Académique Documents
Professionnel Documents
Culture Documents
2013
Contents
List of gures ............................................................................................. 4
Denitions ............................................................................................... 13
Incident patients...................................................................................... 36
Comorbidities in CKD............................................................................... 16
Conclusions ............................................................................................. 50
Appendices .............................................................................................. 52
Bibliography............................................................................................. 76
List of igures
Figure 1. Stratiication of CKD partients by renal and cardio-vascular risk according to eGFR and proteinuria categories ................................................................................ 13
Figure 2. The distribution within the eGFR categories (G1-G5) of the Romanian and the NHANES cohort ................................................................................................................ 13
Figure 3. The distribution of the CKD categories within the Romanian and NHANES cohorts ......................................................................................................................................... 14
Figure 4. The distribution within the proteinuria categories in the Romanian and NHANES cohorts........................................................................................................................... 14
Figure 5. The distribution of risk groups in the Romanian and NHANES cohorts .................................................................................................................................................................. 15
Figure 6. The prevalence of the main comorbidities requiring hospital admittance (CKD Chronic kidney disease, DM diabetes mellitus) ......................................... 16
Figure 7. Number of patients treated by hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (RTx) in 2012 and 2013 in Romania ........................ 19
Figure 8. Estimated number of RRT patients in Romania (per million inhabitants).............................................................................................................................................................. 19
Figure 10. The rate of increase in prevalent dialysis patients in Romania (2009-2012; in percentage as compared to the previous year)................................................. 20
Figure 11. Dialysis patients in Romania (2004-2013) and in Europe (2010) (per million inhabitants - pmi)........................................................................................................... 21
Figure 12. Estimated trends in prevalent patients number and in the rate of increase (percent of the previous year) in Romania 2009-2015 ....................................... 21
Figure 13. Estimated prevalence and incidence of dialysis patients in Romania (pmi - per million inhabitants) .................................................................................................... 22
Figure 14. Estimated number of incident and prevalent hemodialysis (HD) patients in Romania.................................................................................................................................. 23
Figure 15. Estimation of prevalent peritoneal dialysis (PD) patients number in Romania................................................................................................................................................24
Figure 16. The proportions of patients treated by peritoneal dialysis (PD) and of those treated by private dialysis providers in Romania ...............................................24
Figure 17. Trends in dialysis methods usage in Romania (incident patients; HD hemodialysis; DP peritoneal dialysis) ..............................................................................25
Figure 18. The proportions of patients treated by various RRT methods in Romania (prevalent patients on 31.12.2012; N=10,470; prevalent patients on
31.12.2013; N=11,169; DPA automated peritoneal dialysis; DPCA continuous peritoneal dialysis; HDF hemodiailtration; HD- hemodialysis) ...........................26
Figure 19. Incident patients on day 1 in renal replacement therapy in the period 2007-2015 and the percentage of non-preemptive transplant patients) .............27
Figure 20. Origin of kidney grafts for non-preemptive transplantation in 2013 and 2014 ................................................................................................................................................27
Figure 21. Rate of variation (2013/2014; %) in RRT prevalent patients number ..................................................................................................................................................................28
Figure 22. Distribution of dialysis patients in Romania at 31.12.2012 (up) and 31.12.2011 (down). The counties having within both years the lowest
prevalence rates in the country have been highlighted. Data are expressed in number of patients treated per million inhabitants (pmi).
The color scale is deined by the national median and by the quartiles. .....................................................................................................................................................................................29
Figure 23. Dialysis prevalent and incident patients (per 1 million inhabitants) in Romanian counties (in descending order) .........................................................................30
Figure 24. The distribution of incident patients in peritoneal dialysis (PD - up) and in non-preemptive renal transplantation (RTx - down).
The renal transplantation centers and the areas prescribing RTx and HD (blue), PD and HD (green) and exclusively HD (red) are highlighted. ....................................31
Figure 25. Standardized mortality ratio (SMR) in hemodialysis patients by provider (2012) ..........................................................................................................................................33
Figure 26. Standardized mortality ratio (SMR) in hemodialysis patients by provider (2013) ..........................................................................................................................................33
Figure 27. Cumulative survival rated of patients starting renal transplantation (TR), hemodialysis (HD) or peritoneal dialysis (DD)
in 2008-2011 in Romania.................................................................................................................................................................................................................................................................................35
Figure 28. Incident RRT patients in the Europe in 2011 (EDTA-ERA Registry 2011) ...........................................................................................................................................................36
Figure 29. The proportion of RRT incident patients with ages above 65 years of age in Romania (RRR, USA (USRDS) and Europe (EDTA-ERA Registry).................36
Figure 30. Incident RRT patients in 2011 (pmi) (international comparison) ...........................................................................................................................................................................37
Figure 31. Variation 2011/2006 (%) in incident RRT patients number (pmi) (international comparison) ...............................................................................................................37
Figure 32. The proportion of diabetic patients incident in RRT in 2011 (international comparison). ..........................................................................................................................38
Figure 33. Variation 2011/2006 (%) of the proportion of diabetic patients incident in RRT (international comparison)..................................................................................38
Figure 34. The proportions (%) of prevalent patients treated by hemodialysis (HD), peritoneal dialysis (DP) and
renal transplantation (TR) in Europe and Romania .............................................................................................................................................................................................................................39
Figure 35. The proportions (%) of incident patients treated by hemodialysis (HD), peritoneal dialysis (DP) and
renal transplantation (TR) in Europe and Romania .............................................................................................................................................................................................................................39
Figure 36. Patients prevalent on RRT at 31st of December 2011 (pmi) (international comparison) NB. In 2013, in Romania
there were 732 patients treated pmi...........................................................................................................................................................................................................................................................40
Figure 37. Variation 2011/2006 (%) in number prevalent patients undergoing RRT (international comparison) ................................................................................................40
Figure 38. Variation 2011/2006 (%) in prevalent RRT patients number in Europe and in Romania
(HD hemodialysis; DP peritoneal dialysis; TR renal transplantation) ...............................................................................................................................................................................41
Figure 39. Trends of the use of renal replacement therapy methods in Europe and in Romania (variance 2011/2006, in percentage).......................................................41
Figure 40. Unadjusted survival rates of incident dialysis patients in the period 2006-2010 in Europe (EDTA-ERA)
and in Romania (all differences are signiicant).....................................................................................................................................................................................................................................42
Figure 41. The ratio of the dialysis service providers on 31.12.2013 (percentage from the total number of prevalent patients) ....................................................................43
Figure 42. Variation in prevalent patients number 2013/2013 (%) by dialysis service provider..................................................................................................................................43
Figure 43. The proportion of dialysis patients treated in the public sector (%) ......................................................................................................................................................................44
Figure 44. The proportion of PD patients by dialysis providers (percentage of the total number of dialysis patients) .......................................................................................44
Figure 45. The trends in peritoneal dialysis usage by dialysis providers in Romania (PD prevalent patients 2012/2006 in percentage) ...................................................45
Figure 46. Dialysis centers in Romania (2004-2012) ..........................................................................................................................................................................................................................46
Figure 47. The number of patients beneiting from the dialysis program, the program budget (hundreds of thousands of RON) and the costs per patient
(Euro, at the reference NBR currency exchange rate for that year)...............................................................................................................................................................................................46
Figure 48. RRT methods in Romania (2012) and in Europe (EDTA-ERA). Estimated costs of the replacement therapy for one patient/year
(HD hemodialysis, DP peritoneal dialysis; TR renal transplantation)................................................................................................................................................................................47
Figure 49. Modeling the economic impact of the use of PD in 20% of the incident patients (Model DP) compared to the current situation
(over 80% hemodialysis Model HD) and the increase of renal transplantations to 30% (Model TR). Five years after the introduction
of the PD model, the estimated savings compared to the current situation would allow including all incident patients without an increase in the budget. .............47
List of tables
Table I. Prevalence of CKD within the adult population of Romania
14
Table II. Estimation regarding the prevalence of CKD risk groups within the adult population of Romania
15
16
Table IV. Characteristics of the incident patients of the 1st day of dialysis within the period 2007-2013
17
17
Table VI. The rst 15 centers by the number of newly included hemodialysis patients
18
Table VII. The rst 15 centers by the number of newly included peritoneal dialysis patients
18
Table VIII. Ways of prescribing renal replacement therapy methods in the counties of Romania (2012)
31
32
35
Table XI. Factors determining the survival of the patients treated by renal replacement therapy methods
35
Table XII. Unadjusted survival rate at 90 days, 1 year and 2 years for the cohort 2006-2010, incident dialysis patients in Europe and Romania
42
43
Table XIV. Weighted inuences on the expenses of the Program for dialysis renal replacement
49
Table XV. The characteristics of the patients investigated for the survival analysis
53
List of appendices
Appendix 1. The method for the calculation of the standardized mortality ratio .......................................................................................................................... 52
Appendix 2. The method for the calculation of the survival rates .................................................................................................................................................. 53
Appendix 3. Dialysis centers, machines and patients treated on a machine in the counties of Romania in 2012, 2013 and variance 2013/2012
(in percentage) ................................................................................................................................................................................................................................. 54
Appendix 4. Dialysis patients registered on 31.12.2012 and 31.12.2013 in the counties of Romania and the variance 2013/2012 (in percentage) ................. 56
Appendix 5. Patients newly-included in the haemodialysis (HD), peritoneal dialysis (PD), non-preemptive renal transplantation (RT) and
the number of deaths in 2013 in the counties of Romania ............................................................................................................................................................ 58
Appendix 6. Prevalent patients in the dialysis centers in Romania on 31.12.2011 vs. 31.12.2010 and the variance 2012/2011 in percentage
(in the alphabetical order of the counties)...................................................................................................................................................................................... 60
Appendix 7. Prevalent and incident dialysis patients, non-preemptive transplanted or deceased patients in dialysis centers in Romania in 2013
(in the alphabetical order of the counties)...................................................................................................................................................................................... 66
Appendix 8. Haemodialysis centers ordered increasingly by the standardized mortality ratio (SMR) .......................................................................................... 71
Acknowledgements
Physicians
1.
Turkes Ablachim
2.
Constana Andone
3.
Carina Daniela Andrei
4.
Mihaela Anghel
5.
Daniela Anghel
6.
Carmen Elena Anton
7.
Luminia Ardelean
8.
Mihai Ardeleanu
9.
Gabriel Bako
10.
Mihaela Blgradean
11.
Anca Barbu
12.
Cezarina Bejan
13.
Marilena Tetic
14.
Aurel Bizo
15.
Anca Blaga
16.
Ioan Boca
17.
Eniko Bodurian
18.
Gheorghe Boan
19.
Lavinia Brtescu
20.
Constantin Bulancea
21.
Mirinela Buruian
22.
Viorica Butnaru
23.
Maia Caraman
24.
Nicoleta Carastoian
25.
Cecilia Jitea
26.
Adela Chindri
27.
Bogdan Cmpineanu
28.
Iuliana Ciocnea
29.
Daniela Ciortea
30.
Cezar Lucian Cocerjin
31.
Elisaveta Codopan
32.
Adrian Covic
33.
Maria Covic
34.
