Hrev_master Healthcare in Low-resource Settings 2025; volume 13:12927 Distribution of episodes of kidney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana, Albania, during the period 2010-2023 Marsida Duli, Qamil Dika, Elizana Petrela, Genc Burazeri Faculty of Medicine, University of Medicine, Tirana, Albania Abstract Our aim was to describe the distribution of kidney diseases among hospitalized patients in Tirana, the capital of Albania, dur- ing the period 2010-2023. A case-series study was conducted including all episodes admitted with kidney diseases at the University Hospital Center “Mother Teresa” in Tirana during the period 2010-2023 (overall: 15,763 episodes; 46% females; overall mean age: 54.0±17.3 years). We found that ≈56% of the kidney disease episodes were 35-65 years old, followed by >65-year-old individuals (≈28%). Most of the kidney disease episodes (about 43%) hospitalized were from the Tirana region, followed by dis- tricts pertinent to South Albania (23%). Older patients (>65 years) were more prevalent among males compared to females (301% vs 25%, respectively; p<0.001). Patients from the Tirana region were more prevalent among females compared to males (45% vs 42%, respectively, p<0.001). This study provides evidence on the distri- bution of the episodes of kidney diseases admitted at University Hospital Center “Mother Teresa” in Tirana, the largest region in Albania, a country in the Western Balkans that is undergoing deep reforms in all sectors, including also the health sector. Introduction Kidney diseases constitute an important public health problem worldwide.1-3 In particular, the toll of chronic kidney disease is increasing, which is compatible also with the general increase in Noncommunicable Diseases (NCDs).2 The Global Burden of Disease (GBD) 2015 study has estimated that chronic kidney dis- ease concerns about 10% of the adult population worldwide.3 Chronic kidney disease is primarily caused by diabetes, hyperten- sion, vascular disease, and glomerulonephritis,2,3 and also leads to other deleterious health outcomes, such as higher rates of symp- tomatic intracerebral hemorrhage, increased mortality, and poorer functional outcomes in patients with acute ischemic stroke.1,4,5 Furthermore, a fairly recent meta-analysis indicated that chronic kidney disease constitutes a significant comorbidity in patients with acute ischemic stroke highlighting the need for tailored man- agement strategies to enhance patient outcomes.1 In addition, chronic disease patients are at high risk of developing a common mental disorder.6 As a matter of fact, patients with chronic kidney disease and mental disorders have a higher risk of hospitalizations,7 poor quality of life,8 difficulties adhering to medications,9 rapid progression to End-Stage Renal Disease (ESRD),10 as well as several other unfavorable conditions includ- ing mortality.11,12 It has been shown that the mortality risk and hos- pitalization rate among patients with chronic kidney disease accompanied by mental disorders is much higher than among chronic disease patients without mental disorders.10 Albania emerged from the most rigid socialist regime in 1990 and since has been undergoing considerable changes toward a market-oriented system which has been associated with changes in lifestyle and changes in morbidity and mortality patterns.13 The Albanian population is rapidly aging (in 2020, around 15% of the population was aged 65 years and above) as a result of a steady increase in life expectancy, a gradual decrease in fertility rate, and emigration of particularly young adults.14,15 This demographic transition observed in the past thirty years has unavoidably led to a substantial change in the epidemiological profile of the Albanian population, which consists of an outstanding shift from infectious diseases to NCDs, including primarily cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.14,16 However, the proportional mortality from NCDs in the Albanian population in 2021 was estimated at about 73%, displaying a significant Correspondence: Marsida Duli, Faculty of Medicine, University of Medicine, Rr. “Dibres”, no. 371, Tirana, Albania. Tel. +355676071226. E-mail: marsiduli@hotmail.com Key words: Albania, disease episodes, kidney diseases, Tirana, University Hospital Center “Mother Teresa”. Contributions: MD, QD, and GB contributed to the study conceptualiza- tion and design, analysis and interpretation of the data, and writing of the article. EP commented comprehensively on the manuscript. All authors have read and approved the final version of the manuscript, and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Funding: none. Ethics approval and consent to participate: not required. The aggregated data analysis guarantees the anonymity of the patients included in this study. Availability of data and materials: the data presented in this study are available upon request from the corresponding author. Received: 15 August 2024. Accepted: 4 September 2024. Early access: 16 September 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 13:12927 doi:10.4081/hls.2024.12927 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2025;13:12927] [page 9] Non -co mmerc ial us e o nly decrease from around 93% in 2019 (i.e., before the COVID-19 pandemic).16 Yet, the overall mortality rate from NCDs has increased in Albania from 798 deaths in 2019 to 820 deaths in 2021 (per 100,000 population),16 indicating an increase in the death rates from both infectious diseases (due to COVID-19) and NCDs. The main risk factors in the Albanian population include high blood pressure, smoking, and dietary factors.16 According to the estimates of the Global Burden of Disease 2021 study, the proportional mortality due to kidney dysfunction in Albania increased from 5.1% in 1990 to 6.0% in 2021.16 On the other hand, the