Croatia is among the few EU countries in which home hemodialysis is not allowed, although it would make life much easier for 2,500 kidney patients who have to go to hospital three times a week to remove toxic substances from the blood, experts warn on the occasion of World Kidney Day, March 9.

“Home hemodialysis has still not been approved in Croatia, even though it improves the quality of life of patients and reduces their mortality,” said Mario Laganovic, head of the Croatian Society for Nephrology, Dialysis and Transplantation, which has been advocating the introduction of home hemodialysis for a long time.

Home hemodialysis requires changes to regulations that determine that extracorporeal blood circulation may not be performed outside a healthcare facility. Talks have been held with the Croatian Health Insurance Institute (HZZO), and the ball is now in the Health Ministry’s court, says Laganovic.

Cheaper for the healthcare system

Devices for home hemodialysis are easy to use, and patients could determine the pace of dialysis in their own home, under the supervision of a doctor. However, the home method is not suitable for all patients, but for those who are functional enough to learn the procedure.

“Patients on home hemodialysis live the most normal lives, are active at work and do not depend on waiting for medical services, which takes a lot of time,” Laganovic said.

In addition to a number of benefits for patients, the introduction of home hemodialysis would also be cheaper for the health system, as evident from the experience of Western countries.

Classic hemodialysis for one patient costs between €13,280 and €19,920 per year. The option for the patient to use a home device paid for by the HZZO is cheaper for the system, he added.

In this calculation, all costs should be taken into account, including transporting the patient to the hospital by ambulance. There are also significant indirect savings due to fewer complications and less medication.

Some patients travel 50 kilometers to the hospital for hemodialysis

The head of the Department of Nephrology and Dialysis of the Sisters of Mercy Clinical Hospital, Karmela Altabas, calls for the popularisation of the home method of kidney function replacement, as well as the adoption of a legal framework for hemodialysis in home conditions.

“We are one of the last countries in the EU that do not have the possibility of performing hemodialysis at home, and everywhere in examples from around the world show that this is cheaper for the system. Especially because some of our patients travel 50 kilometers to the hospital,” Altabas points out.

It is important, she says, to ensure that the HZZO covers all the costs of this method, and to start educating health professionals on how to educate and manage patients on home hemodialysis.

HZZO: It is necessary to determine the price and professional criteria

In the HZZO, however, they say that they cannot determine the price of home hemodialysis for an individual patient without defined conditions for carrying out this procedure in home conditions.

They also state that it is necessary to determine the professional criteria that patients are suitable for performing the procedure in home conditions, as well as the needs and dynamics of professional supervision and controls in health care institutions.

According to the estimates of the Croatian Institute of Public Health (HZJZ), in Croatia, approximately 300,000 people have some type of kidney disease, and between 3,000 and 4,000 of them are treated with some form of renal replacement therapy.

Classic dialysis is performed in 49 dialysis centers throughout the country.

In Croatia, about 120 kidneys are transplanted annually, in four hospitals – KB Merkur, KBC Zagreb, KBC Rijeka and KBC Osijek.

KB Merkur is the only one performing kidney transplants from living donors.