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THE VARYING NUMBERS OF NEW CASES OF HEMODILAYSIS PATIENTS IN EAST JAVA, INDONESIA: AN OBSEVATION OF THE INCREASING AND DECREASING NUMBERS IN RELATION TO SOCIO-ECONOMIC CONDITION
Djoko Santoso1, Pranawa1 , Moh. Yogiantoro1, , Moh. Thaha1, Widodo1, A. Wardana1, N. Mardiana1, C. Irwanadi1, Soewanto1, Yasuhiko Tomino2
1.Division of Nephrology - Hypertension, Department of Internal Medicine, Dr.Soetomo Hospital, Faculty of Medicine, Airlangga University - Surabaya, Indonesia. 2. Division of Nephrology, Department of Internal Medicine, Juntendo University, Tokyo, Japan

Background:
Chronic maintenance of hemodialysis remains a significant problem in Indonesia up to the present time as it is frequently not ideally performed due to the lack of financial support. The number of new patients of ESRD (End Stage Renal Disease) enrolled in Soetomo Hospital has been increasing recently. It has been doubled even multiplied up to several folds within 3 to 6 years. Socio-economics conditions, such as inflation, government program toward communityﾕs health have also been identified.

Objectives:
To obtain the demographic database in order to estimate the number of new cases of ESRD patients. Furthermore, the socio-economic conditions were identified to find out if they could explain the varying numbers of new cases of ESRD patients.

Subjects and Methods:
A total number of 973 hemodialysis patients enrolled between 2000-2006 in Soetomo Hospital dialysis centre were diagnosed based on their clinical manifestations, routine blood examination. Data were collected within six years, the number of patients with ESRD beginning maintenance dialysis therapy in all 33 districts of East Java was recorded. Further, the number of patients was classified into two groups according to in which city they lived. The first group area (Gerbang Kertasusila) and the second group area (Non-Gerbang Kertasusila)

Results:
Between 2000-2006, 973 new cases of ESRD were recorded. The first group area (Gerbang Kertasusila) had a higher number of new patients (647; 66.5%) while the second group area (Non-Gerbang Kertasusila) which had less access to hemodialysis center had lower numbers of new patients (326; 33.5%).
During the 6 years time, there was a significant increase in numbers of patients. The increase of new patients from 2000 to 2006 was 72% (from 174 patients to 301 patients). Interestingly, the increase of new patients was 2.5 fold when compared between 2001 and 2006. (The number of new patients in 2001 was lower than those in 2000). More interestingly, the increase of new patients was almost 8 fold if compared between 2004 and 2006 (38 new patients and 301 new patients).
The socio-economic condition of Indonesian Government seemed to be responsible for the significant sharp increase or decrease of the number of new patients from time to time. 174, 121, 134, 141, 38, 64, 301 of new hemodialysis patients respectively from 2000-2006.
In 2004, the number of patients dropped sharply from 141 in 2003 to 38 in 2004 due to the effect of inflation which there preceedingly was a change of government with the new elected president.
In 2006, the number of new patients rose highly from 64 patients in 2005 and 301 patients in 2006. If compared with 2004, it increased up to 8 fold. (38 new patients in 2004 and 301 new patients in 2006).
Again, the socio-economic condition played an important role, that in 2006 the government promoted a new national program to support the expense of hemodialysis treatment.

Conclusion: The varying numbers of increase and decrease of new patients in Indonesia was closely related to the dynamic socio-economic situation of Indonesian government.

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