The epidemiology of chronic renal failure and provision of renal services in Albania

Tirana, the only dialysis facility in Albania (pop 4 million), has a stock of 12 patients and three haemodialysis machines. To determine the need for renal services in Albania we studied the incidence and outcome of patients with chronic renal failure (CRF) referred to the renal service in Tirana (pop 300000) over 1 year. Case-notes of all patients with a serum creatinine concentration ≥300 μmol/l during the study period (1992) were examined and outcome at 2 years recorded for each patient. In all, 84 patients (mean age 41.6±17.5 years, 56% male) were referred to nephrologists of whom 35 (42%) came from Tirana, giving an annual incidence of 116 per million pop. 77% were under 40 and had no co-morbid illness. Glomerulonephritis, the most common renal diagnosis, affected 26% patients. 22% patients (mean age 38±18.1) died within 2 years and only 5% received dialysis. The mean age of those who received dialysis was 29±8.3 compared with those who were not dialysed (42±18.0). The 59 patients (24 from Tirana i.e. 80 per million) who were alive with advanced CRF (creatinine>500) had a mean creatinine of 623±93 μmol/l and would be candidates for dialysis. Patients with progressive renal failure in Albania are regularly followed and treated with antihypertensives and dietary modification. The need for RRT, however, is not being met even for young patients with no co-morbidity.