Olimpia Creu
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
Constantin Cruceru
Luminia Damian
Dionisie Dubinciuc
Sergiu Dumitrache
Hortensia Viorica Epure
Lidia Florescu
Gabriela Maria Fociuc
Nicoleta Irina Foc
Valentina Georgescu
Ivona Georgescu
Adrian Ghenu
Mirela Gherman Cprioar
Mirela Liana Gliga
Ovidiu Golea
Sabina Grigorescu
Monica Simona Heeganu
Mariana Iacob
Ioana Iacob
Ion Iancu
Rodica Ilie
Ligia Iosub
Zsoa Rozalia Ivacson
Christian Klein
Raluca Ungureanu Lie
Doriana Lucaciu
Radu Macavei
Florin Mrgineanu
Simona Marian
Adriana Marinescu
Ioana Diana Mari
Beatrice Marusceac
Sorina Masek
Marilena Micu
Ileana Mihilescu
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
Eugen Moa
Dan Munteanu
Mihaela Munteanu
Ioana Nicoleta Nicolae
Marcel Palamar
Radu Viorel Ptea
Ioan Mihai Paiu
Marilena Piper
Mariana Pop
Luminia Popa
Marcela Prav
Daniela Pricop
Monica Radu
Mihai Raicu
Eugenia Rilean
Violeta Roman
Leonard Rou
Mihaela Rou
Cornel Rusan
Oana Schiller
Cristian Seranceanu
Aurelian Simionescu
Petronela odolescu
Costel Spnu
Roxana Dorina Stavr
Ioana Suciu
Dorina Tacu
Ctlin Tacu
Mircea andru
Cristina Teodoru
Delia Timofte
Daniela Elena Tir
Camelia Totolici
Carmen Turcea
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
Liliana Tu
Cristina Vduva
Peter Varga
Mariana Vasilescu
Adina Monica Vere
Gabriela Voicu
Mihai Voiculescu
Carmen Volov
Diana Ziliteanu
Adrian Zugravu
Radu Drgulete
Adriana Buhai
Tatiana uiaga
Mirela Modlc
Cristiana David
Elena Blatu
Claudia Cusai
Ana Maria Dominte
Suzana Anca Berca
Diana Copceanu
Andreea Costea
Mihaela Iavorenciuc
Carmen Denise Cldraru
Adrian-Bogdan Ghigolea
Oana Sklerniacof
10
Cati Aurschioaie
Gaspar Balazs
Zoltan Barabas
Mariana Becheanu
Mirela Beldean
Mihaela Beldiman
Marcela Berar
Mariana Brsan
Istvan Blenyesi
Georgeta Blidariu
Ilie Blotor
Marian Boboc
Maria Boeru
Cristiana Bojica
Adrian Bosie
Marin Braoveanu
Ioana Breaza
Ana Maria Igna
Cristina Bursuc
Narcis Buturug
Otilia Carteleanu
Nicoleta Stoica
Veronica Clin
Cipriana Chereche
Beniamin Chifor
Ionela Chirigiu
Teodora Condriuc
Romulus Corban
Lucian Costchescu
Valerica Crmaru
Georgiana Cutochera
Loredana Danciu
George Dnil
Stela Dnulescu
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
Doru Deju
Adrian Dobrioiu
Olga Dragula
Gina Dumbrav
Elena Durubal
Camelia Epure
Mirela Faur
Livia Flore
Emilian Floroaia
Margareta Grdil
Gabriela Ioni
Delia Iordache
Elena Lazr
Elena Lulciuc
Sergiu Lupulescu
Anca Maczo
Gabriela Maftei
Aurel Marian
Elena Marin
Sorina Matei
Amalia Mihance
Paula Mndreanu
Elena Munteanu
Sanda Nica
Luminia Niu
Mirela Olaru
Monica Olroiu
Rducu Olteanu
Claudiu Oetea
Elena Pais
Ionela Palade
Ionela Pascal
Irina Pert
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
Monica Crciun
Florentina Petrescu
Oana Petru
Tania Cmpeanu
Adriana Ploscar
Veronica Plotenaru
Dana Poborena
Marius Popoac
Melania Prioteasa
Anca Pucerea
Maricica Radu
Carmen Raicu
Liliana Rcoreanu
Monica Rodina
Mdlina Rugin
Anca Rusu
Angelica Sandu
Maria Savu
Ioan Schink
Florentina Sebacher
Bianca Semeniuc
Dorina Serciu
Roxana Seserman
Laura Slabinschi
tefania Stnescu
Doina Stng
Monica Stoica
Elena Stoina
Zoe Stroe
Cristian Stupinean
Monica Suciu
Liliana erban
Armand tefnescu
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
Angela tirbu
Mdlina Tene
Ioana Tipa
Cristina Toac
Carmen Tonia
Erika Trif
Lenua Tuc
Daniela Tudor
Lucian Tudora
Georgeta Turc
Constantin Vldescu
Elena Voiculescu
Francisc Zabos
Mihaela Zaraza
Georgeta Cristina Ni
Eugenia Naftan
Cristina Tutuianu
Elena Ilie
Emilia Chifor
Alina Blc
Cristina Zamora
Nicoleta Huzum
Gabriela Moise
Dana Sabie
Adriana Cerceaun
Elena Anastasiu
Daniela Du
Diana Mocanu
Violeta Gabor
Camelia endroiu
Andreea Boan
11
Data source
The report regarding the situation of renal replacement therapy in Romania is based on the data gathered on-line by the Romanian Renal Registry using the
Hipocrate IT system, with the participation of 97% of the existing dialysis centers in 2013.
The data regarding the kidney transplantation in incident dialysis patients are received from the dialysis centers, while the data regarding the pre-emptive
kidney transplantation and the monitoring of the prevalent kidney transplant patients are provided by a single transplantation center from the four existing
centers. The number of prevalent transplant patients on 31.12.2012 and 2013 was provided by the National Health Insurance House.
Epidemiology of Chronic kidney disease was evaluated using data collected in the Romanian Ministry of Health Program of Health Status Evalution in a cohort
from Iassy county. The new analyses complete the already published data1,2,3.
12
Deinitions
CKD diagnosis, eGFR and proteinuria categories and
the stratication by risk were dened according to
KDIGO 20124 (Figure 1). Because proteinuria was
qualitatively measured using strips or quantitatively,
the results were converted in A1-A3 risk categories
as described by KDIGO, and the eGFR was estimated
based on serum creatinine level and CKD-EPI formula.
>90mL/min
89-60mL/min
45-59/mL/min
44-30mL/min
29-15mL/min
<15mL/min
G1
G2
G3a
eGFR categories
G3b
G4
G5
Risk
Minimum
Low
Moderate
High
A1
<30mg/day
Absent
Proteinuria categories
A2
30 300mg/day
1+
A3
>300mg/day
>1+
Figure 1. Stratication of CKD partients by renal and cardio-vascular risk according to eGFR
and proteinuria categories
70%
6 0%
50%
eGFR categories
4 0%
30%
57.9 %
4 5.3%
4 5.1%
35.4 %
NHANES
Ro
20%
10%
0%
4 .6 %
G1
G2
7.7%
G3a
6 .7%
1.6 % 1.6 % 0.4 %
G3b
0.2%
G4
9 .7%
0.1% 0.1%
G5
G3-G5
Figure 2. The distribution within the eGFR categories (G1-G5) of the Romanian
and the NHANES cohort
13
Proteinuria categories
100%
9 3, 2%
80%
6 0%
NHANES
Ro
4 0%
20%
5, 4 %
0%
A1
4 , 0%
1, 1%
1, 3%
A2
A3
CKD category
Percentage
Number
G1 + A2-A3
0.7%
101.200
G2 + A2-A3
2.8%
404.801
G3a
7.7%
1,113,202
G3b
1.6%
231.315
G4
0.2%
28.914
G5
0.1%
14.457
Total CKD
13.1%
1,893,889
On May 31st 2014 the population of Romania was
of 19,631,292, and the population above 24 years
of age reached to 14,457,168 inhabitants (INS)
9 4 ,9 %
14 %
11, 5%
12%
13, 1%
10%
7, 7%
8%
6 %
4 %
2%
0%
NHANES
4 ,6 %
2, 5%
2, 3%
0, 7%
RO
2, 8%
1, 6 %
1, 6 %
0, 4 %
0, 2%
0, 1%
0, 1%
Figure 3. The distribution of the CKD categories within the Romanian and NHANES cohorts
14
NHANES
NHANES
57.9
57.9
34.5
34.5
3.6
G1
Stratiication by risk
Although the distribution by eGFR and albuminuria
categories diered, there were no major dierences
in the distribution of the two cohorts in the risk groups
(Figure 3).
3.6
G1 G2
1.0
G2 G3a
1.0
G3a G3b
G3b G4
G4
0.2
0.2
G5
0.1
0.1
G5
A1
A1
Percentage
Number
Minimum risk
86.9%
12,468,609
Low risk
9.2%
1,316,303
Medium risk
3.0%
437,177
High risk
0.9%
128,385
15%
15%
10%
A2
A2
A3
A3
Romnia
Romnia
45.1%
45.1% 45.3%
45.3%
10%
5%
6.5%
5%
0%
G1
0%
G1 G2
G2 G3a
G3a G3b
G3b
6.5%
1.3%
1.3%
G4
G4
0.2%
0.2% 0.1%
G5
G5
0.1%
A1
A1
A2
A2
A3
A3
Figure 5. The distribution of risk groups in the Romanian and NHANES cohorts
15
Non-CKD
6.4
10.5
HBP
46.1%
29.3%
Heart failure
19.3%
11.1%
Stroke
8.6%
4.3%
7.5%
4.2%
1.41
0.70
Hospital admissions
(for 100 persons-years)
Comorbidity (% admittances)
The Chronic kidney disease has a higher prevalence in Romania that in the
NHANES cohort: 13.1% vs. 11.5%; the estimated number of adult persons
with CKD in Romania is about 1,900,000.
CKD patients suer more often from diabetes mellitus, HBP, stroke and heart
failure, and their risk of death is twice higher. As a result, the CKD care should
be multidisciplinary (diabetology, cardiology and nephrology).
Table IV. Characteristics of incident patients in the 1st day of dialysis within the period 2007-2013
2007
2008
2009
2010
2011
2012
2013
75
85
102
131
148*
137*
138*
100
100
98
90
92
96
97
Number
1,910
2,036
2,377
2,662
2,987
3,428
3,063
Sex (B%)
58.8
57.8
57.7
57.5
57.6
57.8
56.7
58.1
58,.3
60.5
61.2
62.0
62.6
62.6
34
37
39
39
41
43
42
Glomerulonephritis (%)
17.1
16.2
13.5
13.9
13.6
13.7
12.6
12.4
11.5
11.4
11.2
11.3
11.3
10.0
Hereditary-congenital
nephropathies (%)
5.7
5.8
5.1
4.6
5.3
6.6
4.4
11.7
19.9
18.7
13.3
14.8
15.7
14.7
6.5
11.8
6.2
6.3
14.5
15.4
9.9
Other (%)
15.5
9.4
6.4
7.4
5.5
6.4
10.7
Unknown (%)
31.1
25.4
38.7
43.3
35.0
30.9
37.7
Centers (number)
Reporting centers (%)
65 years (%)
Primary kidney disease
82.3
82.0
83.6
93.5
93.8
95.1
95.0
DP (%)
17.7
18.0
16.4
6.5
6.2
4.9
5.0
Sex (B%)
67.9
Age
average (years)
42.1
65 years (%)
1.4
45.9
2.8
Hereditary-congenital (%)
5.1
Diabetes (%)
2.2
2.8
Other (%)
5.0
Unknown (%)
36.2
17
Newlyincluded
patients
261
Newlyincluded
patients
16
172
133
12
132
IHS - Buzau
10
110
10
103
14
92
76
74
67
67
62
61
61
56
Total
1.527*
* 58% of total number of newly included patients
Total
107*
18
12, 000
+ 8%
10, 322
9 , 551
10, 000
8, 000
2012
6 , 000
4 , 000
2, 4 57 2, 723
- 7%
2, 000
9 19
HD
854
DP
RTx
2013
+ 11%
119 6
1200
1000
800
889
6 80
9 4 0
9 9 1
104 2
109 4
732
6 00
4 00
200
0
2012
2013
2014
2015
2016
2017
2018
2020
19
11.176
12, 000
10, 000
8.371
8, 000
6 , 000
3.06 4
4 , 000
2, 000
1.203 1.59 1
1, 16 4
0 39
19 9 5
1, 4 86
105
19 9 6
2.19 5
1, 9 6 0
235
19 9 7
3.56 5
2.715
4 .272
3, 502
4 .9 74
4 , 09 8
5.800
6 .034
8.4 24
9 .09 7
9 .755
10.4 70
6 .9 86
6 .283 6 .715
4 , 700
4 , 9 86
5, 138
5, 4 6 0
5, 587
6 , 9 86
7, 255
8, 06 8
8, 74 8
9 , 551
2, 39 1
2, 6 4 8
3, 04 9
324
19 9 8
4 16
516
770
876
1100
104 8
114 5
1255
139 9
1385
116 9
1029
1007
9 19
19 9 9
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
DP
HD
10, 322
854
2013
Total
Dialysis patients
d e a n u l a n te ri o r
The rate of increase was not constant: the initial fast increase
(1996-2000; +32.7%/year) slowed down (2001-2003 and
2004-2006), and nally the rate increased again to 7.3%/year
in 2007-2013 (Figure 9).
P r o c e n te fa
9
8, 0%
8
7
7, 2%
7, 3%
6 , 7%
6 ,4 %
6
5
4
2009
2010
2011
2012
2013
20
883
800
6 00
4 00
353
318
331
2004
2005 2006
4 20
4 9 8
507
582
54 7
59 2
6 6 6
200
0
9
8.5
8.0
12500
7.2
10000
7.3
11, 176
9 , 755
7.1
6 .5
84 24
2009
2010
2011
7.1
6 .7
9 , 087
7500
7.5
11, 84 8
10, 4 70
6 .4
12, 537
2012
Rate of increase ( %)
1000
2013
2014
2015
Figure 12. Estimated trends in prevalent patients number and in the rate of increase
(percent of the previous year) in Romania 2009-2015
21
15, 000
4 19
10, 000
8, 371
4 21
4 55
9 , 09 7
8, 4 24
524
4 88
9 , 755
10, 4 70
559
11, 176
582
11, 6 31
12, 226
2, 017
2008
2009
2, 4 88
2010
2, 4 9 8
2011
12, 821
701
6 71
13, 4 16
14 , 010
14 , 6 05
76 0
15, 200
800
6 00
4 00
5, 000
2, 24 8
6 4 1
6 11
730
2, 86 4
2, 79 9
2012
2013
3, 06 2
2014
3, 39 5
2015
Incident patients
3, 589
2016
3, 6 14
3, 557
2017
2018
4 , 051
3, 886
2019
2020
200
20, 000
Figure 13. Estimated prevalence and incidence of dialysis patients in Romania (pmi - per million inhabitants)
The model in Figure 14 suggests that, if the current trends are maintained:
The estimated rate of increase in prevalent patients number for 2014-2015 is 7%;
In 2014, 11,600 patients will be treated by dialysis, and in 2015, 12,200.
In 2014, 3,100 new patients will be included in dialysis, and in 2015, 3,400.