mortality rate and burden of acute glomeru- lonephritis has declined in the past three decades in the Albanian population (age-standardized mortality rates in 1990 and 2021 were 0.52 and 0.14 deaths per 100,000 population, respectively).16 Conversely, in line with the gradual population aging, at a crude level, chronic kidney disease has steadily increased during the period 1990-2021 (mortality rates in 1990 and 2021 were about 7 and 16 deaths per 100,000 population, respectively).16 However, in Albania, the information about kidney diseases in the general pop- ulation is scarce and not well-documented. In this framework, the aim of this study was to describe the dis- tribution of kidney diseases among hospitalized patients in Tirana, the capital of Albania, during the period 2010-2023. Materials and Methods This was a case-series study including all episodes admitted with kidney diseases at the University Hospital Center “Mother Teresa” in Tirana, the largest public hospital in Albania, during the period 2010-2023. The information about the episodes with kidney diseases was provided by the Statistics Office of the University Hospital Center “Mother Teresa” in Tirana, according to each patient’s medical chart. Data on the diagnoses of kidney disease episodes were col- lected for each year under investigation, in addition to selected demographic factors of the patients (including age, gender, and region of the country). Measures of central tendency (mean and median values) and dispersion (standard deviation and the interquartile range) were calculated for the age of the patients admitted with kidney disease episodes during the study period. In addition, absolute numbers and their respective percentages were calculated for the episodes of kidney diseases by selected demographic characteristics of the patients (age-group, gender, and region of Albania) and each year covering the study period (i.e., from 2010 to 2023). Fisher’s exact test was used to compare the gender-specific distribution of the hospitalized episodes of kidney diseases accord- ing to selected demographic factors (age-group and region of the patients). A p-value of ≤0.05 was considered statistically signifi- cant. Statistical Package for the Social Sciences (SPSS, version 19.00) was used for all the statistical analyses. Results Table 1 presents the distribution of episodes of kidney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana during the period 2010-2023 by selected demographic char- acteristics. On the whole, during the period 2010-2023, there were 15,763 episodes of various kidney diseases that required hospital- ization at the University Hospital Center “Mother Teresa” in Tirana. Of these, 54% of the episodes involved male patients, whereas the remaining 46% were pertinent to female patients. Overall, the mean age of the patients admitted with kidney disease episodes for the entire duration of the study period was 54.0±17.3 years. Conversely, the median age was 55.9 years (interquartile range: 43.4-66.5 years). Regarding the age group distribution, the majority (almost 56%) of the kidney disease episodes concerned the age group 35-65 years, followed by individuals aged more than 65 years (almost 28%). As for the regional distribution, most of the kidney disease episodes (about 43%) hospitalized were from the Tirana region, followed by districts pertinent to South Albania (23%). Notably, 109 episodes (0.7% of the overall kidney disease episodes admitted during the period 2010-2023) were from Kosovo (Table 1). Table 2 presents the distribution of kidney disease episodes admitted at the University Hospital Center “Mother Teresa” in Tirana for each year of the study period (i.e., from 2010 to 2023). The year which marked the highest number of admissions of kid- ney diseases episodes was 2018 (8.9% of the overall number of episodes during the period 2010-2023), followed by the year 2019 (8.7%) and next the year 2017 (8.2%) and the year 2022 (8.1%). Conversely, the year with the lowest number of admissions with kidney disease episodes was 2023 (1.8% of the overall number of episodes under the study period) followed by the year 2020 (5.1%) (Table 2). A higher proportion of female patients were younger (<35 years) compared to male patients (19.5% vs 13.5%, respectively) (Table 3). Consequently, older patients (individuals aged 65 years and above) were more prevalent among males compared to females (30.5% vs 24.7%, respectively). These age differences between males and females were highly statistically significant (p<0.001). Patients from the Tirana region were more prevalent among females compared to males (44.6% vs 42.3%, respectively). Conversely, a higher proportion of patients from South Albania was evident among males compared to females (24.7% vs 20.5%, respectively). These regional differences between males and females were highly statistically significant too (p<0.001) (Table 3). Figure 1 presents the trend in the number of episodes with kid- Article Table 1. Distribution of episodes of kidney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana during 2010-2023 by demographic characteristics. Variable Number Percentage Age group <35 years 2564 16.3 35-65 years 8817 55.9 >65 years 4382 27.8 Total 15763 100.0 Gender Males 8502 53.9 Females 7261 46.1 Region Tirana 6835 43.4 North Albania 2469 15.7 Central Albania 2761 17.5 South Albania 3589 22.8 Kosovo 109 0.7 Parameter Age (numerical variable) Mean ± SD 54.0±17.3 years Median (interquartile range) 55.9 years (43.4-66.5 years) [page 10] [Healthcare in Low-resource Settings 2025;13:12927] Non -co mmerc ial us e o nly ney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana by gender and year. During the first three years under investigation (i.e., during the years 2010-2012), the number of episodes with kidney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana