. HASTANESİ PEDİYATRİ 234 21DZA İSTANBUL SSK NİŞANTAŞI DİYALİZ MERKEZİ VEDAT ÇELİK 235 21ZJA İSTANBUL SULTANBEYLİ DİYALİZ MERKEZİ SERHAT AZİZERLİ 236 21MAA İSTANBUL ŞAHVA REŞİTPAŞA DİYALİZ MERKEZİ TUNCER PAKİZ 237 21EFA İSTANBUL ŞİŞLİ ETFAL EĞİTİM VE ARŞ.HST. ABDÜLKADİR ÜNSAL 238 21TXA İSTANBUL ŞİŞLİ ETFAL HASTANESİ PEDİYATRİ GÜL ÖZÇELİK 239 21BUA İSTANBUL TEPEBAŞI VATAN HST. Ekrem EREK 240 21CEA İSTANBUL TÜRK BÖBREK VAKFI AHMET ERMİŞ HST. BİLAL GÖRÇİN 241 21KVA İSTANBUL TÜRKMED DİYALİZ MERKEZİ ÇETİN ÖZENER 242 21NJA İSTANBUL ÜMRANİYE ATA DİYALİZ MERKEZİ GÜNDÜZ GÜVEN 243 21FZA İZMİR AYTUN ÇIRAY ÖDEMİŞ DEVLET HST. BARAN ARAL 244 21DTA İZMİR BAŞKENT ÜNİVERSİTESİ ZÜBEYDE HANIM UYGULAMA VE YELDA ÇINAR ARAŞTIRMA MERKEZİ 245 21JVA İZMİR BERGAMA DEVLET HST. YILDIRIM KEMAL ÖNER 246 21MGA İZMİR ÇEŞME DEVLET HST. NEBİL UĞURSAL 247 21MJA İZMİR ÇİĞLİ DEVLET HST. ASSLI KILAVUZ 248 21BMA İZMİR DOKUZ EYLÜL HST. AYKUT SİFİL 249 21TYA İZMİR DOKUZ EYLÜL ÜTF PEDİYATRİ SALİH KAVUKÇU 250 21NXA İZMİR DR. ERTUĞRUL AKER TİRE DEVLET HST. UĞUR GÖNENÇ 251 21CGA İZMİR DR.BEHÇET UZ ÇOCUK SAĞLIĞI VE HAST. EĞT VE ARŞ. MUSTAFA BAK HST. 252 21SUA İZMİR EGE GÜNEŞ DİYALİZ MERKEZİ UFUKÜNER 253 21CKA İZMİR EGE SAĞLIK VAKFI F. SEVGİ POSTOĞLU 254 21AEA İZMİR EGE ÜTF ALİ BAŞÇI 255 21KQA İZMİR EGE ÜTF PEDİYATRİ SEVGİ MİR 256 21KSA İZMİR EŞREFPAŞA BELEDİYE HST. SERDAR VARER 257 21LEA İZMİR FOÇA DEVLET HST. YILDIRAY ŞİMŞEK 258 21NZA İZMİR İKİNCİ YAŞAM DİYALİZ MERKEZİ İSMAİL İRFAN YALÇIN 259 21EHA İZMİR İZMİR ATATÜRK EĞİTİM VE ARŞ.HST. MUSTAFA CİRİT 260 21ZMA İZMİR İZMİR CENTRAL HOSPİTAL DİYALİZ MERKEZİ EROL SALK 261 21NVA İZMİR İZMİR SEVGİ DİYALİZ MERKEZİ ERDAL KARACA BANU KINAY 262 21PAA İZMİR İZMİR TEPECİK EĞT. VE ARŞ. HST. PEDİYATRİ NEŞAT AKSU 263 21WGA İZMİR NARLIDERE DİYALİZ MERKEZİ HASAN TÜRKOĞLU 264 21ZBA İZMİR NASIR DİYALİZ MERKEZİ MUSTAFA CİRİT 265 21HLA İZMİR ALSANCAK DEVLET HST. ERDAL KARACA 266 21RMA İZMİR ÖZEL ANKA DİYALİZ MERKEZİ MEHMET SONBAHAR 267 21ZLA İZMİR ÖZEL ÇİĞİLİ UMUT DİYALİZ MERKEZİ ASLI KILAVUZ 268 