22
Hemodialysis patients
16 .00
Prev alent HD p atients ( thousands)
12.00
8.00
6 .9 9
7.26
8.07
8.75
9 .55
10.32
11.05
11.79
12.54
13.20
14 .01
14 .75
15.4 9
5.59
4 .00
1.9 1
0.00
2.04
2.38
2.6 6
2.9 8
3.4 4
2.6 4
3.38
3.58
3.78
2015 2016
3.9 6
4 .11
4 .26
4 .4 2
2020
Figure 14. Estimated number of incident and prevalent hemodialysis (HD) patients in Romania
23
14 00
Prevalent PD patients (number)
16 00
R = 0.9 7
139 9 1385
1255
116 9
1200
1029 1007
1000
9 19
854
800
780
6 52
6 00
56 2
503
4 25
330
4 00
24 3
200
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Figure 15. Estimation of prevalent peritoneal dialysis (PD) patients number in Romania
100%
9 5%
87%
80%
6 0%
4 0%
30%
16 %
20%
20%
0%
2007
17%
14 %
11%
2008
2009
2010
12%
12%
11%
10%
2011
9 %
2012
8%
2013
PD patients ( % )
24
4 , 000
3, 500
Incident p atients ( number)
3, 000
2, 4 88
2, 500
2, 000
1, 500
1, 572
3, 380
3, 26 9
2, 801
3, 6 38
2, 6 4 4
1, 9 88
1, 6 6 9
1, 000
500
0
338
2007
36 7
2008
39 0
2009
183
174
2010
HD
2011
174
2012
155
2013
9 1
2014
34
2015
DP
If the programs for re-establishing the use of PD are successful, by the end
of the years 2014 and 2015 there will be 800-900 patients treated by PD,
and 100-150 patients shall be included in the treatment in the years 2014
and 2015 (Figure 18).
25
100%
DPA 1,0%
DPA 1,4%
9 5%
DPCA
7,8%
DPCA
6,2%
HDF
4,0%
HDF
6,2%
9 0%
DPCA
HDF
85%
80%
DPA
HD
HD
87,2%
HD
86,1%
2012
2013
75%
Figure 18. The proportions of patients treated by various RRT methods in Romania
(prevalent patients on 31.12.2012; N=10,470; prevalent patients on 31.12.2013;
N=11,169; DPA automated peritoneal dialysis; DPCA continuous peritoneal dialysis;
HDF hemodialtration; HD- hemodialysis)
26
Transplant patients
R = 0.7781
10.0%
3, 158
8.0%
6 .0%
1, 9 33
2, 4 21
2, 073
3, 700
3, 59 1
6 .2%
5.5%
7.0%
0.0%
3, 000
2, 000
1, 500
4 .0%
2.0%
4 , 000
2, 500
7.2%
4 .1%
4 , 500
3, 500
3, 017
2, 6 81
3, 9 4 6
1.2%
2007
1.8%
1.8%
1, 000
0.7%
2008
2009
2010
500
2011
2012
2013
2014
2015
12.0%
Non-preemptive transplants
(%)
Non-preemptive transplants
Figure 19. Incident patients on day 1 in renal replacement therapy in the period 2007-2015 and the
percentage of non-preemptive transplant patients)
100%
16
18.8
75%
Donor of uknow n type
Cadaveric donor
50%
53
56
25%
0%
2.7
28
22.5
2012
2013
Figure 20. Origin of kidney grafts for non-preemptive transplantation in 2013 and 2014
27
12%
10%
8%
11%
8%
6 %
4 %
2%
0%
-2%
-4 %
-6 %
-8%
HD
-7%
D P
RTx
28
2011
2013
29
MH
B+IF
IS
SB
BR
V N
CJ
GJ
BH
HD
V S
NT
BT
V L
BV
DJ
AB
BC
Romnia
SV
TL
AG
CT
BZ
TM
HR
MM
SM
PH
DB
AR
SJ
BN
CV
TR
OT
IL
MS
CS
GL
CL
GR
151
14 1
132
108
19 1
19 6
9 6
57
80
4 7
0
0
205
227
137
16 6
16 5
102
88
150
210
103
14 0
9 8
116
80
9 2
113
9 4
121
176
129
133
81
134
76
6 6
38
4 1
6 3
20
100
200
750
750
738
375
720
713
6 73
6 73
6 4 7
6 4 7
6 19
6 04
59 1
582
578
574
572
570
558
555
550
54 9
527
513
505
4 9 0
4 86
4 81
4 6 8
4 6 5
4 6 1
4 4 1
4 4 1
4 4 0
4 33
4 29
4 03
39 0
372
36 2
332
330
274
26 3
300
4 00
500
6 00
700
Prevalent patients
Incident patients
800
Figure 23. Dialysis prevalent and incident patients (per 1 million inhabitants) in
Romanian counties (in descending order)
30
2013
PD incident patients (pmi)
2013
RTx incident patients (pmi)
HD+DP+TR
HD+DP
HD+TR
HD
31
2008
2009
2010
2011
2012
2013
Centers (number)*
Number
103
110
119
115
117
123
121
Sex (B%)
53,4
51,8
52,1
53,0
52,6
52,1
52,3
Number
35
30
29
28
28
28
30
Sex (B%)
51,3
47,8
54,0
52,4
52,6
51,9
50,0
- HD (%)
85,4
63,4
68,5
70,4
81,0
84,6
93,3
- DP (%)
14,6
36,6
28,1
29,6
19,0
14,1
6,7
32
9 , 000
4 , 000
1.58
3, 886
1.36
1.5
1.30
1.07
1.27
1.00
3, 000
2, 000
Fresenius
0.5
9 34
9 56
9 4 5
74 8
6 9 2
Public
IHS
D iav erum
Av itum
Other
Romania
Figure 25. Standardized mortality ratio (SMR) in hemodialysis patients by provider (2012)
10, 000
886 5
9 , 000
Prevalent HD patients (number)
5, 000
1, 000
6 , 000
SMR
2.00
7, 000
2.5
8, 000
2.25
7, 000
6 , 000
5, 000
4 , 000
3, 000
1.5
4 132
1.09
2, 000
1, 000
0
Fresenius
1.09
1.26
1.19
1.23
1.05
877
1034
104 3
889
6 9 2
Public
IHS
D iav erum
Av itum
Other
SMR
8, 000
Prevalent HD patients (number)
2.5
8, 16 1
1
0.5
Romania
Figure 26. Standardized mortality ratio (SMR) in hemodialysis patients by provider (2013)
33
The HD patients mortality increased by over 20% in the years 2012, 2013,
in Romania as compared to the reference cohort. Since SMR implies
adjustment, the increase in age or in the diabetes mellitus proportion of
incident patients does not fully account for the rise of the mortality rate.
As other comorbidities or other factors can be involved, further analyses
are needed for clarication of the observed increase in mortality.
Public centers had twice higher SMR than the reference rate, probably
because they initiate the treatment (period with the highest death risk)
and treat the cases with the highest burden of comorbidities.
34
Survival rates
Survival
2
years
3
years
4
years
HD
84,8%
79,7%
75,4%
73,6%
PD
84,9%
79,7
75,5%
73,6%
RTx
97,1%
96,0
95,0%
94,7%
RRT
86,1%
81,2%
77,4%
72,5%
Time (months)
Figure 27. Cumulative survival rated of patients starting renal
transplantation (TR), hemodialysis (HD) or peritoneal dialysis (DD)
in 2008-2011 in Romania
Table XI. Determinants of RRT patients survival in Romania
Determinants
RRT vs RTx
HD (vs. RTx)
PD (vs. RTx)
HR
5,61
5,63
<0,001
<0,001
<0,001
Age
1,03
<0,001
0,94
0,5
Glomerular nephropathies
Tubule-interstitial nephritis
Hereditary nephropathies
Diabetic nephropathy
Unknown/ Others
0,75
0,94
0,62
1,25
1,13
<0,001
<0,01
0,5
<0,001
0,01
0,1
35
International comparisons
The most recent reports published by USRDS
(2011) and EDTA ERA Registry (2012) were used for
comparison7,8.
Incident patients
In 2011, Romania continued to be below the
European average of the incident patients (127
vs. 130 pmi), but had one of the highest rates of
increase (66% vs. 6%) (Figure 28, see also Figure 29,
Figure 30).
Figure 28. Incident RRT patients in the Europe in 2011 (EDTA-ERA Registry 2011)
70%
6 0%
53%
50%
Percent
4 0%
39 %
59 %
59 %
4 9 %
4 9 %
50%
4 2%
32%
30%
20%
10%
0%
Romania
Europa
2006
2010
SU A
2011
Figure 29. The proportion of RRT incident patients with ages above 65 years of age in
Romania (RRR, USA (USRDS) and Europe (EDTA-ERA Registry)
36
SU A
36 9
Japonia
6 6
288
Turcia
50
252
Portugalia
4 3
239
Republic Ceh
19 8
Belgia, olandez
19 5
Belgia, francez
19 2
Grecia
19 0
Frana
14 9
Croaia
14 2
Austria
139
Marea Britanie
136
Bosnia
31
19
7
133
Europa ( ERA-EDTA)
130
Romnia
124
Danemarca
121
Spania
121
Suedia
121
Olanda
118
Romnia
I slanda
Rusia
Turcia
Marea Britanie
Republic Ceh
Europa ( ERA-EDTA)
Olanda
Japonia
Norvegia
Frana
Belgia, francez
Danemarca
Belgia, olandez
SU A
Croia
Bosnia
-4
Grecia
Norvegia
104
-5
Spania
I slanda
104
-6
Finlanda
9 9
-7
Suedia
Scoia
Finlanda
Rusia
81
4 0
-13
-15
Austria
Scoia
Figure 31. Variation 2011/2006 (%) in incident RRT patients number (pmi)
(international comparison)
37
Republica Ceh
24 .8%
Finlanda
24 .2%
Portugalia21.2%
14 .3%
Austria
13.8%
Croaia
7.6 %
7.0%
Grecia
4 .1%
Marea Britanie
2.3%
Spania
-0.5%
-1.8%
Boznia
-2.4 %
Suedia
-6 .6 %
-7.0%
Scoia
-8.5%
Danemarca
-10.1%
Frana
-12.1%
-13.4
% ( ERA-EDTA)
Europa
37.9 %
I slanda
35.0
Rusia
34 .6
Marea Britanie
Bosnia
31.5
Croaia
30.1
Danemarca
30.0
Scoia
Romnia
29 .2
Spania
25.6
Frana
24 .6
Europa ( EDTA-ERA)
Finlanda
24 .3
Olanda
23.8
Belgia ( olandez)
Suedia
23.3
Grecia
23.0
Belgia ( francez)
21.6
Austria
Norvegia
21.5
Belgia ( olandez)
21.0
Belgia ( francez)
20.7
Norvegia
Rusia
I slanda
17.1
15.8
15.2
37.9 %
24 .8%
Rusia
24 .2%
Marea Britanie
21.2%
-0.5%
Bosnia
14 .3%
Croaia
13.8%
Danemarca
7.6 %
Scoia
7.0%
Romnia
4 .1%
2.3%
I slanda
Spania
Frana
Europa ( EDTA-ERA)
-1.8%
Finlanda
-2.4 %
Olanda
-6 .6 %
Belgia ( olandez)
-7.0%
Suedia
-8.5%
-10.1%
Grecia
Belgia ( francez)
Romania
14 .2
-12.1%
Austria
Olanda
14 .1
-13.4 %
Norvegia
38
80%
74 .3%
70%
6 0%
50%
Prevalent patients
Even though it increased rapidly after 2006, the
number of prevalent RRT patients remained in 2013
one of the lowest in Europe (732 in 2013 compared
to the European average of 891 pmi in 2011). Yet
the increase rate in Romania continues to be one
of the highest among the European countries and
it is 3 times higher than the European average (see
Figure 34, Figure 35).
RRT method
In prevalent patients from Europe, hemodialysis and
renal transplantation were used in 2010 in almost
similar proportions (51% and 42%) followed by
peritoneal dialysis (8%). In Romania, hemodialysis
was the most frequently used (74%), followed
by renal transplantation (20%) and by peritoneal
dialysis (6%) (Figure 35).
In Europe, in incident patients, hemodialysis was
the most frequently used method (79%), followed
by peritoneal dialysis (15%), while the pre-emptive
renal transplantation was performed in 6%. In
Romania, HD is also highly dominant, followed by
PD and in only 1% of cases by RTx (Figure 36).
Although the increase in patients with a functional
kidney graft was seven times higher than the European
rate, in Romania the proportion of RTx patients
is almost half of the European mean (Figure 40
(see Figure 39).
