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.

There is no medical field where the impact of medical evolution is more palpable than in kidney transplantation. The pioneers of this procedure, 70 years ago, laid out the foundation for organ transplantation in general and kidney transplantation in particular. Despite the incredible advancements that have been made since, huge differences exist worldwide in terms of access, equity and quality of care. Nowhere are these disparities more prominent than in developing countries with limited resources, underfunded healthcare systems and transplantation infrastructures, particularly the Western Balkans. This position paper delineates the biggest barriers hindering the development of kidney transplantation in the Western Balkans, put forth and agreed upon by a group of regional experts on the field, based on the Modified Delphi Method. Limitations in training, infrastructure, restrictive and outdated legislative practices, lack of a centralized coordination network and fragmented regional collaboration, emerged as the principal challenges. Endorsed by European Society for Organ Transplantation (ESOT), this paper outlines a pragmatic and practical framework to overcome these obstacles, towards building robust and sustainable transplantation programs that ensure high-quality and equitable access to kidney transplantation, for all patients in this region.

Objective. We describe a rare case of satisfactory renal allograft function without immunosuppressive therapy following allogeneic hematopoietic stem cell transplantation (alloHSCT). Case Report. The patient was a 64-year-old male who had undergone a kidney transplant from a sibling donor in 2007. After 16 years, he required alloHSCT for acute myeloid leukemia (AML), with the same sibling serving as the donor for both transplants. HLA was a 50% match. Post-alloHSCT, immunosuppressive therapy was discontinued, and the renal allograft function remained stable. The patient later developed severe complications and succumbed to infection. Insights into the precise tolerance mechanisms were limited because laboratory evaluation for chimerism was not performed. Conclusion. There is potential for immunosuppressive-free renal allograft function after alloHSCT. This case underscores the significant risk of infection-related mortality. To achieve the best outcome, rigorous patient selection, tailored conditioning regimens, robust infection prevention strategies, and the possibility of combined transplantation for carefully selected patients are needed.

elevated nocturnal BP clinic BP monitoring alone is inadequate. ABPM should become golden standard to confirm adequate BP control in patients with kidney disease.

INTRODUCTION Peritoneal dialysis and hemodialysis are complementary ways of treating end-stage renal failure. Changing the dialysis modality from hemodialysis to peritoneal dialysis is a rare and poorly studied phenomenon. MATERIALS AND METHODS Retrospective cohort study conducted on the population of adult patients with end-stage chronic renal failure who were treated at the Nephrology Clinic of the Clinical Center of the University of Sarajevo in the period from 2006 to 2023. A total of 109 adult patients, whose medical documentation was complete and who were in the peritoneal dialysis program at the Nephrology Clinic of the Clinical Center of the University of Sarajevo during the observed period, were included in this study. One group started the treatment with peritoneal dialysis, and the other with hemodialysis. Demographic data were collected for each patient: age, gender, underlying kidney disease, comorbidities (heart disease and diabetes), duration of treatment modality, data on modality change, complications and treatment outcomes. Data from physical and electronic patient histories were used. RESULTS Total of 109 adult patients were included in this study. They are divided into two groups. Group 1 (n=99) in which peritoneal dialysis was the first treatment modality and Group 2 (n=10) in which haemodialysis was the first treatment modality, but in which patients, after a certain time, were transferred to peritoneal dialysis. The median age of patients in Group 1 was 60 (-/-14.07) years and 54 (-/+12.23) years for Group 2. Within Group 1 the most common cause of terminal renal failure was diabetic nephropathy (n=40, 40.4%) and nephroangiosclerosis (n=24, 24.24%). The mean age of onset of peritoneal dialysis was 60 (-/-14.07) years, while the mean age of cessation of peritoneal dialysis was 63 (±13.69) years. The average duration of peritoneal dialysis treatment was 38.36(±34.14) months. During the stay at peritoneal dialysis, death was recorded in 63 patients (62.38%). The number of patients who replaced peritoneal dialysis treatment with hemodialysis was 26. The most common reason for switching to haemodialysis was insufficiency of peritoneal dialysis (n=13, 14%). After switching to haemodialysis, the average length of staying on it was 10.22 months. The reason for discontinuation of haemodialysis was death (n=17, ) or transplantation (n=1, 3.7%). Kaplan-Meier test shown worse outcome in patients with haemodialyis first than peritoneal dialysis first. CONCLUSION Changing the dialysis modality carries with it a high risk of mortality, especially in the first month. Changing the way of active treatment with dialysis speaks in favor of severe comorbidities.

