Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Editorial Review
[What do we know about chronic kidney disease at the beginning of the 21st century?].
Data are presented on the number of chronic kidney disease (CKD) patients and on the most common causes of the disease, with special reference to data collected at the Registry of Renal Replacement Therapy by Dialysis and Kidney Transplantation in the Republic of Croatia. Emphasis is put on the very high cost of managing patients with end-stage CKD. As currently there is no drug able to halt progression of kidney damage in CKD, attention is focused on early detection of renal disease, screening of CKD patients, specific therapy, slowing down disease progression, and treatment of complications and comorbidities. The role of general practitioners and compliance of patients who have to decide on the mode of renal replacement therapy, as well as of continuous education of nephrologists and public awareness of renal diseases is underlined.
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Renal transplantation has significantly improved survival of patients with end-stage renal disease (ESRD). Transplantation is the best treatment in this population of patients. Despite the introduction of various preventive measures, viral hepatitis, i.e. hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, are still a major problem because they are common in patients on renal replacement therapy as well as in allograft recipients. ⋯ The use of nucleid acid testing (NAT) could be useful because it involves amplification of viral gene products and thus is not dependent on antibody formation. Therefore, by using this method the period between the infection and detectability, which is known as the window period, could be reduced. However, this method is expensive and time consuming.
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The usage of temporary and permanent dialysis catheters for hemodialysis vascular access has been on continual increase. The reason for this increase is aging population on hemodialysis with blood vessels inappropriate for arteriovenous fistula creation. ⋯ Monitoring of dialysis catheter function, choice of the site of catheter insertion and methods of salvaging catheters from thrombosis and treating catheter-related local and systemic infections are described in this paper. Constant evaluation, proper care and hygiene of dialysis catheters are highly recommended.