Europe ( 2011)
50.8%
4 1.6 %
4 0%
Romania ( 2013)
30%
19 .6 %
20%
7.6 %
10%
0%
HD
6 .1%
DP
TR
Figure 34. The proportions (%) of prevalent patients treated by hemodialysis (HD),
peritoneal dialysis (DP) and renal transplantation (TR) in Europe and Romania
100%
9 3.3%
79 .0%
75%
Europe ( EDTA)
50%
Romania
25%
15.4 %
5.7%
0%
HD
DP
5.6 %
1.0%
TR
Figure 35. The proportions (%) of incident patients treated by hemodialysis (HD),
peritoneal dialysis (DP) and renal transplantation (TR) in Europe and Romania
39
Japonia
2, 309
SU A
1, 9 24
Belgia, francez
1, 271
Republica Ceh
Romnia
1, 184
Turcia
Grecia
1, 103
I slanda
Frana
1, 09 1
Bosnia
1, 075
Austria
1, 001
Croaia
9 80
Republica Ceh
Olanda
Suedia
104 .8%
Rusia
Belgium, olandez
Spania
110.9 %
50.9 %
4 7.4 %
37.3%
27.7%
Olanda
24 .5%
Marea Britanie
20.5%
Belgia, francez
18.6 %
9 74
Japonia
18.1%
9 6 1
Norvegia
16 .1%
SU A
15.7%
9 30
Norvegia
874
Belgium, olandez
14 .6 %
Marea Britanie
871
Croaia
14 .5%
Turcia
86 8
Frana
13.3%
Danemarca
851
Grecia
11.9 %
Scoia
84 2
Spania
11.8%
Finlanda
10.4 %
Austria
10.2%
Suedia
9 .3%
Danemarca
8.8%
Scoia
7.4 %
Finlanda
803
Bosnia
705
I slanda
6 6 5
Romnia
Rusia
6 24
19 6
Figure 36. Patients prevalent on RRT at 31st of December 2011 (pmi) (international
comparison) NB. In 2013, in Romania there were 732 patients treated pmi
40
Norvegia
Portugalia
Olanda
Spania
Suedia
Austria
Frana
Finlanda
Marea Britanie
Danemarca
Cehia
Croia
Grecia
Romania ( 2012)
Serbia
Turcia
Bosnia Heregovina
Rusia
4 6
4 2
0
100
336
221
126
102
9 5
200
39 9
39 0
300
4 00
4 34
538
520
500
4 83
4 74
500
6 29
6 10
577
6 00
700
Figure 38. Variation 2011/2006 (%) in prevalent RRT patients number in Europe and in Romania
(HD hemodialysis; DP peritoneal dialysis; TR renal transplantation)
TR
23.0%
-37.0%
DP
-20.6 %
8.8%
HD
-50.0%
138.0%
3.5%
0.0%
50.0%
Romania
100.0%
150.0%
Europe
Figure 39. Trends of the use of renal replacement therapy methods in Europe
and in Romania (variance 2011/2006, in percentage)
41
Survival on RRT
A cohort of dialysis patients who started the therapy in 2006-2010 in Romania (N=10.588) was comparatively analyzed with corresponding data reported by
EDTA-ERA Registry. The unadjusted survival rate of the patients treated in Romania is lower within the rst three months, but signicantly better after one
and two years, which emphasizes once again the deciencies in the care before starting the dialysis (Table XII, Figure 40).
Table XII. Unadjusted survival rate at 90 days, 1 year and 2 years for the cohort 2006-2010, incident dialysis patients in Europe and Romania
Parameter
Age groups (years)
0-19
20-44
45-64
65-74
75+
90 days
1 year
2 years
EDTA-ERA
RRR
EDTA-ERA
RRR
EDTA-ERA
RRR
98.8 (97.7-99.4)
99.0 (99.8-99.1)
96.7 (96.5-96.9)
93.4 (93.1-93.7)
89.3 (89.0-89.6)
94.1 (90.4-97.8)
98.1 (97.5-98.6)
93.2 (92.4-93.9)
89.6 (88.4-90.7)
82.5 (80.3-84.6)
96.0 (94.1-97.3)
96.2 (95.8-96.5)
89.3 (88.9-89.6)
80.6 (80.2-81.0)
71.2 (70.8-71.5)
92.7 (88.6-96.8)
94.9 (93.9-95.8)
86.9 (85.9-87.8)
81.8 (80.2-83.3)
72.6 (70.0-75.1)
93.8 (91.4-95.6)
91.9 (91.4-92.4)
81.0 (80.6-81.4)
68.0 (67.6-68.3)
54.8 (54.5-55.1)
91.2 (86.7-95.7)
92.2 (90.8-93.5)
80.5 (79.3-81.6)
71.7 (69.0-73.0)
63.7 (60.9-66.4)
Sex
Male
94.1 (93.3-94.2) 91.3 (90.5-92.0) 82.4 (82.1-82.6)
84.6 (83.6-85.5)
70.4 (70.1-70.6)
77.8 (76.8-78.7)
Female
93.5 (93.3-93.7) 92.6 (91.8-93.3) 81.7 (81.4-82.1)
86.1 (85.1-87.0)
70.2 (69.8-70.5)
79.2 (78.0-80.3)
Primary kidney disease
71.4 (69.0-73.7)
69.1 (68.6-69.5)
82.3 (80.3-84.2)
Diabetic nephropathy
95.0 (94.7-95.2) 91.4 (89.8-92.9) 82.9 (82.5-83.3)
75.0 (71.8-78.1)
67.5 (67.0-68.0)
83.0 (80.4-85.5)
HBP/Renal vascular disease
94.2 (93.9-94.5) 92.1 (90.1-94.0) 81.3 (80.8-81.8)
84.1 (83.5-84.7)
86.1 (84.3-87.8)
91.1 (89.7-92.4)
97.3 (97.0-97.6) 95.8 (94.8-96.7) 91.2 (90.7-91.7)
Glomerulonephritis
69.8 (69.5-70.1)
78.4 (77.4-79.3)
84.7 (83.9-85.4)
92.9 (92.7-93.1) 91.0 (90.2-91.7) 80.8 (80.5-81.1)
Other causes/ not specied
Total
93.9 (93.7-94.0) 91.9 (91.3-92.4) 82.1 (82.0-82.3)
85.3 (84.7-85.8)
70.3 (70.1-70.5)
78.4 (77.6-79.1)
Red survival rate lower in EDTA-ERA Registry (EDTA-ERA); Blue survival rate higher in Romanian Renal Registry (RRR)
100%
9 3.9 %
9 1.9 %
82.1%
80%
EDTA-ERA
Ro
85.3%
70.3%
78.4 %
6 0%
4 0%
20%
0%
9 0 days
1 year
2 years
42
Table XIII. Dialysis centers and prevalent patients by provider in Romania (2012/2011)
Dialysis providers
Centers
HD
PD
Total
2012
2013
2012
2013
Public
57
57
1125
1137
136
Avitum
827
998
31
44
Diaverum
10
10
868
1178
52
70
Fresenius Nephrocare
35
35
4543
4714
13
13
1108
1192
Other
14
14
1080
1103
109 1261
2013 Variation*
1246
-1.2%
859
1042
21.3%
920
1248
35.7%
336
281 4879
4995
2.4%
325
323 1433
1515
5.7%
38
27 1118
1130
1.1%
Public
11%
4 0%
Av itum
9%
D iav erum
11%
FNC
45%
35.7%
35%
30%
25%
21.3%
20%
15%
10%
5.7%
5%
0%
-5%
2.4 %
1.1%
-1.2%
Public
Avitum
Diaverum
FNC
IHS
Alii
Figure 42. Variation in prevalent patients number 2013/2013 (%) by dialysis service provider
43
5
9 5
13
87
30
2007
2008
88
12
12
2011
2012
2013
84
70
16
2009
2010
Public
9 2
88
Private
Figure 43. The proportion of dialysis patients treated in the public sector (%)
Other
8%
Others
8%
Public
18%
Avitum
5%
Public
18%IHS
32%
IHS
32%
Avitum
5%
Diaverum
6 %
FNC
Diaverum
31%
6 %
FNC
31%
44
50%
4 1.9 %
4 0%
34 .6 %
30%
20%
10%
0%
-0.6 %
-10%
-20%
-30%
-4 0%
-16 .4 %
-19 .9 %
-28.9 %
Public
Avitum
Diaverum
FNC
I HS
Others
-26 .0%
Romania
Figure 45. The trends in peritoneal dialysis usage by dialysis providers in Romania
(PD prevalent patients 2012/2006 in percentage)
45
150
120
9 0
134
106
6 0
30
71
70
1
0
2004
2005
137
138
85
69
0
2006
74
5
2007
29
22
11
12
2008
2009
New centers
2010
2011
2012
2013
Total
20, 000
16,611
16,021
16,449
17,263
15,841
13,861
15, 000
10, 000
6 , 034
6 , 283
6 , 715
6 , 9 86
3, 6 4 4
3, 888
4 , 028
2004
2005
2006
2007
Patients
9 , 09 7
14,013
9 , 755
8, 371
8, 4 24
4 , 880
4 , 9 51
5, 389
5, 79 6
2008
2009
2010
2011
5, 000
3, 508
14,071
14,604
10, 4 70
Costs
-19%
13,910
11, 176
Patients
+100%
6 , 819
6 , 871
2012
2013
Figure 47. The number of patients beneting from the dialysis program, the program budget
(hundreds of thousands of RON) and the costs per patient
(Euro, at the reference NBR currency exchange rate for that year)
46
17, 000
TR, 20%
TR, 42%
8%
74%
51%
Europe ( EDTA)
12, 500
Romania
HD
D P
11, 750
TR
7%
C heltuieli/ an ( Euro)
Figure 49. Modeling the economic impact of the use of PD in 20% of the incident patients
(Model DP) compared to the current situation (over 80% hemodialysis Model HD) and the increase
of renal transplantations to 30% (Mod-el TR). Five years after the introduction of the PD model, the
estimated savings compared to the current situation would allow including all incident patients without
an increase in the budget.
47
Treatment quality
Moreover, from both a medical and an economical perspective, it would be ideal to
combine PD with RTx, and to initiate HD only in those patients who have no indications
for or refuse PD or RTx, and in those in which these methods have failed.
A model of the economic impact of the increase to 20% in the ratio of incident
peritoneal dialysis patients and to 400 kidney grafts per year shows that after 5 years
the obtained savings would allow newly-included patients to be treated without
increasing the dialysis program budget (Figure 49).
To improve patients allocation to RRT methods, the following are needed:
Programs addressing pre-dialysis CKD patients care;
Financing at least 400 grafts per year (eventually, unlimited number of grafts);
Conditioning the reimbursement of medicine costs in the post-renal transplantation
program by reporting to the Romanian Renal Registry, similar to the dialysis program.
Increasing taris for peritoneal dialysis.
Table XIV. Weighted inuences on the expenses of the Pro-gram for dialysis renal replacement
a)
Haemodialysis
Nature of cost
Weight within
the expenses (%)
Increase (%)
HD materials
26.2%
18.35
4.8%
Medicines
20.6%
23.8%
4.9%
Other materials
2.1%
5.0%
0.1%
Laboratory tests
2.0%
0.0%
0.0%
2.1%
0.0%
0.0%
Other costs
10.8%
5.0%
0.5%
Transportation
10.4%
5.0%
0.5%
Wage costs
25.7%
9.0%
2.3%
100.0%
13.2%
Weight within
the expenses (%)
Increase (%)
3.4
18.1%
0.6%
Dialysis solutions
62.8
29.4%
18.5%
Medicines
13.4
23.8%
3.2%
Laboratory tests
1.9
0.0%
0.0%
0.8
0.0%
0.0%
Other costs
2.1
5.0%
0.1%
Solutions transportation
7.4
5.0%
0.4%
0.7%
0.7%
8.1
9.0%
0.7%
100.0
24.2%
Total
b)
Peritoneal dialysis
Nature of cost
PD materials
Patient transportation
Wage costs
Total
The increase of Leu/EURO exchange rate, the increase of VAT, of cost of medicines (including the
introduction of new preparations) and of the wages increased the costs of dialysis therapy. Since
the increase of expenses directly reects on the quality of therapy, it is necessary to increase
prices by 10-13% for HD and by 15-20% for PD.
49
Conclusions
1. Chronic kidney disease has a higher prevalence in Romania that in the
USA: 13.1% vs. 11.5%; the estimated number of adult persons with CKD
in Romania is about 1,900,000.
2. Since the number of CKD patients with medium-high risk is 565,000, a
nephrologist should care approximately 1,900 patients.
3. CKD patients suer more often from diabetes mellitus, HBP, strokes and
heart failure, and their death risk is twice higher. Consequently, CKD care
should be multidisciplinary (diabetology, cardiology and nephrology).
4. The medical assistance is mainly provided in hospital (over a quarter of
the patients are admitted into hospital), regardless of the state of the
kidney, and the CKD patients have almost twice as many visits in the
ambulatory clinic. Thus, it is necessary to organize multidisciplinary CKD
medical care programs that must promote ambulatory care.
5. The framework contract for 2014 included stipulations in favor of the
multidisciplinary care of CKD patients in the ambulatory clinic, but the
Application norms are relatively less precise and cannot be implemented,
since the 10th version of the International Classication of Diseases
used in Romania is not updated to include Chronic kidney disease (N18).
Temporarily, until it is brought up-to-date, we suggest accepting the N18
code (in the current classication - Chronic kidney failure) for the Chronic
kidney disease in hospital admittance cases and the code 685 in the
ambulatory patients.
6. The number of the RRT patients in Romania (732 pmi) is below the
European average of the year 2012 (947 pmi), but it has a rate of increase
above the European mean.
