Background: The Renal Registry of Bosnia and Herzegovina systematically collects national data on kidney replacement therapy for patients with end-stage kidney disease (ESKD). This report summarizes 2 decades of registry data (2002-2022), showing trends in incidence, prevalence, modality distribution, and patient outcomes. Methods: Data were obtained annually from 30 dialysis centers across the country. Incidence, prevalence, and survival rates for hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation were calculated per million population (pmp). Descriptive statistics and Kaplan–Meier survival analyses were performed using SPSS 25. Results: Between 2002 and 2022, the number of dialysis centers increased from 18 to 30, and the total treated population rose by 43.5% (from 1687 to 2421 patients). Hemodialysis remained the predominant modality (80.4%), while PD accounted for only 3.0% of all dialysis patients. The incidence rate in 2022 was 118.9 pmp, and the prevalence reached 685.6 pmp. The leading causes of ESKD were diabetic nephropathy (29.5%) and hypertensive nephropathy (13.1%). The crude mortality rate among dialysis patients in 2022 was 13.2%, primarily due to cardiovascular disease. By the end of 2022, a total of 402 patients lived with a functioning kidney graft. Conclusion: Over the past 2 decades, Bosnia and Herzegovina has experienced steady growth in its dialysis population and gradual improvements in registry coverage. However, the country continues to face challenges, including low utilization of PD and limited transplantation activity. Strengthening early chronic kidney disease detection and expanding organ donation programs remain key national priorities.   Cite this article as: Resić H, Rebić D, Turković AM. The renal registry of Bosnia and Herzegovina. Turk J Nephrol. Published online May 11, 2026. doi: 10.10.5152/turkjnephrol.2026.25988.

ABSTRACT The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses specifically on comparisons by age. The complete ERA Registry Annual Report 2023 is available in the Supplementary information. For 2023, data were collected from 34 countries in Europe and countries bordering the Mediterranean Sea. Using these data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2023, the ERA Registry covered 519 million people in the participating countries. The incidence of KRT was 151 per million population (pmp). Among incident patients, 29% were aged ≥75 years, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). Most patients (83%) started KRT with haemodialysis (HD), 11% started with peritoneal dialysis (PD), and 6% underwent pre-emptive kidney transplantation. On 31 December 2023, the prevalence of KRT was 1101 pmp. Among prevalent patients, 24% were aged ≥75 years, 62% were male, and the most common PRD was of miscellaneous origin (18%). Moreover, 56% of prevalent patients received HD, 5% received PD, and 39% were living with a functioning graft. In 2023, the kidney transplantation rate was 43 pmp, with 69% of kidneys coming from deceased donors. For patients starting KRT between 2014 and 2018, 5-year survival probability was 51%. The proportions of incident and prevalent patients aged ≥75 varied considerably across European countries. In addition, incident patients aged ≥75 were more often male, and had more often hypertension as PRD compared with younger patients. Only 1% of incident patients aged ≥75 received a pre-emptive kidney transplant, while among prevalent patients of the same age, 22% was living with a functioning graft.

BACKGROUND AND HYPOTHESIS Kidney replacement therapy (KRT) practices in Europe are heterogeneous, with apparent differences between Western and Central/Eastern Europe. However, time trends in KRT incidence and prevalence in Central and Eastern Europe are not previously reported. Therefore, we aimed to describe trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021. METHODS Data on incident and prevalent KRT patients from 19 Central and Eastern European countries between the years 2010 and 2021 were derived from the European Renal Association (ERA) Registry. Time trends were calculated using JoinPoint regression. RESULTS Overall, KRT incidence increased with 1.5% (95% confidence interval (CI): +0.7 to + 2.6%) per year from 106.3 per million population (pmp) in 2010 to 119.6 pmp in 2019. However, trends differed within the region. While in Bosnia and Herzegovina KRT incidence significantly decreased from 2010 to 2019, it remained stable in nine and increased in eight countries. The overall KRT prevalence increased with 5.1% (95% CI: +4.5 to + 5.7%) per year from 426.2 pmp in 2010 to 651.2 pmp in 2019. KRT prevalence increased in all countries, except for Belarus where it remained stable, and was mainly attributable to increases in the prevalence of kidney transplantation. The COVID-19 pandemic did not have a major impact on KRT incidence and prevalence in the region, as most trends remained until 2021. CONCLUSIONS Although we found an overall increase in KRT incidence and prevalence in the region, large country variations remain, much larger than observed in Western Europe. The results of this study can help to define country-specific priorities for the optimization of KRT care in Central and Eastern Europe.

