In a sterile hospital room lit by neon lights, rows of beds and chairs are lined up alongside quietly humming machines.
Patients lie next to devices that filter their blood, while nurses carefully move around them.
In the bed next to the door lies Milan Milićević from a village near Kraljevo, who has been waiting for a kidney transplant for about a year.
"You get used to everything, I've accepted dialysis as part of everyday life," he says with a tired smile as he lies in the hospital in Vrnjacka Banja.
More than 850 million people in the world suffers from some form of kidney disease, and it is expected to become the fifth leading cause of death in the world by 2040.
People with chronic kidney disease experience increasingly weaker functioning of these organs, but often do not notice any symptoms until the disease progresses, explains nephrologist Zoran Paunić for BBC Serbian.
"The pain occurs with kidney stones or cysts," he adds.
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Hidden symptoms
In 2014, in his sixth decade, Milan learned that his kidneys were not working properly.
His blood pressure was high, and his legs were swollen.
"Over time, I gradually came to dialysis, which I have been on since 2022."
"I tolerate it well, I don't have any problems, only nausea when the therapy is over," he adds to BBC Serbian.
He mostly adheres to the diet prescribed for him.
"Sometimes I break a little, but mostly I'm careful," he adds.
For kidney dysfunction most often indicates urine analysis.
The main indicators of kidney disease are protein in the urine, but also high blood pressure and diabetes, says Dr. Paunić.
"These diseases are called silent killers."
"Hypertension damages internal organs, and is often caused by kidney disease or a blocked or narrowed blood vessel in this organ," he explains.
Diabetes "also attacks the kidneys, so about 20 or 30 percent of long-term diabetics also struggle with kidney disease."
Chronic kidney disease has five stages.
"During the first one, there are some irregularities in the urine, but other values such as urea and creatinine are normal," says the doctor.
Creatinine and urea are two waste products of protein metabolism that are produced in the body and excreted by the kidneys into the urine
"In the second and third stages, these values are more altered, and the disease is only detected in the fourth."
"Symptoms vary - from leg cramps, nausea and fatigue to problems with urination and worse vision," says Paunić.
In the fifth stage of the disease, the kidneys stop working.
"Patients are emaciated, have problems with anemia, and their blood calcium and phosphorus levels are altered, cramps are more intense, and water accumulates in the body," the doctor explains.
How do the kidneys function?
Kidneys are paired bean-shaped organs located on either side of the spine, just below the ribs.
Their primary function is to filter blood, remove waste, and regulate the balance of fluids and electrolytes in the body.
During filtration, blood enters the kidney through the renal artery, a blood vessel in the abdominal cavity.
Then, a network of capillaries in the kidneys filters the blood and removes waste substances.
Useful ingredients - water, minerals and glucose - are returned to the blood, and waste and excess fluid are excreted through urine, which passes to the bladder.
The blood then arrives in the body purified and ready to circulate again.
What is dialysis and how does it work?
Dialysis is the process of removing waste products and excess fluid from the blood when the kidneys stop working properly.
It often involves diverting blood to a purification machine.
The kidneys filter the blood, removing harmful waste products and excess fluid, turning them into urine, which is excreted from the body.
If the kidneys are not functioning properly, they will not be able to clean the blood properly.
Waste products and fluid can build up to dangerous levels in the body.
If kidney disease is not treated, a series of unpleasant symptoms make it difficult for the body to function, and ultimately leads to death.
Dialysis filters unwanted substances and fluids from the blood before this happens.
When the kidneys stop working, renal replacement therapy is used, explains Paunić.
"This can be done in three ways: hemodialysis, peritoneal dialysis, and kidney transplantation," he adds.
Hemodialysis is performed periodically, two to three times a week, so "patients are often tied to the place where they live and where they are treated."
Dialysis via abdominal pouch "is done by people on their own and does not require hospital conditions," says the doctor.
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'Patient waiting'
About 2.000 people in Serbia is waiting for an organ transplant, according to data from the Ministry of Health for 2024.
Although it has been performed for many years, organ transplantation has not taken root in practice in Serbia, says Paunić.
"Transplants are more often performed from living people - relatives, but organ transplants from brain-dead people are rarely performed in our country," he points out.
Transplantation can be performed even before hemodialysis is needed, and in younger people, transplantation after several years of dialysis via peritoneal dialysis may be the solution, he adds.
Milan's current alternative is a transplant.
"My mother and brother can't give me a kidney because they have health problems."
"For now, I'm waiting patiently," he says.
How to best care for your kidneys?
- The most important thing is drink enough fluids.
- Water is essential for the kidneys - it helps flush out harmful substances and prevents the formation of stones. Experts recommend an intake of about two liters per day.
- Processed foods high in salt and phosphorus can increase the risk of kidney disease.
- Painkillers, such as ibuprofen and diclofenac, can damage the kidneys if used frequently and without control.
- Cigarettes reduce blood flow to the kidneys, while excessive alcohol consumption can cause damage.
- Since kidney disease often develops without symptoms, experts recommend Regular blood and urine tests, especially for people with high blood pressure, diabetes, or a family history of these diseases.
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