7. The annual rate of increase in RRT patients number is 7-8% and shall only
decrease in 2016-2017, when most of the existing patients shall be able
to receive treatment, and the death rates would equal the rate of the
therapy inclusion. That is why:
50
51
Appendices
Appendix 1. The method for the calculation of the standardized mortality ratio
National reference mortality rates were calculated on a cohort of 11,829 hemodialysis patients alive on January 1st 2010, monitored over a 3-year period.
Patients who started hemodialysis 90 days before January 1st were excluded, and those who received renal transplantation or were no longer included in the
records in the observation period were censored.
As the major determinants of mortality are age and primary kidney disease (especially diabetic nephropathy), the national mortality rates were calculated by
8 age groups and 4 etiologies, including diabetes mellitus, in relation to the frequency of the primary kidney diseases reported in Romania)9.
By using these national rates, the expected number of deaths in a certain population can be calculated. The standardized mortality ratio is the ratio between
the expected number of deaths noticed in the respective population and the expected ratio. The European Renal Registry uses the same procedure for
comparisons.
The assessment of the survival rate by SMR is superior to the assessment of the crude mortality rate. However, the reference value is the national average
mortality rate, which does not necessarily correspond to an optimum care. On the other hand, due to the diversity and the multiple comorbidities of the
hemodialysis patients, the SMR must also be interpreted with care, as an orienting comparison. Thus, a center can provide an excellent care to a subgroup of
patients and a decient care to another subgroup, which would lead to a SMR of almost 1.00 by cancelling the two eects.
Accordingly, SMR is only an orienting parameter, which can indicate a care issue when the value is below 1, without allowing the identication of causes and
imposing additional analyses.
52
The data regarding the evolution of HD and PD patients were obtained from the Romanian Renal Registry, and those related to the survival of (preemptive
and non-preemptive) RT patients were obtained from the Fundeni Clinical Institute.
The data included 9,540 adult incident patients undergoing renal replacement therapy (HD, PD and RT) in the period 2008-2011 (4 years), with a total
monitoring period of 5 years: 01.01.2008-31.12.2012. The analysis used the renal replacement therapy method on day 91. The patients lost to follow-up were
censored. The characteristics of the investigated patients are presented in Table XV.
Table XV. The characteristics of the patients investigated for the survival analysis
Number of patients
Male (%)
Total
TR
HD
PD
9540
490
8050
1000
57
64
58
51
17
12
6
14
7
44
42
9
6
7
1
35
16
12
6
14
7
14
16
13
5
17
12
37
48
3
3
2
44
17
41
34
8
48
3
3
2
44
47
2
2
1
48
p
<0,001
<0.001
<0.001
The unadjusted survival rates were calculated (Kaplan Meier), which were subsequently adjusted in a Cox logistic regression model.
53
Appendix 3. Dialysis centers, machines and patients treated on a machine in the counties of Romania in 2012, 2013 and variance 2013/2012 (in percentage)
County
Population
HD patients
2012
AB
342,376
Dialysis centers
2013
Variance
No
pmi
No
pmi
168
491
192
561
14.3%
2012
2013
HD machines
Variance
No
pmi
No
pmi
2.9
5.8
100.0%
2012
2013
Variance
No
pmi
Patients/
machine
No
pmi
Patients/
machine
39
114
4.3
40
116.8
4.8
Ap
2.6%
Variance
machine
11.4%
AG
612,431
283
462
312
509
10.2%
4.9
4.9
0.0%
59
96
4.8
73
119.2
4.3
23.7%
-10.9%
AR
430,629
179
416
187
434
4.5%
4.6
4.6
0.0%
30
70
6.0
35
81.3
5.3
16.7%
-10.5%
2,272,163
1,348
593
1,546
680
14.7%
21
9.2
20
8.8
-4.8%
329
145
4.1
393
173.0
3.9
19.5%
-4.0%
616,168
326
529
318
516
-2.5%
6.5
8.1
25.0%
63
102
5.2
70
113.6
4.5
11.1%
-12.2%
B + IF
BC
BH
575,398
351
610
351
610
0.0%
5.2
3.5
-33.3%
49
85
7.2
73
126.9
4.8
49.0%
-32.9%
BN
286,225
109
381
126
440
15.6%
7.0
7.0
0.0%
32
112
3.4
33
115.3
3.8
3.1%
12.1%
BR
321,212
199
620
199
620
0.0%
9.3
9.3
0.0%
56
174
3.6
67
208.6
3.0
19.6%
-16.4%
BT
412,626
219
531
227
550
3.7%
7.3
4.8
-33.3%
31
75
7.1
47
113.9
4.8
51.6%
-31.6%
BV
549,217
252
459
288
524
14.3%
9.1
9.1
0.0%
57
104
4.4
85
154.8
3.4
49.1%
-23.4%
BZ
451,069
139
308
156
346
12.2%
2.2
2.2
0.0%
31
69
4.5
31
68.7
5.0
0.0%
12.2%
CJ
691,106
435
629
454
657
4.4%
10.1
10.1
0.0%
122
177
3.6
119
172.2
3.8
-2.5%
7.0%
CL
306,691
76
248
84
274
10.5%
3.3
3.3
0.0%
21
68
3.6
21
68.5
4.0
0.0%
10.5%
CS
295,579
91
308
88
298
-3.3%
6.8
6.8
0.0%
29
98
3.1
32
108.3
2.8
10.3%
-12.4%
CT
684,082
304
444
330
482
8.6%
7.3
7.3
0.0%
76
111
4.0
86
125.7
3.8
13.2%
-4.1%
CV
210,177
43
205
90
428
109.3%
4.8
9.5
100.0%
17
81
2.5
18
85.6
5.0
5.9%
97.7%
DB
518,745
182
351
222
428
22.0%
5.8
5.8
0.0%
55
106
3.3
58
111.8
3.8
5.5%
15.7%
DJ
660,544
336
509
350
530
4.2%
4.5
4.5
0.0%
68
103
4.9
73
110.5
4.8
7.4%
-3.0%
GJ
341,594
196
574
208
609
6.1%
8.8
8.8
0.0%
58
170
3.4
68
199.1
3.1
17.2%
-9.5%
GL
536,167
114
213
124
231
8.8%
5.6
5.6
0.0%
38
71
3.0
39
72.7
3.2
2.6%
6.0%
GR
281,422
71
252
74
263
4.2%
3.6
3.6
0.0%
12
43
5.9
22
78.2
3.4
83.3%
-43.1%
HD
418,565
251
600
253
604
0.8%
9.6
9.6
0.0%
75
179
3.3
62
148.1
4.1
-17.3%
21.9%
HR
310,867
144
463
150
483
4.2%
12.9
12.9
0.0%
40
129
3.6
40
128.7
3.8
0.0%
4.2%
IL
274,148
90
328
101
368
12.2%
7.3
7.3
0.0%
29
106
3.1
28
102.1
3.6
-3.4%
16.2%
IS
772,348
446
577
499
646
11.9%
5.2
5.2
0.0%
102
132
4.4
102
132.1
4.9
0.0%
11.9%
MH
265,390
180
678
184
693
2.2%
7.5
7.5
0.0%
41
154
4.4
42
158.3
4.4
2.4%
-0.2%
MM
478,659
206
430
224
468
8.7%
6.3
6.3
0.0%
67
140
3.1
61
127.4
3.7
-9.0%
19.4%
MS
550,846
183
332
196
356
7.1%
5.4
5.4
0.0%
56
102
3.3
56
101.7
3.5
0.0%
7.1%
NT
470,766
262
557
268
569
2.3%
8.5
8.5
0.0%
62
132
4.2
63
133.8
4.3
1.6%
0.7%
54
County
Population
HD patients
2012
OT
436,400
Dialysis centers
2013
Variance
No
pmi
No
pmi
146
335
163
374
11.6%
2012
2013
HD machines
Variance
No
pmi
No
pmi
4.6
4.6
0.0%
2012
2013
Variance
No
pmi
Patients/
machine
No
pmi
Patients/
machine
27
62
5.4
35
80.2
4.7
Ap
Variance
machine
29.6%
-13.9%
PH
762,886
320
419
339
444
5.9%
3.9
5.2
33.3%
61
80
5.2
88
115.4
3.9
44.3%
-26.6%
SB
397,322
253
637
264
664
4.3%
10.1
10.1
0.0%
89
224
2.8
80
201.3
3.3
-10.1%
16.1%
SJ
224,384
88
392
99
441
12.5%
8.9
8.9
0.0%
19
85
4.6
19
84.7
5.2
0.0%
12.5%
SM
344,360
132
383
134
389
1.5%
5.8
5.8
0.0%
30
87
4.4
31
90.0
4.3
3.3%
-1.8%
SV
634,810
332
523
339
534
2.1%
6.3
6.3
0.0%
84
132
4.0
77
121.3
4.4
-8.3%
11.4%
TL
213,083
113
530
116
544
2.7%
9.4
9.4
0.0%
35
164
3.2
44
206.5
2.6
25.7%
-18.3%
TM
683,540
314
459
308
451
-1.9%
7.3
7.3
0.0%
94
138
3.3
73
106.8
4.2
-22.3%
26.3%
TR
380,123
147
387
159
418
8.2%
5.3
5.3
0.0%
33
87
4.5
33
86.8
4.8
0.0%
8.2%
VL
371,714
177
476
204
549
15.3%
8.1
8.1
0.0%
36
97
4.9
52
139.9
3.9
44.4%
-20.2%
VN
340,310
156
458
172
505
10.3%
5.9
5.9
0.0%
35
103
4.5
37
108.7
4.6
5.7%
4.3%
VS
Romania
395,499
190
480
224
566
17.9%
7.6
7.6
0.0%
59
149
3.2
59
149.2
3.8
0.0%
17.9%
20,121,641
9,551
475
10,322
513
8.1%
137
6.8
138
6.9
0.7%
2346
117
4.1
2565
127.5
4.0
9.3%
-1.2%
55
Appendix 4. Dialysis patients registered on 31.12.2012 and 31.12.2013 in the counties of Romania and the variance 2013/2012 (in percentage)
County
Population
HD patients
2012
2013
Variance
No
pmi
No
pmi
PD patients
2012
2013
Variance
No
pmi
No
pmi
Total
2012
2013
Variance
No
pmi
No
pmi
AB
342,376
168
491
192
561
14.3%
8.8
8.8
0.0%
171
499
195
569.5
14.0%
AG
612,431
283
462
312
509
10.2%
14
22.9
11
18.0
-21.4%
297
485
323
527.4
8.8%
AR
430,629
179
416
187
434
4.5%
16.3
7.0
-57.1%
186
432
190
441.2
2.2%
2,272,163
1,348
593
1,546
680
14.7%
166
73.1
157
69.1
-5.4%
1514
666
1703
749.5
12.5%
BC
616,168
326
529
318
516
-2.5%
29
47.1
26
42.2
-10.3%
355
576
344
558.3
-3.1%
BH
575,398
351
610
351
610
0.0%
11
19.1
21
36.5
90.9%
362
629
372
646.5
2.8%
BN
286,225
109
381
126
440
15.6%
0.0
0.0
0.0%
109
381
126
440.2
15.6%
BR
321,212
199
620
199
620
0.0%
32
99.6
30
93.4
-6.3%
231
719
229
712.9
-0.9%
BT
412,626
219
531
227
550
3.7%
14
33.9
13
31.5
-7.1%
233
565
240
581.6
3.0%
BV
549,217
252
459
288
524
14.3%
40
72.8
27
49.2
-32.5%
292
532
315
573.5
7.9%
BZ
451,069
139
308
156
346
12.2%
70
155.2
72
159.6
2.9%
209
463
228
505.5
9.1%
CJ
691,106
435
629
454
657
4.4%
10
14.5
11
15.9
10.0%
445
644
465
672.8
4.5%
CL
306,691
76
248
84
274
10.5%
0.0
0.0
0.0%
76
248
84
273.9
10.5%
CS
295,579