was higher in females than in males. On the other hand, for each subsequent year (i.e., from 2013 to 2023), the number of kidney disease episodes hospi- talized was higher in males than in females. Of note, the number of kidney disease episodes admitted at the University Hospital Center “Mother Teresa” in Tirana in 2023 was remarkably low (N=287) compared with the other years covering the study period. This may be due to the under-recording of the cases for this year, a finding which deserves further investigation. Discussion This study provides evidence on the distribution of kidney dis- eases among hospitalized patients in Tirana, the capital of Albania, during the period 2010-2023. The main findings of this study indi- cate that about 56% of the kidney disease episodes were confined to the age group 35-65 years, followed by older individuals (about 28%). Most of the kidney disease episodes (about 43%) hospital- ized were from the Tirana region, followed by districts in South Albania (23%). The year 2018 exhibited the highest number of admissions of kidney disease episodes (8.9%). Conversely, the year 2023 had the lowest number of admissions with kidney dis- ease episodes (1.8%). Older patients (>65 years) were more preva- lent among males compared to females. Patients from the Tirana region were more prevalent among females compared to males, whereas a higher proportion of patients from South Albania was evident among males compared to females. During the years 2010- 2012, the number of episodes with kidney diseases was higher in females than in males, whereas during 2013-2023 the number of kidney disease episodes hospitalized was higher in males than in females. The episodes of kidney diseases admitted during the study period included chronic kidney disease, acute glomerulonephritis, Article Figure 1. Number of episodes with kidney diseases admitted at the University Hospital Center “Mother Teresa” in Tirana by gender and year. [Healthcare in Low-resource Settings 2025;13:12927] [page 11] Table 2. Distribution of kidney disease episodes admitted at the University Hospital Center “Mother Teresa” in Tirana by year. Year Number Percentage Cumulative percentage 2010 1121 7.1 7.1 2011 1111 7.0 14.2 2012 1099 7.0 21.1 2013 1186 7.5 28.7 2014 1225 7.8 36.4 2015 1161 7.4 43.8 2016 1227 7.8 51.6 2017 1288 8.2 59.7 2018 1398 8.9 68.6 2019 1364 8.7 77.3 2020 804 5.1 82.4 2021 1209 7.7 90.0 2022 1283 8.1 98.2 2023 287 1.8 100.0 Total 15763 100 Table 3. Gender-specific distribution of episodes of kidney dis- eases admitted at the University Hospital Center “Mother Teresa” in Tirana by age and region. Variable Males (%) Females (%) p Age-group <0.001 <35 years 13.5 19.5 35-65 years 56.0 55.8 >65 years 30.5 24.7 Total 100 100 Region <0.001 Tirana 42.3 44.6 North Albania 15.5 15.9 Central Albania 16.9 18.3 South Albania 24.7 20.5 Kosovo 0.7 0.7 Total 100 100 Non -co mmerc ial us e o nly acute kidney injuries, polycystic kidney disease, nephrotic syn- drome, nephrolithiasis (kidney stones), urinary tract infections, diabetic nephropathy, as all as other kidney diseases and conditions which have deleterious effects on the kidneys’ functions. Chronic kidney disease represented the most prevalent condi- tion. This progressive condition characterized by structural and functional changes in the kidney is globally recognized as an important public health problem.17 This disease increases the risk of end-stage kidney disease and is an independent risk factor for cardiovascular diseases and premature death.18,19 At a global level, the prevalence of chronic kidney disease is increasing, with the fastest progression occurring in low-income and middle-income countries such as Albania.3,17,20,21 The main risk factors for this con- dition include hyperglycemia, hypertension, hyperlipidemia, and obesity.17,22,23 The GBD study showed that in 2017, there were 697.5 million cases of chronic kidney disease worldwide, with 1.2 million deaths from this condition.24 Projections indicate that by 2040, chronic kidney disease will be the fifth leading cause of mortality.25 However, the development of nephrology and the focus on the treatment of early-stage chronic kidney disease decrease mortality and prevent the progression of ESKD.26 While there is no specific information about kidney diseases for the general population of Albania, the age-standardized mortal- ity rate from all NCDs in 2019 was estimated at 520 (95% CI=413- 649) deaths per 100,000 population.14,16 In 2019, about 93% (95% CI=92-94%) of all deaths in Albania were caused by NCDs.14,16 In particular, cardiovascular diseases constitute 57% (95% CI=52- 60%) of the overall mortality in the Albanian population.14,16 This study may have some limitations including the reporting system pertinent to the University Hospital Center “Mother Teresa” in Tirana, which still needs strengthening and improve- ment. Hence, some data on kidney disease patients including labo- ratory results (creatinine levels, or glomerular filtration rate) may be incomplete or inaccurate, which could lead to misdiagnosis. Also, poor coordination between the Nephrology Department and other departments such as Radiology may result in fragmented data (regarding imaging procedures such as ultrasounds, or CT scans). In addition, this is a tertiary hospital and episodes admitted at this center may not necessarily represent all episodes of kidney diseases across Albania. Conclusions Despite the aforementioned potential limitations, this study provides a valuable description of the burden of kidney diseases admitted at the largest tertiary care facility in Albania. Further studies are needed to provide a more comprehensive overview and more detailed analyses regarding the burden of kidney diseases in Albania. 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