21NSA İZMİR ÖZEL EGE NEFROLOJİ DİYALİZ MERKEZİ GÜLAY AŞÇI 269 21GUA İZMİR ÖZEL İZMİR HST. ATİLLA ÜZÜM 270 21KWA İZMİR ÖZEL NEFRON KARŞIYAKA DİYALİZ MERKEZİ SONER DUMAN 271 21ASA İZMİR SSK TEPECİK EĞİTİM VE ARŞ.HST.ERİŞKİN HEMODİYALİZ FATİH AKMAN 272 21JJA İZMİR ŞİFA TIP MERKEZİ TUNCAY SOYAL 273 21BFA İZMİR TC SAĞLIK BAKANLIĞI İZMİR EĞİTİM VE ARŞ.HST. HÜSEYİN UZUNER 274 21UQA İZMİR TORBALI M. ENVER ŞENERDEM DEVLET HST. ERTUĞRUL UĞURTAŞ 275 21JWA İZMİR UĞUR DİYALİZ MERKEZİ A. ÖZLEM DURMUŞ 276 21UPA İZMİR URLA DEVLET HST. NİHAT KURTULUŞ 277 21UTA K. MARAŞ AFŞİN DEVLET HST. ŞAHİN SAYAN 278 21DEA K. MARAŞ DEVLET HST.HÜSNÜ ÖKSÜZ DİYALİZ MERKEZİ İSMET ÖNDER IŞIK 279 21MRA K. MARAŞ ELBİSTAN DEVLET HST. HAMDİ EKİCİ 280 21SWA K. MARAŞ FRESENİUS KAHRAMANMARAŞ DİYALİZ MERKEZİ ÖNDER IŞIK 281 21NTA KARABÜK KARABÜK VATAN HST. MUSTAFA YETKİN 282 21GLA KARAMAN KARAMAN DEVLET HST. ÖZCAN SERDOHAN
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 81 Center No City Name of center Responsible person code 283 21GAA KARS KARS DEVLET HST. SÜLEYMAN POYRAZ 284 21CSA KASTAMONU DR. MÜNİF İSLAMOĞLU KASTAMONU DEVLET HST. ADEM ERSOY 285 21SXA KASTAMONU İNEBOLU DEVLET HST. MEHMET ÖZBURAK 286 21LMA KASTAMONU TOSYA DEVLET HST. MURAT KARAKAŞ 287 21SYA KAYSERİ ERCİYES DİYALİZ MERKEZİ MEHMET DEMİRKAYA 288 21DRA KAYSERİ ERCİYES ÜNİVERSİTESİ SEMİHA KİBAR ORGAN NAKLİ VE RUHAN DÜŞÜNSEL HAKAN DİYALİZ MERKEZİ POYRAZOĞLU 289 21JCA KAYSERİ ERCİYES ÜTF PEDİYATRİ RUHAN DÜŞÜNSEL 290 21ELA KAYSERİ KAYSERİ DEVLET HST. SABİHA KARAYA 291 21FKA KAYSERİ KAYSERİ SSK BÖLGE HST. NEVZAT EKİNCİOĞLU 292 21UAA KAYSERİ ÖZEL MELİKGAZİ HST. ŞULE ULUSOY CENGİZ 293 21WCA KAYSERİ RTS AHMET DİYALİZ MERKEZİ OKTAY OYMAK 294 21YTA KIRIKKALE KIRIKKALE DİYALİZ MERKEZİ RAFET KOÇ 295 21FAA KIRIKKALE KIRIKKALE KADIN DOĞUM VE ÇOCUK HASTALIKLARI HST. RAFET KOÇ 296 21CQA KIRKLARELİ KIRKLARELİ DEVLET HST. SAFİ KARAL 297 21SZA KIRKLARELİ LÜLEBURGAZ DEVLET HST. MEHMET GÖRÇİN 298 21ZHA KIRKLARELİ ÖZEL DERMAN HST. ZEKİ PAKSOY 299 21YFA KIRKLARELİ ÖZEL ESEN DİYALİZ MERKEZİ ÖZLEM ESKİOĞLU 300 21JAA KIRŞEHİR KIRŞEHİR DEVLET HST. İSA TANYERİ 301 21LJA KİLİS KİLİS DEVLET HST. ABDULLAH ÖZAYTÜRK 302 21FMA KOCAELİ ATALİZ DİYALİZ MERKEZİ FERHAN LATİFE YAVUZ GÖKÇE 303 21DWA KOCAELİ DERİNCE DEVLET HST. MİNE ERKAN 304 21RYA KOCAELİ GÖLCÜK DEVLET HASAN ÇAKIR 305 21REA KOCAELİ KARAMÜRSEL DEVLET HST. BEYTİ KARACA 306 21PYA KOCAELİ KOCAELİ BÜYÜKŞEHİR BELEDİYESİ BELDE A. Ş DİYALİZ HASAN ÇAKIR MERKEZİ 307 21GCA KOCAELİ KOCAELİ DEVLET HST. BAYRAM KALAYCI 308 21NFA KOCAELİ KOCAELİ ÜTF AHMET YILMAZ 309 21WEA KOCAELİ KOCAELİ ÜTF PEDİYATRİ ZELAL BİRCAN 310 21VMA KOCAELİ M. KAZIM DİNÇ KANDIRA DEVLET HST. İSMAİL ERMAN 311 21TAA KOCAELİ NOVAK GEBZE DİYALİZ MERKEZİ KADİR FARUK DEMİRKOL 312 21UBA KOCAELİ ÖZEL MARUF DİYALİZ MERKEZİ FEVZİ AKÇINAR 313 21RKA KOCAELİ R. N. C. RENAL NEFROLOJİ MERKEZİ MUSTAFA AYDIN 314 21WKA KOCAELİ RENALİS DİYALİZ MERKEZİ HASAN DERMENCİ 315 21GDA KONYA AKŞEHİR DEVLET HST. İBRAHİM DUMAN 316 21ERA KONYA BEYŞEHİR DEVLET HST. ERSİN KOBANER 317 21UCA KONYA CİHANBEYLİ DEVLET HST. HALİL İBARAHİM TORUN 318 21HYA KONYA ÇUMRA DEVLET HST. SERAP SEZER 319 21TBA KONYA FRESENİUS KONYA DİYALİZ MERKEZİ ZEKİ TOMBUL 320 21DCA KONYA KONYA EREĞLİ DEVLET HST. CENGİZ ÇALIŞIR 321 21EPA KONYA KONYA NUMUNE HST. HALİL ÖZTÜRK 322 21ZQA KONYA ÖZEL İLGİ DİYALİZ MERKEZİ HÜSEYİN AKA 323 21MYA KONYA ÖZEL KONYA DİYALİZ MERKEZİ MELİH ANIL 324 21KXA KONYA ÖZEL ÖLMEZ HEMODİYALİZ MERKEZİ HASAN HULUSİ SUR 325 21WRA KONYA ÖZEL RTS BEYHEKİM DİYALİZ MERKEZİ BANU TEK 326 21DSA KONYA SELÇUK ÜTF LÜTFULLAH ALTINTEPE 327 21YLA KONYA SEYDİŞEHİR DEVLET HST. BEKİR BORAZAN 328 21RJA KONYA SİMAV DEVLET HST. MUSTAFA ÖZGÜN 329 21DXA KONYA SSK KONYA BÖLGE HST. MEHMET POLAT 330 21PMA KONYA TÜRKİYE SAĞLIK VE TEDAVİ VAKFI KONYA VAKIF HST. BEYHAN ULUER 331 21JDA KÜTAHYA DOÇ. DR. MUSTAFA KALEMLİ TAVŞANLI DEVLET HST. LÜTFÜ USLUER 332 21FJA KÜTAHYA EVLİYA ÇELEBİ DEVLET HST. FAHRETTİN DEMİRER 333 21UEA KÜTAHYA GEDİZ DEVLET HST. SAADETTİN HARMANDALI 334 21CPA KÜTAHYA KÜTAHYA DEVLET HST. MUSTAFA EKER 335 21HKA MALATYA FRESENİUS GÜNEYDOĞU HEMODİYALİZ MERKEZİ MUSTAFA ESENTÜRK 336 21FHA MALATYA İNÖNÜ ÜTF HÜLYA TAŞKAPAN 337 21HNA MALATYA MALATYA DEVLET HST. ERDAL GÖÇMEZ 338 21PZA MALATYA ÖZEL MALATYA HST. ERDAL GÖÇMEZ 339 21GBA MANİSA ALAŞEHİR DEVLET HST. ZAFER ULAŞAN