91
308
88
298
-3.3%
19
64.3
19
64.3
0.0%
110
372
107
362.0
-2.7%
CT
684,082
304
444
330
482
8.6%
30
43.9
21
30.7
-30.0%
334
488
351
513.1
5.1%
CV
210,177
43
205
90
428
109.3%
4.8
4.8
0.0%
44
209
91
433.0
106.8%
DB
518,745
182
351
222
428
22.0%
18
34.7
17
32.8
-5.6%
200
386
239
460.7
19.5%
DJ
660,544
336
509
350
530
4.2%
32
48.4
28
42.4
-12.5%
368
557
378
572.3
2.7%
GJ
341,594
196
574
208
609
6.1%
13
38.1
13
38.1
0.0%
209
612
221
647.0
5.7%
GL
536,167
114
213
124
231
8.8%
56
104.4
54
107.6
-3.6%
170
317
178
332.0
4.7%
GR
281,422
71
252
74
263
4.2%
0.0
0.0
0.0%
71
252
74
263.0
4.2%
HD
418,565
251
600
253
604
0.8%
9.6
14.3
50.0%
255
609
259
618.8
1.6%
HR
310,867
144
463
150
483
4.2%
3.2
3.2
0.0%
145
466
151
485.7
4.1%
IL
274,148
90
328
101
368
12.2%
29.2
21.9
-25.0%
98
357
107
390.3
9.2%
IS
772,348
446
577
499
646
11.9%
93
120.4
71
91.9
-23.7%
539
698
570
738.0
5.8%
MH
265,390
180
678
184
693
2.2%
12
45.2
15
56.5
25.0%
192
723
199
749.8
3.6%
MM
478,659
206
430
224
468
8.7%
16.7
12.5
-25.0%
214
447
230
480.5
7.5%
B + IF
56
County
Population
HD patients
2012
2013
Variance
No
pmi
No
pmi
PD patients
2012
2013
Variance
No
pmi
No
pmi
Total
2012
2013
Variance
No
pmi
No
pmi
MS
550,846
183
332
196
356
7.1%
12.7
16.3
28.6%
190
345
205
372.2
7.9%
NT
470,766
262
557
268
569
2.3%
17
36.1
10
21.2
-41.2%
279
593
278
590.5
-0.4%
OT
436,400
146
335
163
374
11.6%
18
41.2
13
29.8
-27.8%
164
376
176
403.3
7.3%
PH
762,886
320
419
339
444
5.9%
17
22.3
16
21.0
-5.9%
337
442
355
465.3
5.3%
SB
397,322
253
637
264
664
4.3%
23
57.9
22
55.4
-4.3%
276
695
286
719.8
3.6%
SJ
224,384
88
392
99
441
12.5%
0.0
0.0
0.0%
88
392
99
441.2
12.5%
SM
344,360
132
383
134
389
1.5%
29
84.2
27
78.4
-6.9%
161
468
161
467.5
0.0%
SV
634,810
332
523
339
534
2.1%
12.6
10
15.8
25.0%
340
536
349
549.8
2.6%
TL
213,083
113
530
116
544
2.7%
4.7
4.7
0.0%
114
535
117
549.1
2.6%
TM
683,540
314
459
308
451
-1.9%
16
23.4
27
39.5
68.8%
330
483
335
490.1
1.5%
TR
380,123
147
387
159
418
8.2%
11
28.9
10.5
-63.6%
158
416
163
428.8
3.2%
VL
371,714
177
476
204
549
15.3%
11
29.6
11
29.6
0.0%
188
506
215
578.4
14.4%
VN
340,310
156
458
172
505
10.3%
55
161.6
57
167.5
3.6%
211
620
229
672.9
8.5%
VS
395,499
190
480
224
566
17.9%
15
37.9
15
37.9
0.0%
205
518
239
604.3
16.6%
20,121,641
9,551
475
10,322
513
8.1%
919
45.7
854
42.4
-7.1%
10,470
520
11,176
555.4
6.7%
Romania
57
Appendix 5. Patients incident in hemodialysis (HD), peritoneal dialysis (PD), non-preemptive renal transplantation (TR) and the number of deaths in 2013 in the counties of Romania
County
Population
HD + PD patients
prevalent
patients**
Average
pmi
PD
PD/HD
No
No
Deaths 2013
HD+DP
No
TR
pmi
No
No
pmi
pmi
AB
342,376
183
535.7
34
0.0
34
18.5
99.3
0.5
2.9
18
9.8
52.6
AG
612,431
316
515.3
27
3.7
28
8.9
45.7
0.3
1.6
45
14.3
73.5
AR
430,629
192
445.1
74
0.0
74
38.6
171.8
1.0
4.6
49
25.6
113.8
2,272,163
1,647
724.7
580
44
7.6
624
37.9
274.6
125
7.6
55.0
224
13.6
98.6
BC
616,168
350
568.0
37
11
29.7
48
13.7
77.9
1.7
9.7
52
14.9
84.4
BH
575,398
381
661.4
105
4.8
110
28.9
191.2
2.1
13.9
84
22.1
146.0
BN
286,225
119
416.9
35
0.0
35
29.3
122.3
2.5
10.5
23
19.3
80.4
B + IF
BR
321,212
235
731.3
54
16.7
63
26.8
196.1
0.0
0.0
26
11.1
80.9
BT
412,626
238
577.8
28
3.6
29
12.2
70.3
1.7
9.7
24
10.1
58.2
BV
549,217
312
568.4
82
3.7
85
27.2
154.8
1.9
10.9
37
11.9
67.4
BZ
451,069
222
492.7
34
10
29.4
44
19.8
97.5
0.0
0.0
29
13.0
64.3
CJ
691,106
459
663.7
84
2.4
86
18.8
124.4
1.1
7.2
50
10.9
72.3
CL
306,691
79
257.3
0.0
7.6
19.6
0.0
0.0
2.5
6.5
CS
295,579
110
372.7
66.7
10
9.1
33.8
1.8
6.8
27
24.5
91.3
CT
684,082
350
511.9
92
2.2
94
26.8
137.4
0.6
2.9
57
16.3
83.3
CV
210,177
65
306.9
15
6.7
16
24.8
76.1
1.6
4.8
10
15.5
47.6
DB
518,745
217
417.8
61
1.6
62
28.6
119.5
0.5
1.9
4.2
17.3
DJ
660,544
380
574.7
103
4.9
108
28.5
163.5
0.3
1.5
42
11.1
63.6
GJ
341,594
218
639.2
31
9.7
34
15.6
99.5
1.4
8.8
28
12.8
82.0
GL
536,167
176
329.0
20
12
60.0
32
18.1
59.7
1.1
3.7
27
15.3
50.4
GR
281,422
71
253.2
0.0
0.0
0.0
0.0
12
16.8
42.6
HD
418,565
256
610.4
88
3.4
91
35.6
217.4
1.6
9.6
34
13.3
81.2
HR
310,867
149
479.8
22
0.0
22
14.7
70.8
2.0
9.7
6.0
29.0
IL
274,148
102
372.1
18
0.0
18
17.6
65.7
0.0
0.0
6.9
25.5
IS
772,348
561
726.6
274
2.6
281
50.1
363.8
1.6
11.7
66
11.8
85.5
MH
265,390
197
742.0
36
2.8
37
18.8
139.4
1.5
11.3
31
15.7
116.8
MM
478,659
224
468.5
44
0.0
44
19.6
91.9
0.0
0.0
18
8.0
37.6
MS
550,846
199
361.9
18
0.0
18
9.0
32.7
1.5
5.4
14
7.0
25.4
58
County
Population
HD + PD patients
prevalent
patients**
Average
pmi
PD
PD/HD
No
No
Deaths 2013
HD+DP
No
TR
pmi
No
No
pmi
pmi
NT
470,766
287
608.9
24
0.0
24
8.4
51.0
1.0
6.4
52
18.1
110.5
OT
436,400
171
391.7
30
10.0
33
19.3
75.6
0.0
0.0
28
16.4
64.2
PH
762,886
346
453.3
67
7.5
72
20.8
94.4
0.0
0.0
62
17.9
81.3
SB
397,322
285
717.5
67
4.5
70
24.6
176.2
2.1
15.1
38
13.3
95.6
SJ
224,384
91
407.0
28
0.0
28
30.7
124.8
1.1
4.5
18
19.7
80.2
SM
344,360
163
473.3
27
11.1
30
18.4
87.1
5.5
26.1
19
11.7
55.2
SV
634,810
350
550.8
133
0.0
133
38.0
209.5
0.0
0.0
56
16.0
88.2
TL
213,083
114
533.4
21
0.0
21
18.5
98.6
0.9
4.7
5.3
28.2
TM
683,540
334
489.2
65
7.7
70
20.9
102.4
2.7
13.2
50
15.0
73.1
TR
380,123
161
422.2
48
6.3
51
31.8
134.2
0.0
0.0
31
19.3
81.6
VL
371,714
209
562.3
44
11.4
49
23.4
131.8
1.0
5.4
26
12.4
69.9
VN
340,310
222
652.6
45
6.7
48
21.6
141.0
0.0
0.0
14
6.3
41.1
VS
395,499
226
572.1
37
0.0
37
16.4
93.6
0.4
2.5
33
14.6
83.4
20,121,641
10,966
545.0
2,644
155
5.9
2,799
25.5
139.1
227
2.1
11.3
1,487
13.6
73.9
Romania
59
Appendix 6. Prevalent patients in the dialysis centers in Romania on 31.12.2011 vs. 31.12.2010 and the variance 2012/2011 in percentage (in the alphabetical order of the counties)
Dialysis Center
County
Prevalent patients1
HD
PD
HD + PD
2012
2013
Variance
2012
2013
Variance
2012
2013
Variance2
1.
AB
168
186
10.7%
0.0%
171
189
10.5%
2.
AB
3.
FNC Pitesti
AG
167
179
7.2%
11
11
0.0%
178
190
6.7%
4.
Nefrocare CL - Cmpulung
AG
46
55
19.6%
46
55
19.6%
5.
AG
70
78
11.4%
-100.0%
73
78
6.8%
6.
7.
Hemo-Vest Arad
Arad County Clinical Emergency Hospital
AR
AR
149
30
157
30
5.4%
0.0%
6
1
3
0
-50.0%
-100.0%
155
31
160
30
3.2%
-3.2%
8.
154
137
-11.0%
42
32
-23.8%
196
169
-13.8%
9.
CMDTAMP Bucharest
36
39
8.3%
36
39
8.3%
10.
348
344
-1.1%
16
17
6.3%
364
361
-0.8%
11.
80.0%
-37.5%
13
14
7.7%
12.
13.
0.0%
0.0%
22
38
72.7%
10
-10.0%
32
47
46.9%
14.
118
136
15.3%
200.0%
120
140
16.7%
15.
IHS Fundeni
91
92
1.1%
43
43
0.0%
134
135
0.7%
16.
134
136
1.5%
18
12
-33.3%
152
148
-2.6%
17.
139
157
12.9%
0.0%
143
161
12.6%
18.
50
101
102.0%
50
101
102.0%
19.
72
92
27.8%
72
88
22.2%
20.
21.
72
98
36.1%
-50.0%
76
99
30.3%
19
37
94.7%
12
11
-8.3%
31
47
51.6%
22.
23.
28
21
-25.0%
28
21
-25.0%
24.
15
11
-26.7%
0.0%
17
13
-23.5%
25.
25
400.0%
13
333.3%
38
375.0%
26.
14
13
60
Dialysis Center
County
Prevalent patients1
HD
PD
HD + PD
2012
2013
Variance
2012
2013
Variance
2012
2013
Variance2
27.
32
51
59.4%
-50.0%
34
52
52.9%
28.
FNC Bacau
BC
200
205
2.5%
29
26
-10.3%
229
231
0.9%
29.
BC
36
36
30.
BC
61
60
-1.6%
61
60
-1.6%
31.
32.
BC
BC
26
39
17
0
-34.6%
-100.0%
0
0
0
0
26
39
17
0
-34.6%
-100.0%
33.
FNC Oradea
BH
194
194
0.0%
194
194
0.0%
34.
BH
157
157
0.0%
11
21
90.9%
168
178
6.0%
35.
Diaverum Bistrita
BN
85
97
14.1%
85
97
14.1%
36.
BN
24
29
20.8%
24
29
20.8%
37.
IHS Braila
BR
125
126
0.8%
31
30
-3.2%
156
156
0.0%
38.
Specimed Braila
BR
57
65
14.0%
57
65
14.0%
39.
BR
17
-52.9%
-100.0%
18
-55.6%
40.
Avitum Botosani
BT
135
225
66.7%
13
333.3%
138
238
72.5%
41.
BT
84
-100.0%
11
-100.0%
95
-100.0%
42.
BT
43.
FNC Brasov
BV
160
178
11.3%
38
22
-42.1%
198
200
1.0%
44.
BV
74
92
24.3%
74
94
27.0%
45.
BV
-50.0%
-100.0%
-60.0%
46.
BV
14
16
14.3%
0.0%
15
17
13.3%
47.
BV
48.
IHS Buzau
BZ
139
156
12.2%
70
72
2.9%
209
228
9.1%
49.
NEFROCARE DJ Dej
CJ
33
37
12.1%
33
37
12.1%
50.
CJ
76
86
13.2%
76
86
13.2%
51.
CJ
84
91
8.3%
84
91
8.3%
52.
CJ
188
192
2.1%
10
11
10.0%
198
203
2.5%
61
Dialysis Center
County
Prevalent patients1
HD
2012
2013
PD
HD + PD
Variance
2012
2013
Variance
2012
2013
Variance2
53.
CJ
54.
CJ
17
-64.7%
17
-64.7%
55.
CJ
37
40
8.1%
37
40
8.1%
56.
IHS Calarasi
CL
76
84
10.5%
76
84
10.5%
57.
VAMAGO Resita
CS
87
82
-5.7%
17
16
-5.9%
104
98
-5.8%
58.
CS
50.0%
50.0%
50.0%
59.
FNC Constanta
CT
158
164
3.8%
0.0%
161
167
3.7%
60.
CT
42
42
0.0%
-40.0%
47
45
-4.3%
61.
IHS Constanta
CT
20
23
15.0%
-33.3%
26
27
3.8%
62.
Eurodializa Mangalia
CT
27
33
22.2%
27
33
22.2%
63.
CT
57
68
19.3%
16
11
-31.3%
73
79
8.2%
64.
65.
CV
43
84
95.3%
0.0%
44
85
93.2%
CV
66.
DB
69
74
7.2%
69
74
7.2%
67.
DB
97
120
23.7%
-11.1%
106
127
19.8%
68.
