Web Correspondent Report on Nephrology in Hungary
by Judit Nagy
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Prof
Judit Nagy Second Department of Medicine and Nephrological Center Pecs University, Faculty of Medicine Pecs, Hungary |
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Budapest |
History
of Nephrology
In Hungary, a country with a population of 10 million people, the four Medical
Universities (in Budapest, Debrecen, Pécs and Szeged) were the first
educational institutions in which nephrological teaching and scientific activity
took place. The Hungarian Nephrological Society was founded in 1976 as a non-profit
organisation to regulate the practice of nephrology, to provide a forum for
nephrological education and to increase and control the level of nephrological
scientific work. A nephrological subspecialisation has been actuve since 1984.
The training period in internal medicine lasts 5 years, in paediatrics 4 years,
and subspecialization in nephrology requires two additional years of study.
Training in nephrology consists of one year of practice in clinical nephrology,
6 months in haemodialysis, 2 months in CAPD, 1 month in transplantation, 1
month in urology, 1 month in the intensive care unit and 1 month in paediatrics
for internists or 1 month in internal medicine for paediatricians. There are
no regulations for the fixed number of positions in nephrology. Currently,
about 110 specialised nephrologists work in public and private dialysis units
as well as in public nephrological departments with in- and outpatient services.
A further 160 medical doctors, most of whom are preparing for the nephrological
examination, work in these units as well.
The 240 members of the Hungarian Nephrological Society elect a twenty-member
Council every four years which runs the society according to the Constitution,
which was ratified by the General Assembly for the first time in 1989 and
recently modified in 2002.
‘Hypertension and Nephrology’ is a bimonthly journal that was
founded by the Hungarian Nephrological Society and the Hungarian Hypertension
Society in 1997. Furthermore, the Nephrological Society has had a web page
on the Internet (www.nephrologia.hu)
since 2001. The regular forum for educational and scientific activity of the
Society is theyearly National Congress of Nephrology, the Budapest Summer
School, the Debrecen Nephrology Education Congress, the Pécs Diabetic
Nephropathy Meeting and the Pediatric Nephrology Meeting held yearly or every
other year. These activities are organised by the Scientfiic and Educational
Committee of the Society.
Nurses may obtain a subspecialisation degree in nephrology after earning their
official nursing degree. At the end of 2001, approximately 180 nurses with
a nephrological subspecialization and more than 550 nurses with a general
degree were employed in nephrology units, and more than 100 dialysis technicians
were employed by dialysis units.
Nephrological
Health Care
Medical treatment (hospital, dialysis, transplantation, laboratory, diagnostic
imaging examinations and medical visits) is covered financially by the Hungarian
National Health Insurance Programme. Some drugs (e.g. erythropoietin, calcitriol
and Ketosteril) for dialysis and predialysis patients are available free of
charge. Other drugs (e.g. most of the antihypertensive drugs) are available
at a reduced price for all nephrological patients. Some of them are free of
charge for patients living on less than the standard minimum income.
Renal
Replacement Therapy in Hungary
Data are collected and analysed by the Hungarian Registry for Dialysis and
Transplantation, which was begun in 1970. This is a yearly survey, and the
response rate of the units has been 94-96%. Most of the dialysis units are
private (run by Braun-Eurocare, Fresenius and Gambro) or run by Hungarian
Funds. The private units are also supported by the National Health Insurance
Programme on the basis of the number of haemodialysis or CAPD treatments performed.
The first haemodialysis session in Hungary took place in 1957. For many years,
the number of renal replacement treatments was limited. Today, however, the
acceptance rate has come to be 100%, if there are no medical contraindications
and patients agree to undergo renal replacement therapy. The continiously
increasing number of patients in the chronic dialysis program or with a functioning
kidney graft is shown in Fig 1. One thousand two hundred eighty-nine new patients
started chronic renal replacement therapy in 2001, which translates into 130
new patients per million persons in the general population. At the same time,
in 2001, the number of all patients on chronic renal replacement therapy was
5505 per million persons in Hungary. The mean age of patients at the start
of renal replacement therapy is also increasing (Fig 2).
The first cadaver kidney transplantation was performed in 1962. For years,
renal transplantation was available only in Budapest. Now, each University
Medical Faculty has a kidney transplantation unit. As a result, the number
of kidney transplantations is increasing, and the number of patients with
a functioning graft is also increasing (Fig 3). In 2000 the University of Pécs
started a pancreas-kidney transplantation program and, at the end of 2002,
a total of 23 diabetic patients were living with a successful kidney-pancreas
graft.
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Figure
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Figure
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Figure
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