title: Hemodialysis treatment in patients with Balkan endemic nephropathy: an epidemiological study.
abstract: OBJECTIVE
  To analyze hemodialysis (HD) treatment of patients with Balkan endemic nephropathy (BEN) from five endemic villages in the South Morava Region of Serbia. Analyses of patterns of incidence may generate hypotheses about the underlying causes of BEN, and prevalence data provide information on the current and likely future burden on health services for managing BEN.
  
  
  METHODS
  A total of 143 end-stage kidney disease patients (ESKD) with BEN were admitted to the renal replacement program from 1974 to 2004: 121 to HD, 15 peritoneal dialysis, and 7 kidney transplantation. As a control group, 117 patients with other kidney disease (chronic pyelonephritis, glomerulonephritis, and ischemic nephropathy) admitted to HD at the time of BEN patients and matched by age and gender were studied.
  
  
  RESULTS
  Most of the BEN patients (93.4%) treated by HD were born from 1917 to 1941. The majority of patients (79.3%) started HD from 1977 to 1991 (period of 15 years). The mean age of BEN patients starting HD treatment was 49.1 years in the period from 1974 to 1978, and increased steadily in the following years, being 72.5 years in the last period of study (2004-2006) The mean survival time of BEN males was 4.70 (95% CI 3.66-5.75) and for females was 5.02 (95% CI 1.47-4.53). Difference between males and females was not statistically significant (log rank 0.14, p = 0.7, P > 0.5). Mean survival times of 4.84 (95% CI 3.97-5.70) in BEN patients and 3.1 (95% CI 2.78-3.84) in other kidney disease patients were found. Difference between BEN patients and controls was statistically significant (log rank 8.38, p = 0.0038, P < 0.01).
  
  
  CONCLUSIONS
  The population of endemic villages around the South Morava River admitted to HD treatment after 1974 was exposed to environmental toxicant(s) from 1917 to 1941. The most intense effect of environmental exposure was in that period, with ESKD in patients in their forties. The exposure to environmental toxicants has diminished, so ESKD of BEN has become less frequent and manifested in the older age, mean 72.5 in the period from 2004 to 2006. Different type of exposure was registered in some other endemic regions in Serbia and abroad.
authors.affiliation: Faculty of Medicine, Nis, Serbia.
authors.forename: Rade
authors.initials: R
authors.lastname: Cukuranovic
authors.forename: Ivan
authors.initials: I
authors.lastname: Jovanovic
authors.forename: Sladjana
authors.initials: S
authors.lastname: Miljkovic
authors.forename: Natalija
authors.initials: N
authors.lastname: Stefanovic
authors.forename: Slobodan
authors.initials: S
authors.lastname: Vlajkovic
authors.forename: Miomir
authors.initials: M
authors.lastname: Prokopovic
authors.forename: Vladisav
authors.initials: V
authors.lastname: Stefanovic
mesh_terms: D000368:Aged; D001449:Balkan Nephropathy / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012737:Sex Factors; D015022:Yugoslavia / Q000453:epidemiology