DB
16
28
75.0%
0.0%
25
37
48.0%
69.
IHS Craiova
DJ
83
102
22.9%
24
22
-8.3%
107
124
15.9%
70.
DJ
190
202
6.3%
190
202
6.3%
71.
DJ
63
46
-27.0%
-25.0%
71
52
-26.8%
72.
Avitum Targu-Jiu
GJ
137
145
5.8%
-11.1%
146
153
4.8%
73.
GJ
74.
GJ
59
61
3.4%
25.0%
63
66
4.8%
75.
IHS Galati
GL
87
97
11.5%
49
50
2.0%
136
147
8.1%
76.
77.
GL
-12.5%
-12.5%
GL
19
20
5.3%
-42.9%
26
24
-7.7%
62
Dialysis Center
County
Prevalent patients1
HD
PD
HD + PD
2012
2013
Variance
2012
2013
Variance
2012
2013
Variance2
78.
GR
71
74
4.2%
71
74
4.2%
79.
FNC Deva
HD
134
136
1.5%
134
136
1.5%
80.
IHS Petrosani
HD
60
64
6.7%
200.0%
61
66
8.2%
81.
HD
34
36
5.9%
34
36
5.9%
82.
HD
23
17
-26.1%
0.0%
26
20
-23.1%
83.
HR
95
100
5.3%
95
100
5.3%
84.
HR
47
48
2.1%
0.0%
48
49
2.1%
85.
HR
100.0%
100.0%
86.
HR
-100.0%
-100.0%
87.
IL
80
92
15.0%
-25.0%
88
97
10.2%
88.
IL
10
-10.0%
10
-10.0%
89.
IS
216
240
11.1%
54
39
-27.8%
270
279
3.3%
90.
NEFROCARE MS Iasi
IS
202
224
10.9%
31
24
-22.6%
233
247
6.0%
91.
IS
20
26
30.0%
20
26
30.0%
92.
IS
12.5%
0.0%
16
17
6.3%
93.
MH
166
174
4.8%
12
15
25.0%
178
189
6.2%
94.
MH
14
10
-28.6%
14
10
-28.6%
95.
MM
56
64
14.3%
56
64
14.3%
96.
MM
83
89
7.2%
-14.3%
90
95
5.6%
97.
MM
67
71
6.0%
-100.0%
68
71
4.4%
98.
Avitum Sighisoara
MS
34
40
17.6%
34
41
20.6%
99.
MS
116
117
0.9%
14.3%
123
125
1.6%
100.
MS
33
39
18.2%
33
39
18.2%
101.
Diaverum Roman
NT
62
67
8.1%
50.0%
64
70
9.4%
102.
NT
62
68
9.7%
-25.0%
66
71
7.6%
103.
NT
135
132
-2.2%
11
-63.6%
146
136
-6.8%
63
Dialysis Center
County
Prevalent patients1
HD
2012
PD
2013
Variance
2012
2013
HD + PD
Variance
2012
2013
Variance2
104.
NT
-66.7%
-66.7%
105.
Nefrolab Slatina
OT
108
137
26.9%
100.0%
110
141
28.2%
106.
OT
38
26
-31.6%
16
-43.8%
54
35
-35.2%
107.
IHS Busteni
PH
11
14
27.3%
11
14
27.3%
108.
PH
56
56
109.
Nefroclinic Ploiesti
PH
206
198
-3.9%
17
16
-5.9%
223
214
-4.0%
110.
PH
103
71
-31.1%
103
71
-31.1%
111.
Diaverum Medias
SB
47
51
8.5%
16.7%
53
58
9.4%
112.
Diaverum Sibiu
SB
153
157
2.6%
-16.7%
159
162
1.9%
113.
Diaverum Sibiu
SB
47
49
4.3%
11
10
-9.1%
58
59
1.7%
114.
SB
16.7%
16.7%
115.
NEFROMED SJ Zalau
SJ
84
95
13.1%
84
95
13.1%
116.
SJ
0.0%
0.0%
117.
SM
118
124
5.1%
29
27
-6.9%
147
151
2.7%
118.
SM
14
10
-28.6%
14
10
-28.6%
119.
Avitum Suceava
SV
121
123
1.7%
121
125
3.3%
120.
FNC Suceava
SV
145
153
5.5%
0.0%
152
160
5.3%
121.
122.
NEFROMED BM Radauti
"Sf. Ioan cel Nou" County Emergency Hospital Suceava
SV
48
53
10.4%
0.0%
49
52
6.1%
SV
18
10
-44.4%
18
10
-44.4%
123.
TL
85
81
-4.7%
0.0%
86
82
-4.7%
124.
TL
28
35
25.0%
28
35
25.0%
125.
Avitum Timisoara
TM
92
107
16.3%
33.3%
98
115
17.3%
126.
127.
128.
TM
TM
181
0
170
0
-6.1%
-
8
1
16
0
100.0%
-100.0%
189
1
186
0
-1.6%
-100.0%
TM
23
16
-30.4%
23
17
-26.1%
129.
TM
18
15
-16.7%
100.0%
19
17
-10.5%
130.
TR
128
137
7.0%
128
137
7.0%
64
Dialysis Center
County
Prevalent patients1
HD
PD
HD + PD
2012
2013
Variance
2012
2013
Variance
2012
2013
Variance2
131.
TR
19
22
15.8%
11
-63.6%
30
26
-13.3%
132.
VL
100.0%
100.0%
133.
VL
134
158
17.9%
134
158
17.9%
134.
VL
43
46
7.0%
-37.5%
51
51
0.0%
135.
136.
IHS Focsani
"Sf. Pantelimon" Vrancea County Emergency Hospital,
Focsani
VN
144
161
11.8%
54
55
1.9%
198
216
9.1%
VN
12
11
-8.3%
100.0%
13
13
0.0%
137.
VS
82
103
25.6%
15
-40.0%
97
111
14.4%
138.
VS
105
110
4.8%
105
116
10.5%
139.
VS
11
266.7%
11
266.7%
10.470
11.158
6.6%
Romania
1
2
9.551
10.322
8.1%
919
854
-7.1%
65
Appendix 7. Prevalent and incident dialysis patients, non-preemptive transplanted or deceased patients in dialysis centers in Romania in 2013 (in the alphabetical order of the counties)
Dialysis center
County
Prevalent patients*
HD
PD
Newly-included patients
PD/HD HD+DP HD
%
PD
PD/HD
Deaths
HD+DP
TR
No
No
No
No
No
No
No
1.
2.
AB
178
1.7%
181
11
0.0%
11
6.1%
No
1
0.6%
18
%
9.9%
AB
0.0%
23
0.0%
23
920.0%
0.0%
0.0%
3.
AG
178
10
5.7%
188
0.0%
0.0%
23
12.3%
4.
Nefrocare CL - Campulung
AG
50
0.0%
50
0.0%
2.0%
12.0%
5.
AG
77
0.8%
78
27
3.7%
28
36.1%
0.0%
16
20.6%
6.
Hemo-Vest - Arad
AR
156
3.1%
161
0.0%
1.2%
21
13.1%
7.
AR
31
0.8%
31
74
0.0%
74
240.7%
0.0%
28
91.1%
8.
153
37
24.4%
191
133.3%
3.7%
0.0%
28
14.7%
9.
CMDTAMP Bucharest
38
0.2%
38
100.0%
5.3%
0.0%
13.2%
10.
347
16
4.5%
362
0.0%
0.8%
13
3.6%
11.
97.8%
15
0.0%
13.2%
0.0%
0.0%
12.
13.
0.0%
49
0.0%
49
0.0%
35
22.9%
43
36
13.9%
41
95.5%
0.0%
11
25.6%
14.
127
3.2%
131
0.0%
1.5%
1.5%
17
13.0%
15.
IHS Fundeni
87
44
50.8%
131
0.0%
0.8%
0.8%
6.9%
16.
132
14
10.3%
146
0.0%
1.4%
15
10.3%
17.
151
2.9%
155
0.0%
0.0%
20
12.9%
18.
80
0.0%
80
0.0%
5.0%
8.7%
19.
87
0.0%
87
0.0%
0.0%
0.0%
20.
21.
93
3.9%
97
0.0%
0.0%
9.3%
32
12
37.7%
44
172
16
9.3%
188
428.9%
0.0%
11
25.1%
22.
23.
18
0.0%
18
110
0.0%
110
614.0%
0.0%
20
111.6%
24.
17
23.0%
21
24
4.2%
25
119.5%
4.8%
11
52.6%
25.
11
12 109.1%
23
43
14
32.6%
57
247.8%
0.0%
17.4%
66
Dialysis center
County
Prevalent patients*
HD
PD
No
No
10
BC
26.
27.
28.
Newly-included patients
PD/HD HD+DP HD
PD
PD/HD
Deaths
HD+DP
TR
No
No
No
No
No
No
0.0%
10
0.0%
40.0%
0.0%
0.0%
44
4.6%
46
133
2.3%
136
298.9%
0.0%
44
96.7%
202
28
14.0%
230
14
7.1%
15
6.5%
2.6%
32
13.9%
29.
MALP Moinesti
BC
0.0%
0.0%
0.0%
11.0%
30.
BC
61
0.0%
61
0.0%
3.3%
0.0%
8.2%
31.
BC
19
5.8%
20
19
10
52.6%
29
147.5%
0.0%
25.4%
32.
BC
30
0.0%
30
0.0%
6.7%
0.0%
30.2%
33.
BH
198
0.0%
198
53
0.0%
53
26.8%
1.5%
51
25.8%
34.
BH
164
19
11.5%
183
52
9.6%
57
31.1%
2.7%
33
18.0%
35.
Diaverum - Bistrita
BN
94
0.0%
94
0.0%
3.2%
13
13.8%
36.
BN
25
0.0%
25
35
0.0%
35
141.9%
0.0%
10
40.5%
37.
IHS Braila
BR
127
32
24.8%
159
0.6%
0.0%
10
6.3%
38.
Specimed Braila
BR
61
0.0%
61
0.0%
0.0%
0.0%
39.
BR
14
6.0%
15
54
14.8%
62
418.0%
0.0%
16
107.9%
40.
Avitum Botosani
BT
208
12
5.8%
220
0.0%
1.8%
1.8%
22
10.0%
41.
BT
13
13.8%
15
0.0%
0.0%
13.2%
42.
BT
0.0%
24
4.2%
25
833.3%
0.0%
0.0%
43.
BV
170
29
16.9%
198
0.0%
1.5%
3.0%
20
10.1%
44.
BV
88
2.3%
90
17
11.8%
19
21.1%
0.0%
4.4%
45.
BV
1.2%
61
1.6%
62
907.3%
0.0%
102.4%
46.
BV
16
6.3%
17
0.0%
5.9%
0.0%
35.3%
47.
BV
48.
IHS - Buzau
BZ
150
73
48.7%
223
34
10
29.4%
44
19.7%
0.0%
29
13.0%
49.
NEFROCARE DJ - Dej
CJ
37
0.0%
37
0.0%
2.7%
18.7%
50.
CJ
82
0.0%
82
0.0%
3.7%
0.0%
12
14.7%
51.
CJ
92
0.0%
92
0.0%
2.2%
0.0%
52.
CJ
186
11
5.8%
197
0.0%
1.0%
27
13.7%
53.
CJ
0.0%
100.0%
100.0%
0.0%
0.0%
54.
CJ
10
0.9%
10
76
1.3%
77
796.6%
0.0%
0.0%
67
Dialysis center
County
Prevalent patients*
HD
PD
No
No
Newly-included patients
PD/HD HD+DP HD
PD
PD/HD
No
No
No
Deaths
HD+DP
TR
No
No
No
55.
CJ
39
0.4%
39
0.0%
10.2%
0.0%
10.2%
56.
IHS Calarasi
CL
79
0.0%
79
0.0%
7.6%
0.0%
2.5%
57.
VAMAGO - Resita
CS
85
16
18.9%
102
50.0%
3.0%
2.0%
18
17.7%
58.
CS
35.5%
75.0%
81.6%
0.0%
104.9%
59.
CT
161
2.2%
165
0.0%
0.6%
10
6.1%
60.
CT
43
8.4%
46
0.0%
0.0%
11
23.8%
61.
IHS Constanta
CT
23
21.2%
28
0.0%
3.6%
7.1%
62.
Eurodializa - Mangalia
CT
34
0.0%
34
0.0%
0.0%
8.8%
63.
CT
65
12
18.9%
77
92
2.2%
94
122.6%
0.0%
31
40.4%
64.
65.
CV
62
1.6%
63
0.0%
8.0%
1.6%
11.1%
CV
6.3%
10
10.0%
11
776.5%
0.0%
211.8%
66.
DB
69
0.0%
69
0.0%
0.0%
11.5%
67.
DB
113
8.0%
122
0.0%
0.8%
0.0%
68.
DB
17
50.5%
25
61
1.6%
62
244.7%
0.0%
3.9%
69.
IHS Craiova
DJ
93
22
23.7%
115
0.0%
0.0%
17
14.7%
70.
DJ
200
0.0%
200
0.0%
0.5%
2.5%
71.
DJ
57
11.9%
63
103
4.9%
108
170.3%
0.0%
20
31.5%
72.