82 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 Center No City Name of center Responsible person code 340 21PNA MANİSA CELAL BAYAR ÜTF SEYHUN KÜRŞAT 341 21VYA MANİSA CELAL BAYAR ÜTF PEDİYATRİ 342 21RXA MANİSA DEMİRCİ DEVLET HST. NEJLA TÜRK ÇAKIR 343 21TCA MANİSA EGE-SA MANİSA ÖZEL DİYAZLİ MERKEZİ MEHMET ERTEM 344 21HMA MANİSA MANİSA DEVLET HST. PERİHAN TUNCA 345 21PXA MANİSA NEFRONEGE NEFROLOJİ MERKEZİ A.Ş. SAVAŞ PARMAKSIZOĞLU 346 21NLA MANİSA ÖZEL EGE DİYALİZ MERKEZİ İBRAHİM DİLEK 347 21LLA MANİSA SALİHLİ DEVLET HST. FİKRİ EROL 348 21TDA MANİSA SOMA DEVLET HST. AHMET AHŞEN 349 21ZNA MANİSA SOMA ÖZEL DİYALİZ MERKEZİ KADİR ÖZKAYA 350 21RWA MANİSA TURGUTLU DEVLET HST. CUMA ÖZGÜR 351 21MXA MERSİN ANAMUR NASİP ŞAHİN 352 21WPA MERSİN ATA MERSİN DİYALİZ MERKEZİ MEHMET OLCAY 353 21EJA MERSİN MERSİN DEVLET HST. MEHMET EMİN BAHÇE 354 21JXA MERSİN MERSİN SİLİFKE DEVLET HST. MEHMET FIRAT 355 21YYA MERSİN MERSİN ÜTF PEDİYATRİ ALİ DELİBAŞ 356 21KMA MERSİN RNC MERSİN DİYALİZ MERKEZİ NECATİ KIRALP 357 21RVA MERSİN SSK TARSUS HST. AHMET SEZER 358 21VCA MUĞLA 75. YIL MİLAS DEVLET HST. ÇETİN İNCE 359 21MEA MUĞLA BODRUM DEVLET HST. AKİF YILMAZ 360 21YGA MUĞLA FETHİYE DEVLET HST. BEHZAT GÜLER 361 21KCA MUĞLA MARMARİS DEVLET HST. TAYYİBE ERKENEZ 362 21CMA MUĞLA MUĞLA DEVLET HST. NEZİB TUNCAY 363 21NDA MUĞLA ÖZEL FETHİYE DİYALİZ MERKEZİ TALAT ÖRNEK 364 21VTA MUĞLA ÖZEL YÜCELEN HST. ŞAHİN AYDIN 365 21GEA MUŞ MUŞ DEVLET HST. MESUT ÇOLAK 366 21FDA NEVŞEHİR KAPADOKYA DİYALİZ MERKEZİ YUSUF KENAN İŞERİ 367 21ESA NEVŞEHİR NEVŞEHİR DEVLET HST. SEVDAL BİRMAN 368 21JSA NEVŞEHİR ÜRGÜP DEVLET HST. SÜLEYMAN EKMEN 369 21EUA NİĞDE NİĞDE DEVLET HST. TUNCAY GÜRBÜZ 370 21WTA NİĞDE NİĞDE ÖZEL HEMODİYALİZ MERKEZİ M. ATAKAN CANBULAT 371 21BXA ORDU ORDU DEVLET HST. HÜSEYİN SAĞLAM 372 21EMA ORDU ÜNYE DEVLET HST. ÖNDER BURSALI ADNAN BÜYÜKYAZICI 373 21MUA OSMANGAZİ OSMANGAZİ ÜTF PEDİYATRİ NURDAN KURAL 374 21WDA OSMANİYE FRESENİUS SAĞLIK HİZMETLERİ A.