ABSTRACT Background This article compares the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates and mortality on KRT between Europe and the USA, including sex comparisons. Methods Data were derived for 2022 from the population-based European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). Results In 2022, the KRT incidence in the USA [388.7 per million population (pmp)] was 2.7-fold higher than in Europe (146.2 pmp), with a greater difference for women (3.2-fold) than for men (2.4-fold). The proportion of women initiating KRT was lower in Europe (35%) than in the USA (41%). Between 2013 and 2022, the KRT incidence in Europe was stable in women (+0.1% annually) but increased in men (+1.1%). In the USA, the KRT incidence increased similarly in women (+0.2%) and men (+0.3%). On 31 December 2022, the KRT prevalence was 2-fold (women 2.2-fold, men 1.9-fold) higher in the USA (2444.2 pmp) than in Europe (1218.6 pmp). The proportion of women was lower in Europe (38%) than in the USA (41%). The kidney transplantation rate was 1.7-fold higher in the USA (79.1 pmp) than in Europe (45.4 pmp), 1.9-fold for women and 1.7-fold for men, with women accounting for 37% of the recipients versus 39% in the USA. The KRT mortality rate was 1.5 times higher in the USA [145.0 per 1000 patient-years (py)] compared with Europe (100.5 per 1000 py): 1.6-fold for women and 1.4-fold for men. In Europe, mortality was lower for women receiving KRT (93.7 per 1000 py) than for men (104.6 per 1000 py), whereas in the USA the reverse was true (women 148.9 per 1000 py, men 142.2 per 1000 py). Conclusion The US had a notably higher KRT incidence, prevalence, kidney transplantation rate and mortality compared with Europe. Differences between Europe and the USA were larger for women than for men.

AIM Lung ultrasound (LUS) can be used for an assessment of volume overload in patients with end-stage kidney disease (ESKD) and those undergoing dialysis. The aim of this study was to analyse whether the initial use of LUS in evaluating volume status could benefit patients by optimizing haemodialysis treatment and improving their clinical status. METHODS The study included 50 haemodialysis patients in stage V of ESKD with the diagnosis of ischaemic heart failure with reduced (HFrEF) or midrange ejection fraction (HFmrEF). The assessment of volume status was verified solely by LUS (along with the analysis of B lines as measures of volume status). The specified laboratory parameters were performed initially, after three, and after six months. RESULTS The number of B-lines on LUS were decreased during the six-month follow-up compared to baseline, indicating a reduction in volume overload due to the LUS-guided protocol. Statistically significant differences were observed in the average creatinine (p=0.001) and parathormone (PTH) (p=0.003) levels over the six-month monitoring period. Significant differences were also noted in triglyceride (p=0.000) and potassium (p=0.02) levels. No significant differences were found in the values of other monitored parameters. CONCLUSION In haemodialysis patients diagnosed with heart failure, LUS can aid the achievement of a more efficient volume reduction by decreasing B-lines, which are indicative of congestion. Our study also demonstrated beneficial effects of LUS on potassium and parathormone levels.

The aim of the study was to elucidate predictors associated with the initial choice of vascular access (VA) type. The secondary aim was to determine the initial VA's median utilization time and the factors governing it. This prospective cohort study included 387 hemodialysis (HD) patients admitted to the Clinic for Hemodialysis, Clinical Center University of Sarajevo, in consecutive order between January 2006 and December 2016. We selected the primary predictors for the initial VA type using a random forest algorithm. We further quantified factors governing the initial choice of VA: temporary catheters (TC), compared to arteriovenous fistula (AVF), using multivariate logistic regression. Finally, we used log-rank and Cox regression models to estimate the median time on each initial VA and find predictors governing it. Of the 387 patients, 265 (68,5%) used TC at dialysis initiation and 122 (31,5 %) AVF. Predictors of the TC's vs. AVF's initial use were older age (OR=1.02, CI=1.0, 1.03, p=0.03) and primary cause of CKD, particularly diabetes, compared to all other causes of kidney disease (CKD). Median time on initial AVF was 57.0 months (95%CI =36.9, 64.1), and on initial TC 4.99 months (95%CI =2.69, 8.48). Younger age (HR=.98,95%CI=.97, .99, p=.01), male sex (HR=1.51, 95%CI=1.05, 2.19, p=.03), and hypertension (HR=1.63, 95%CI=1.13,2.36, p=.01) predicted median time on initial TC, while older age (HR for patients>70years = 1.86, 95%CI=1.09, 3.17, p=.02), and diabetes (HR=1.97, 95%CI=1.19, 3.24, p=.01), predicted median time on initial AVF. These results point to late VA referrals and delays in transitioning to permanent VA.

