title: Nephrology and renal replacement therapy in Romania--transition still continues (Cinderella story revisited).
abstract: INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context.
  
  
  METHODS
  Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated).
  
  
  RESULTS
  In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2).
  
  
  CONCLUSIONS
  Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.
authors.affiliation: Dr. Carol Davila' University Hospital of Nephrology, Bucharest, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mircescu
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Capsa
authors.forename: Maria
authors.initials: M
authors.lastname: Covic
authors.forename: Mirela Gherman
authors.initials: MG
authors.lastname: Caprioara
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Gluhovschi
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Golea
authors.forename: Nicolae
authors.initials: N
authors.lastname: Ursea
authors.forename: Liliana
authors.initials: L
authors.lastname: Gârneata
authors.forename: Vasile
authors.initials: V
authors.lastname: Cepoi
authors.forename: Nicolae
authors.initials: N
authors.lastname: Constantinovici
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D009398:Nephrology / Q000639:trends*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data / Q000639:trends*; D012383:Romania / Q000453:epidemiology