Ş. OSMANİYE DİYALİZ TURGAY GÜLER MERKEZİ 375 21JEA OSMANİYE OSMANİYE DEVLET HST. TURGAY GÜLER 376 21JTA OSMANİYE OSMANİYE KADİRLİ DEVLET HST. CENGİZ IŞIK 377 21EQA RİZE PAZAR DEVLET HST. RİNDOL CANKAR 378 21ENA RİZE RİZE DEVLET HST. CENGİZ DUYGULU 379 21DYA RİZE SSK RİZE BÖLGE HST. ALP ÖZATA 380 21VZA SAKARYA AKYAZI DEVLET HST. BİRCAN YARICI SEYRAN DOĞAN 381 21ZGA SAKARYA BİLGE HST. AYHAN AYDIN 382 21VDA SAKARYA KARASU DEVLET HST. SAMİ AYHAN 383 21CAA SAKARYA SAKARYA DEVLET HST. FERİT YAVUZ YILMAZ 384 21WFA SAKARYA SAKARYA GEYVE DEVLET HST. SERAP ÇELİK 385 21TEA SAKARYA SAKARYA HENDEK DEVLET HST. İSMAİL HAKKI BALİÇ 386 21EVA SAMSUN BAFRA DEVLET HST. HASAN ŞEKERCİOĞLU 387 21KRA SAMSUN ÇARŞAMBA DEVLET HST. ALİ BAKAN 388 21EWA SAMSUN HAVZA DEVLET HST. EROL CAFER 389 21BHA SAMSUN ONDOKUZ MAYIS ÜTF KUDDUSİ CENGİZ 390 21MVA SAMSUN ONDOKUZ MAYIS ÜTF PEDİYATRİ OZAN ÖZKAYA 391 21HZA SAMSUN ÖZEL BAFRA DİYALİZ MERKEZİ HASAN ŞEKERCİOĞLU 392 21LWA SAMSUN ÖZEL SAMSUN DİYALİZ MERKEZİ MEHMET KUNDAK 393 21ETA SAMSUN SAMSUN DEVLET HST. KAMURAN KAYNAR 394 21HBA SAMSUN SSK SAMSUN BÖLGE HST. M.AKİF UZUN 395 21TFA SAMSUN VEZİRKÖPRÜ DEVLET HST. YASİN GÜNEŞ 396 21GFA SİİRT SİİRT DEVLET HST. TAHSİN ÇELEPKOLU
Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004 83 Center No City Name of center Responsible person code 397 21JQA SİNOP AYANCIK DEVLET HST. İSKENDER YÜKSEL 398 21DJA SİNOP SİNOP ATATÜRK DEVLET HST. KAMİL DURMUŞ 399 21EXA SİNOP BOYABAT DEVLET HST. OKHAN ÇETİN 400 21GKA SİVAS 1. İZZETTİN KEYKAVUS DEVLET HST. CEVAT TÜRKAY 401 21DUA SİVAS CUMHURİYET ÜNİVERSİTESİ FÜSUN GÜLTEKİN 402 21VPA SİVAS SSK BÖLGE HST. MELİH KINCIR 403 21VAA SİVAS SUŞEHRİ DEVLET HST. ÖZDAL ÖZTEKİN 404 21LPA ŞANLIURFA BİRECİK DEVLET HST. AHMET ÖZBAY 405 21PBA ŞANLIURFA ÖZEL ŞANLI DİYALİZ MERKEZİ ATİLLA ŞENOCAK 406 21RFA ŞANLIURFA SSK