A. Hellenic Society of Nephrology – History

 

The Hellenic Society of Nephrology (HSN) was founded in 1970 as a non-profit Association to enhance and assist the study and practice of nephrology, to provide a forum for the promulgation of research, and to meet the professional and continuing education needs of its members.

As with many other national societies, several influential professors, mainly of Internal Medicine, participated in early years of the HSN, notably Prof. D. Valtis and Prof. S. Papastamatis.

 

Nephrology up to 1980 was practised as an unofficial subspecialty of Internal Medicine, but since then has been recognised as a main specialty. The training period consists of two-years training in Internal Medicine followed by four-years training in Nephrology. The training in nephrology requires two-years practice in clinical nephrology, one year in haemodialysis, six months in CAPD and six months in transplantation. The title of specialization is granted as a single-accreditation specialty by a three-member examining committee.

 

From its foundation to now the members of the HSN elect a seven-member Council every two years, which rules the society according to a constitution ratified by the General Assembly for the first time in 1970 and modified in 1979 and recently in 1999. With the last change in our constitution the HSN became both the official scientific society of nephrology and the trade union of nephrologists in Greece. In this perspective, of the nearly 550 members of our society by the end of the year 2000, the right to elect and be elected is restricted only to the 360 qualified nephrologists.

 

The HSN is committed to providing continuing education to assist members in certification and re-certification, and to encourage them to continually update their skills, knowledge, and competencies.

 

The Journal HELLENIC NEFROLOGY is the quarterly official publication of the Hellenic Society of Nephrology. Also, the HSN offers several scientific grants, research awards and fellowships, as well as educational conferences:

The last congress (12th Congress of Nephrology, 29 May – 1 June 2002) was held in the city of Ioannina, the next instead one is going to take place at the Island of Rhodes in 16-19 June 2004.

 

The HSN has also organised several International Congresses and Meetings:

 

As of December of 1999, the HSN has created a web-page (http://www.ene.net.gr) available as a useful means of communication with its members and other institutions. The objective of our website is to publish all relevant information, news and scientific articles and activities of nephrology in Greece and in the entire world.

 

 

 

B. Organizational Issues: Nephrology network, Nephrologists and Nurses

 

Nephrology in Greece is practiced on a two-tiered basis, state and private. The distribution of state and private units and their increasing numbers from 1986 to 2000 are shown in Figure 1. During the last 15 years the number of the regular dialysis units (RDUs) has nearly doubled, from 58 to 106. This increase has been seen in a similar trend in the two large urban areas of Athens and Thessaloniki and the rural areas of the periphery of Greece. However, by the end of 2000, of the 106 RDUs, 77 were state owened, and 29 private, and the majority of the private units (90%) were functioning in Athens (n=23) and Thessaloniki (4). This indicates that the expansion of the state sector took place mainly in the periphery of Greece.

 

The delivery of health care in nephrology is given by Departments of Nephrology, which are based almost exclusively in state hospitals, while private institutions provide only haemodialysis facilities. Of the 77 state units the majority of them, 61 (80%), belong to the National Health System (called in Greek, ESY), there are 7 University Departments of Nephrology, 5 units in Military Hospitals and 3 belonging to the largest State Insurance Company (IKA). Of the 77 state units, 35 are Departments of Nephrology consisting of clinical nephrology clinics, RDUs and CAPD units (only 4 of the 35 have transplantation services) and the remaining 42 units function as RDUs. Two of the 77 state units provide service to paediatric patients.

 

 

Figure 1. The distribution of Renal Units and their increased number between the years

1986 to 2000, Hellenic Renal Registry 1986-2000.

 

 

Full training in nephrology (4 years) is provided by 24 state Departments of Nephrology, 10 units provide variable training from 1 to 3 years and 42 units are not entitled to train doctors in nephrology. By the end of 2001 there were 97 doctors training in nephrology.

There is a fixed number of establishment state positions (109) in Nephrology, which are offered after evaluation by a Board according to set qualification criteria. Nowadays, most of these jobs are occupied and very few have been advertised to be completed. However, the current number of nephrologists working both in the public and private sector is estimated to be around 350, which, practically leaves no unemployed qualified nephrologists, as those who do not occupy a state or private job may practice nephrology privately in their own practice.

 

With regard to the nurses in nephrology an official nursing degree is obtained after three-years of study in Nursing Schools and passing a final examination. A small number of nurses have obtained a university degree, which requires a 4-year course and training. Except for the routine training, no further degree or studies is required in order to work in Nephrological Services. By the end of 2001, 1507 nurses were employed in nephrology.

C. Incidence and Prevalence of Renal Insufficiency in Greece – Hellenic Renal Registry

The Hellenic Renal Registry started in 2000 under the Board of Registry Coordination and Control of RRT (called in Greek, YSE), a state body attached to the Ministry of Health. YSE is a state organization, which keeps the records of renal replacement therapy (RRT) patients, with the support of our society. This is compulsory for all dialysis units and in effect has resulted in nearly 100% response rate of RRT data. This was a good reason to join the new ERA Registry in 2000 and contribute to annual reports since then.

 

The last report of our Registry showed that at 31.12.2000, the total number of patients alive on RRT was 8,431, which represents 773 patients per million population (pmp) (Figure 2). This figure, split by treatment modality, was as follows: 6,226 patients on Hemodialysis (73.8%), 733 patients on CAPD (8.7%) and 1472 patients had a functioning kidney graft (17.5%). During the last 15 years there was a 3-fold increase in patients in all RRT modalities. With regards to new patients starting treatment each year from 1986 to 2000 there was a dramatic increase from 55.9 pmp to 151.4 pmp (1650 ESRD patients started RRT on 2000) (Figure 3). The patients’ mean age at initiation of RRT was increased from 53.9 in 1988 to 64.5 years in 2000.

 

Figure 2. Stock patients pmp  by mode of RRT, Hellenic Renal Registry, 1986-2000.

 

Figure 3. New patients by mode of RRT and pmp annual rates, Hellenic Renal

Registry, 1986-2000.

 

 

With regards to primary renal diseases in new patients diabetes has become the leading cause of RRÔ patients since1997 (Figure 4). Diabetic patients in RRT increased 28-fold from 1988 to 2000, and this increase was observed mainly in the age group of patients more than 65 years old.

 

Figure 4. Primary Renal Diseases in New Patients Starting RRT between 1986 – 2000,

Hellenic Renal Registry 1986-2000.

 

 

Finally, with regards to mortality the main causes of death were from cardiovascular diseases (46%), followed by infections (10%).