The shortage of applications for fellowships in nephrology is a worldwide challenge. This is the first survey to explore in Europe the reasons physicians choose (and do not choose) a career in nephrology. An anonymous questionnaire was sent to the presidents of societies that are members of the European Renal Association (ERA), who invited trainees and nephrologists to respond. Statistical analysis was performed using SPSS v.26. (SPSS Inc., Chicago, IL, USA). Continuous variables were compared by Student's t-test or by one-way ANOVA. Responders included 516 (49%) females and 542 (51%) males. They comprised 278 (26%) trainees, and 780 (74%) nephrologists. The majority (64%) believe that students have an unfavourable perception of nephrology. For trainees, nephrology is not considered an attractive option due to ‘chronically ill patients’ (35%), ‘lack of contact during undergraduate training’ (37%), ‘nephrology is too challenging’ (38%), ‘poor remuneration’ (22%), ‘negative role models’ (15%), and ‘long working hours’ (14%). The factors with the greatest impact on choosing a career include a positive role model (46%), practical experience during medical school and early postgraduate training (42%). Trainees emphasize that work–life balance is very important for the younger generation. A strong mentorship along with early engagement is associated with a higher likelihood of pursuing a career in nephrology. It is crucial to create a strategy that will provide a positive experience, renew the interest in nephrology careers and ensure enough nephrologists to treat the growing number of patients with kidney disease.

ABSTRACT Background Inherited kidney diseases (IKDs) and congenital anomalies of the kidney and urinary tract (CAKUT) are causes of kidney failure requiring kidney replacement therapy (KRT) that major renal registries usually amalgamate into the primary renal disease(PRD) category ‘miscellaneous’ or in the glomerulonephritis or pyelonephritis categories. This makes IKDs invisible (except for polycystic kidney disease) and may negatively influence the use of genetic testing, which may identify a cause for IKDs and some CAKUT. Methods We re-examined the aetiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry. Results In 2019, IKD-CAKUT was the fourth most common cause of kidney failure among incident KRT patients, accounting for 8.9% of cases [IKD 7.4% (including 5.0% autosomal dominant polycystic kidney disease), CAKUT 1.5%], behind diabetes (23.0%), hypertension (14.4%) and glomerulonephritis (10.6%). IKD-CAKUT was the most common cause of kidney failure among patients <20 years of age (41.0% of cases), but their incidence rate was highest among those ages 45–74 years (22.5 per million age-related population). Among prevalent KRT patients, IKD-CAKUT (18.5%) and glomerulonephritis (18.7%) were the two most common causes of kidney failure overall, while IKD-CAKUT was the most common cause in women (21.6%) and in patients <45 years of age (29.1%). Conclusion IKD and CAKUT are common causes of kidney failure among KRT patients. Distinct categorization of IKD and CAKUT better characterizes the epidemiology of the causes of chronic kidney disease (CKD) and highlights the importance of genetic testing in the diagnostic workup of CKD.

ABSTRACT Background In 2020, the coronavirus disease 2019 (COVID-19) pandemic caused disruptions in kidney replacement therapy (KRT) services worldwide. The aim of this study was to assess the effect of the COVID-19 pandemic in 2020 on the incidence of KRT, kidney transplantation activity, mortality and prevalence of KRT across Europe. Methods Patients receiving KRT were included from 17 countries providing data to the European Renal Association Registry. The epidemiology of KRT in 2020 was compared with average data from the period 2017–2019. Changes occurring during the first and second waves of the pandemic were also explored. Results The incidence of KRT was 6.2% lower in 2020 compared with 2017–2019, with the lowest point (−22.7%) during the first wave in April. The decrease varied across countries, was smaller in males (−5.2%) than in females (−8.2%) and was moderate for peritoneal dialysis (−3.7%) and haemodialysis (−5.4%) but substantial for pre-emptive kidney transplantation (−23.6%). The kidney transplantation rate decreased by 22.5%, reaching a nadir of −80.1% during the first wave, and was greatest for living donor kidney transplants (−30.5%). While in most countries the kidney transplantation rate decreased, in the Nordic/Baltic countries and Greece there was no clear decrease. In dialysis patients, mortality increased by 11.4% and was highest in those 65–74 years of age (16.1%), in those with diabetes as the primary renal disease (15.1%) and in those on haemodialysis (12.4%). In transplant recipients, the mortality was 25.8% higher, but there were no subgroups that stood out. In contrast to the rising prevalence of KRT observed over the past decades across Europe, the prevalence at the end of 2020 (N = 317 787) resembled that of 2019 (N = 317 077). Conclusion The COVID-19 pandemic has had a substantial impact on the incidence of KRT, kidney transplant activity, mortality of KRT and prevalence of KRT in Europe with variations across countries.