ŞANLIURFA HST. (BALIKLIGÖL DEVLET HST. ) YILMAZ ERTÖRER 407 21GHA ŞANLIURFA ŞANLIURFA DEVLET HST. HİKMET ŞEYHANLIGİL FEYZULLAH UÇMAK 408 21VLA TEKİRDAĞ ÇORLU DEVLET HST. NECİP ERŞAN 409 21WHA TEKİRDAĞ ÖZEL ÇORLU ŞİFA HST. HÜSEYİN ÖZDEMİR 410 21PFA TEKİRDAĞ ŞARKÖY DEVLET HST. MUZAFFER SEZER 411 21HXA TEKİRDAĞ TBV TEKİRDAĞ ŞUBESİ HACI HÜSEYİN TERZİ DİYALİZ MİNE ÖZÇAKI MERKEZİ 412 21GMA TEKİRDAĞ TEKİRDAĞ DEVLET HST. MEHMET TÜRK 413 21HGA TEKİRDAĞ TRAKYA DİYALİZ MERKEZİ ALAATTİN AKAY 414 21CVA TOKAT DR. CEVDET AYKAN DEVLET HST. İDRİS MALKAN 415 21RHA TOKAT MED-LİFE ÖZEL DİYALİZ MERKEZİ MUSTAFA SERT 416 21HTA TOKAT NİKSAR DEVLET HST. SELAMİ AYDIN 417 21RZA TOKAT TOKAT ERBAA DEVLET HST. MEHMET YAMAK 418 21LFA TOKAT TURHAL DEVLET HST. NUSRET AYDOĞAN 419 21HQA TOKAT ZİLE DEVLET HST.SALİHA KIRGÖZ ŞÖHRET TUNAY 420 21DAA TRABZON FARABİ HST.TRABZON ŞÜKRÜ ULUSOY 421 21RGA TRABZON KARADENİZ TEKNİK ÜTF PEDİYATRİ ELİF BAHAT 422 21RBA TRABZON ÖZEL KARADENİZ HST. HAMZA BOZALİOĞLU 423 21PHA TRABZON SÜRMENE DEVLET HST. DURSUN İNAN 424 21BCA TRABZON TRABZON NUMUNE HST. CEVAT TOPAL 425 21CUA TRABZON TRABZON SSK HST. TANER ŞEN 426 21USA TUNCELİ TUNCELİ DEVLET HSTANESİ MEHMET ÖZDEMİR 427 21LGA UŞAK UMUT HEMODİYALİZ MERKEZİ LTD. ŞTİ. SELAHATTİN ÇAKIROĞLU 428 21CCA UŞAK UŞAK DEVLET HST. SELAHATTİN ÇAKIROĞLU 429 21GNA VAN YÜKSEK İHTİSAS HST. HASAN GÜLER 430 21NRA VAN YÜZÜNCÜ YIL ÜTF REHA ERKOÇ 431 21WVA VAN YÜZÜNCÜ YIL ÜTF PEDİYATRİ 432 21LUA YALOVA BAŞKENT ÜNİVERSİTESİ ELMALIK DİYALİZ MERKEZİ FAHRETTİN ALKAYA 433 21HHA YALOVA YOLOVA DEVLET HST. MUSTAFA MEHMETOĞLU 434 21MLA YOZGAT SORGUN DEVLET HST. RIZA MERSİN 435 21VEA YOZGAT YERKÖY DEVLET HST. MURAT YILDIZ 436 21GPA YOZGAT YOZGAT DEVLET HST. ARİF YÜCEL 437 21GGA ZONGULDAK KARABÜK DEVLET HST. ESER MUSTAFA ÖZCAN 438 21GJA ZONGULDAK KARADENİZ EREĞLİ DEVLET HST. NAKİ GÖKHAN TURAN 439 21DFA ZONGULDAK SSK ZONGULDAK BÖLGE HST. AHMET BOZKAYA 440 21CYA ZONGULDAK ZONGULDAK DEVLET HST. ŞEHMUS ERTOP
84 Registry of the Nephrology, Dialysis and Transplantation in Turkey, 2004