Abstract Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus. Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012. Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia <10 mmol / l. We found that 47,5% of patients had HbA1c> 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%. Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

ABSTRACT Background The aim of this study was to provide an overview of age, sex and primary renal disease (PRD) distribution among first kidney transplant recipients across Europe. Method The European Renal Association (ERA) Registry database was used to obtain data on patients aged 20 years or older receiving their first kidney transplant between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year. Results In total, 99 543 adults received a first kidney transplant. Overall, 23% of the recipients were 65 years or older, 36% were female, and 21% had glomerulonephritis and 15% diabetes mellitus as PRD. Compared with deceased donor kidney transplant recipients, living donor kidney transplant recipients were less often 65 years or older (13% versus 26%), more often had glomerulonephritis (25% versus 20%) and less often diabetes mellitus (8% versus 17%) as PRD. We found large international differences, which were most prominent for age and PRD and less prominent for sex. Over time, the largest change in recipient characteristics was observed for the percentage of recipients aged 65 years or older, increasing from 18% in 2010 to 28% in 2019 for all countries combined with a similar trend in most countries. Conclusion We observed large differences for age and PRD distribution between recipients of living and deceased donor kidneys and between European countries. Over time, the percentage of older first kidney transplant recipients increased.

Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.

Aim To assess morphological characteristics of carotid blood vessels in uremic patients before to the initiation of the dialysis treatment, and corelate data with various dialysis therapy modules. Methods The study included 30 patients with end-stage renal disease (ERDS) prior to commencing dialysis, 30 patients treated with haemodialysis and 30 patients treated with continuous ambulatory peritoneal dialysis. The control group consisted of 15 subjects with normal kidney function (eGFR>60ml/min). Carotid intima-media thickness (CIMT), as well as lipid status values (cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A, apolipoprotein B) were evaluated. Results The significant difference in CIMT was detected between the control and haemodialysis groups (p<0.001), and between the control and the peritoneal dialysis group (p=0.004). In patients in the predialysis group, CIMT was influenced by cholesterol (p=0.013), HDL (p=0.044), LDL (p=0.001) and ApoB (p=0.042) values. A significant difference in CIMT was proved between the haemodialysis and predialysis group of patients (p<0.001). The only variable from the patient's lipometabolic profile significantly associated with the change in IMT in uremic patients was HDL. A significant difference was found in the average value for systolic blood pressure (p<0.001) and diastolic blood pressure (p=0.018) in patients before starting the dialysis treatment compared to patients treated with other dialysis methods. Conclusion Patients on haemodialysis treatment had a significantly greater CIMT, which is in relation with a higher cardiovascular risk.

Introduction: Heart failure (HF) still remains as one of the most common causes of hospital admission with a high mortality rate. Aim: To investigate the possible prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation after an index hospitalization and to investigate their possible additive prognostic value. Patients and Methods: Two hundred twenty-two patients hospitalized with acute HF were monitored and followed for 18 months. Results: BNP at discharge has the highest sensitivity and specificity in the prediction of decompensation. For a cutoff value of 423.3 pg/ml, sensitivity was 64.3% and specificity was 64.5%, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P < 0.001). The hazard risk (HR) for decompensation when the discharge BNP was above the cutoff value was 2.18. Cystatin C, at a cutoff value of 1.46 mg/L, had a sensitivity of 57% and specificity of 57.8%, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125, in the prediction of decompensation in patients with acute heart failure (AHF) and at a cutoff value of 80.5 IU/L, had a sensitivity of 60.5% and specificity of 53.3%, with a positive predictive value of 64.5% and an AUC of 0.59 (P = 0.022). The time till onset of decompensation was significantly shorter in patients with four versus three elevated biomarkers (P = 0.047), with five versus three elevated biomarkers (P = 0.026), and in patients with four versus two elevated biomarkers (P = 0.026). The HR for decompensation in patients with five positive biomarkers was 3.7 (P = 0.001) and in patients with four positive biomarkers was 2.5 (P = 0.014), compared to patients who had fewer positive biomarkers. Conclusion: BNP, cystatin C, and CA125 are predictors of decompensation, and their combined usage leads to better prediction of new decompensation.

Background: To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods: We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results: A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion: We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.