Avitum - Targu-Jiu
GJ
143
6.2%
152
20
10.0%
22
14.5%
0.7%
23
15.1%
73.
GJ
62
5.6%
66
0.0%
3.1%
7.6%
74.
GJ
0.0%
11
0.0%
11 1100.0%
0.0%
0.0%
75.
GJ
1 1200.0%
0.0%
0.0%
76.
IHS Galati
GL
93
49
52.2%
142
0.0%
0.7%
16
11.3%
77.
78.
5.6%
0.0%
12.8%
0.0%
21
26.7%
27
20
12
60.0%
32
120.8%
0.0%
11
41.5%
79.
GR
71
0.0%
71
0.0%
0.0%
12
16.8%
80.
HD
135
0.0%
135
0.0%
0.7%
19
14.1%
81.
IHS Petrosani
HD
63
3.2%
65
0.0%
3.1%
14.0%
82.
HD
36
0.0%
36
56
0.0%
56
155.6%
0.0%
0.0%
83.
HD
18
14.6%
20
32
9.4%
35
172.8%
4.9%
29.6%
68
Dialysis center
County
Prevalent patients*
HD
PD
No
No
Newly-included patients
PD/HD HD+DP HD
%
PD
PD/HD
No
No
No
Deaths
HD+DP
TR
No
No
No
84.
HR
101
0.0%
101
0.0%
1.0%
2.0%
85.
HR
45
2.0%
46
0.0%
4.3%
13.0%
86.
HR
0.0%
17
0.0%
17 1020.0%
0.0%
0.0%
87.
HR
0.0%
0.0%
5 1000.0%
0.0%
200.0%
88.
IL
86
6.4%
91
0.0%
0.0%
7.7%
89.
IL
11
0.0%
11
18
0.0%
18
167.4%
0.0%
0.0%
90.
IS
230
47
20.3%
276
83.3%
11
4.0%
1.4%
33
12.0%
91.
NEFROCARE MS Iasi
IS
215
27
12.7%
242
0.0%
0.8%
2.1%
11
4.5%
92.
IS
26
0.3%
26
261
0.4%
262 1010.9%
0.0%
21
81.0%
93.
IS
91.4%
17
20.0%
35.8%
0.0%
6.0%
94.
MH
172
14
8.1%
186
36
2.8%
37
19.9%
1.6%
26
14.0%
95.
MH
11
0.8%
11
0.0%
0.0%
46.5%
96.
MM
61
0.0%
61
0.0%
0.0%
3.3%
97.
MM
85
7.9%
91
0.0%
1.1%
0.0%
3.3%
98.
MM
72
0.0%
72
43
0.0%
43
59.6%
0.0%
13
18.0%
99.
Avitum - Sighisoara
MS
38
0.7%
38
0.0%
13.2%
2.6%
7.9%
100.
MS
118
6.1%
125
0.0%
4.8%
0.8%
6.4%
101.
MS
37
0.0%
37
0.0%
19.0%
2.7%
8.1%
102.
Diaverum - Roman
NT
64
4.2%
67
0.0%
0.0%
13.5%
103.
NT
71
4.9%
75
0.0%
1.3%
16
21.5%
104.
NT
135
4.6%
141
0.0%
0.7%
1.4%
16
11.3%
105.
NT
0.0%
23
0.0%
23
766.7%
0.0%
11
366.7%
106.
Nefrolab - Slatina
OT
129
2.6%
133
0.0%
0.8%
0.0%
17
12.8%
107.
OT
28
11
38.7%
39
29
10.3%
32
82.4%
0.0%
11
28.3%
108.
IHS Busteni
PH
12
0.0%
12
0.0%
0.0%
8.3%
109.
PH
37
0.0%
37
0.0%
0.0%
24.5%
110.
Nefroclinic - Ploiesti
PH
199
17
8.6%
216
1.4%
0.0%
22
10.2%
111.
PH
81
0.2%
81
67
3.0%
69
85.5%
0.0%
30
37.2%
112.
Diaverum - Medias
SB
47
16.4%
55
3.6%
0.0%
10
18.2%
113.
Diaverum - Sibiu
SB
159
3.0%
163
0.0%
3.1%
11
6.7%
69
Dialysis center
County
Prevalent patients*
HD
PD
No
No
Newly-included patients
PD/HD HD+DP HD
%
PD
PD/HD
No
No
No
Deaths
HD+DP
TR
No
No
No
114.
Diaverum Sibiu
SB
47
11
23.3%
58
0.0%
1.7%
3.5%
115.
SB
0.9%
67
1.5%
68
762.6%
0.0%
15
168.2%
1.1%
1.1%
14
15.8%
27 1012.5%
0.0%
150.0%
116.
NEFROMED SJ - Zalau
SJ
89
0.0%
89
0.0%
117.
SJ
0.0%
27
0.0%
118.
SM
122
28
22.9%
150
0.0%
2.0%
2.7%
4.7%
119.
SM
12
2.0%
13
24
12.5%
27
214.6%
39.7%
12
95.4%
120.
Avitum - Suceava
SV
120
1.1%
122
0.0%
0.0%
18
14.8%
121.
SV
152
4.9%
159
0.0%
0.6%
0.0%
3.1%
122.
123.
NEFROMED BM - Radauti
"Sf. Ioan cel Nou" County Emergency Hospital Suceava
SV
54
1.9%
55
0.0%
0.0%
5.5%
SV
14
0.0%
14
132
0.0%
132
937.3%
0.0%
30
213.0%
124.
TL
83
1.2%
84
0.0%
1.2%
7.1%
125.
TL
30
0.0%
30
21
0.0%
21
70.8%
0.0%
0.0%
126.
Avitum - Timisoara
TM
101
6.7%
108
100.0%
1.9%
0.9%
16
14.8%
127.
TM
174
13
7.5%
187
1.1%
1.1%
18
9.6%
128.
TM
129.
TM
19
4.5%
19
62
3.2%
64
329.6%
30.9%
16
82.4%
130.
TM
18
6.8%
20
0.0%
10.3%
0.0%
0.0%
131.
TR
132
0.0%
132
0.0%
0.0%
28
21.2%
132.
TR
20
42.9%
29
48
6.3%
51
178.4%
0.0%
10.5%
133.
VL
80.0%
0.0%
0.0%
134.
VL
152
0.0%
152
0.0%
1.3%
17
11.2%
135.
VL
45
15.1%
52
44
2.3%
45
87.4%
0.0%
17.5%
136.
137.
IHS Focsani
VN
County Emergency Hospital "Sf. Pantelimon" Vrancea
- Focsani
VN
149
53
35.7%
202
0.0%
0.0%
13
6.4%
18
11.1%
20
45
6.7%
48
240.0%
0.0%
5.0%
138.
VS
94
12
12.3%
106
0.0%
0.9%
8.5%
139.
140.
VS
109
5.5%
115
0.0%
0.0%
18
15.7%
37
0.0%
37
792.9%
0.0%
128.6%
5.9%
2.799
2.1% 1.487
13.6%
Romania
VS
0.0%
10.022
878
8.8%
25.7% 227
70
Appendix 8. Haemodialysis centers ordered increasingly by the standardized mortality ratio (SMR)
Prevalent
patients*
SMR
CI 95%
130
0.39
0.15
0.62 Low
36
0.35
-0.05
0.74 Low
47
0.29
-0.01
0.59 Low
45
0.27
0.54 Low
76
0.14
0.04
0.25 Low
94
0.13
0.04
0.23 Low
154
0.58
0.25
0.9 Low
92
0.56
0.15
0.96 Low
87
0.56
0.15
0.96 Low
167
0.49
0.21
0.76 Low
49
0.49
0.02
0.96 Low
327
0.62
0.38
0.86 Low
35
5.45
-1.22
12.12 Similar
26
0.44
-0.14
1.02 Similar
68
0.57
0.08
1.05 Similar
89
0.59
0.15
1.04 Similar
98
0.63
0.19
1.08 Similar
117
0.65
0.23
1.07 Similar
38
0.67
-0.09
1.44 Similar
152
0.69
0.29
1.1 Similar
55
0.7
0.04
1.37 Similar
75
0.79
0.1
1.47 Similar
CMDTAMP Bucharest
32
0.8
-0.19
1.8 Similar
130
0.8
0.3
1.29 Similar
72
0.81
0.17
1.45 Similar
30
0.82
-0.21
1.84 Similar
Hemodialysis center
Fresenius NephroCare Pitesti - Dialysis center
Signicance
71
Hemodialysis center
Prevalent
patients*
118
SMR
CI 95%
0.83
0.31
1.36 Similar
47
0.84
-0.03
1.7 Similar
127
0.84
0.34
1.34 Similar
33
0.86
-0.25
1.97 Similar
156
0.87
0.39
1.35 Similar
62
0.87
0.07
1.67 Similar
59
0.87
0.07
1.67 Similar
105
0.95
0.31
1.59 Similar
164
0.97
0.43
1.51 Similar
154
0.98
0.45
1.51 Similar
65
0.12
1.88 Similar
150
1.02
0.41
1.63 Similar
128
1.03
0.38
1.67 Similar
131
1.08
0.42
1.74 Similar
118
1.13
0.39
1.87 Similar
75
1.18
0.23
2.12 Similar
162
1.19
0.53
1.84 Similar
146
1.24
0.54
1.94 Similar
75
1.26
0.21
2.3 Similar
132
1.34
0.5
2.17 Similar
63
1.34
0.1
2.58 Similar
19
1.35
-0.83
3.53 Similar
17
1.45
-0.98
3.89 Similar
119
1.48
0.54
2.43 Similar
175
1.52
0.74
2.31 Similar
27
1.53
-0.61
3.67 Similar
28
1.53
-0.62
3.69 Similar
Signicance
72
Hemodialysis center
Baia Mare County Emergency Hospital - Haemodialysis center Baia Mare
Prevalent
patients*
45
SMR
CI 95%
Signicance
1.54
-0.14
3.22 Similar
65
1.58
0.2
2.96 Similar
61
1.59
0.11
3.07 Similar
45
1.6
-0.17
3.37 Similar
90
1.61
0.34
2.87 Similar
20
1.65
-0.74
4.04 Similar
120
1.66
0.58
2.75 Similar
130
1.71
0.65
2.77 Similar
162
1.72
0.73
2.71 Similar
101
1.73
0.49
2.97 Similar
80
1.75
0.31
3.19 Similar
39
1.77
-0.3
3.84 Similar
47
1.79
-0.13
3.7 Similar
128
1.8
0.65
2.94 Similar
90
1.8
0.43
3.17 Similar
"Sf. Ap. Andrei" Galati County Clinical Emergency Hospital - Dialysis center
15
1.84
-1.62
5.3 Similar
112
1.84
0.62
3.06 Similar
52
1.85
-0.01
3.71 Similar
26
1.87
-1.02
4.75 Similar
80
1.89
0.35
3.43 Similar
56
1.89
0.09
3.7 Similar
27
1.91
-0.68
4.5 Similar
57
1.92
0.18
3.66 Similar
110
1.93
0.57
3.29 Similar
65
1.97
0.26
3.67 Similar
113
2.02
0.66
3.38 Similar
67
2.08
0.22
3.94 Similar
73
Prevalent
patients*
44
Hemodialysis center
SMR
CI 95%
Signicance
2.09
-0.15
4.32 Similar
54
2.12
0.1
4.14 Similar
12
2.15
-2.21
6.51 Similar
63
2.16
0.19
4.13 Similar
26
2.2
-1
5.39 Similar
119
2.28
0.84
3.71 Similar
11
2.43
-2.81
7.67 Similar
2.49
-5.21
10.2 Similar
16
2.54
-2.04
7.12 Similar
11
2.58
-3.16
8.31 Similar
2.64
-5.76
11.04 Similar
54
2.69
-0.04
5.41 Similar
14
2.75
-2.41
7.92 Similar
2.75
-6.19
11.69 Similar
42
2.85
-0.29
5.99 Similar
2.86
-3.85
9.58 Similar
17
3.09
-2.23
8.41 Similar
3.17
-4.65
11 Similar
31
3.24
-0.8
7.28 Similar
43
3.65
-0.47
7.76 Similar
3.72
-10.35
17.8 Similar
26
3.9
-1.44
9.24 Similar
10
3.96
-4.95
12.87 Similar
17
4.06
-3.11
11.23 Similar
14
4.24
-4.33
12.82 Similar
24
4.32
-1.19
10.55 Similar
13
4.51
-4.88
13.91 Similar
74
Hemodialysis center
Brasov County Clinical Emergency Hospital - Dialysis center
Prevalent
patients*
20
SMR
CI 95%
Signicance
5.11
-3.45
13.68 Similar
205
2.47
1.25
3.7 High
NE
NE
NE NE
11
NE
NE
NE NE
NE
NE
NE NE
Fundeni Clinical Institute - Pediatric department, Nephrology department and the Pediatric dialysis
department
NE
NE
NE NE
10
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
47
NE
NE
NE NE
"Sf. Ioan cel Nou" County Emergency Hospital Suceava - Dialysis center
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
39
NE
NE
NE NE
60
NE
NE
NE NE
15
NE
NE
NE NE
NE
NE
NE NE
NE
NE
NE NE
26
NE
NE
NE NE
NE
NE
NE NE
8161
1.27
1.19
1.36 High
75
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