Post on 03-Sep-2019
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May 2013© national renal registry, Malaysiaissn 1675-8862
Published by:
The National Renal RegistryMalaysian society of nephrologysuite 1604, plaza permata6, Jalan Kampar50400 Kuala lumpurMalaysia
telephone. : (603) 4045 8636Direct fax : (603) 4042 7694e-mail : nrr@msn.org.myWeb site : http://www.msn.org.my
Important information:
1. this report is copyrighted. however it may be freely reproduced without the permission of the national renal registry. acknowledgment would be appreciated. suggested citation is: yn lim, Bl goh, lM ong, (eds) twentieth report of the Malaysian Dialysis and transplant 2012, Kuala lumpur 2013
2. this report is also published electronically on the website of the national renal registry at: http://www.msn.org.my
3. hard copies of the report can be made available with donation of rM60.00 per copy to defray the cost of printing.
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ACKNOWLEDGEMENTS
The Malaysian Dialysis and Transplant Registry of the National Renal Registry would like to thank each and everyone who have in one way or another contributed to
the success of the Malaysian Dialysis and Transplant Registry.
In particular we would like to thank the following:
The Nephrologists, physicians and staff of the Dialysis and Transplant follow-up centres: thank you for participating in the Registry.
The success of the Registry depends on you.
The Ministry of Health, Malaysia for financial support and other support seen and unseen;
The Clinical Research Centre, in particular Dr Goh Pik Pin and Dr Jamaiyah for their tireless effort in supporting the work of registries.
For their generous support:-
Roche
AIN Medicare
Baxter Healthcare
Fresenius Medical Care
Lucenxia
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NRR ADviSORy COMMiTTEE MEMbERS 2012 to 2014
MEMBERS: MSN APPOINTMENT: FACILITIES
Datuk Dr. Ghazali Ahmad chairman hospital Kuala lumpur
Dr. Abdul Halim Abd Gafor university representative university Kebangsaan Malaysia Medical centre
Dr. S. Prasad Menon private sector representative sime Darby Medical centre subang Jaya
Dr. Ong Loke Meng crc representative hospital penang
Mr. Tam Chong Chiang aDMan representative hospital tengku ampuan afzan, Kuantan
Dr. Lim Yam Ngo MDtr sub-committee chairperson hospital Kuala lumpur
Dr. wong Hin Seng eMoss sub-committee chairperson hospital selayang
Dato' Dr. wan Shaariah Md Yusuf MrrB sub-committee chairperson tuanku Ja’afar hospital, seremban
Dr. Goh Bak Leong MDtr editor hospital serdang
Dr. Rafidah Abdullah honorary Msn treasurer sultan haji ahmad shah hospital
statistician Jasmine Chew Sze Ming
nrr Manager Lee Day Guat
clinical research associate
Choo Cheh Loo
Suhazelini Ali
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AbOuT ThE MALAySiAN DiALySiS AND TRANSpLANT REGiSTRy (MDTR)……..
the Malaysia Dialysis and transplant registry (MDtr) collects information on patients with end stage renal disease (esrD) on renal
replacement therapy (rrt) in Malaysia.
Objectives:
the objectives of the registry are as follows:
1. Describe the natural history of ESRD. the registry shall describe the characteristics of patients with esrD, its management,
and patient survival and quality of life outcomes with treatment; and shall describe variation thereof across different groups,
healthcare sectors or geographic regions, and its secular trend over time in Malaysia.
2. Determine effectiveness of treatments for ESRD. the registry shall determine clinical effectiveness and cost effectiveness
of treatments of esrD in real-world clinical practices in Malaysia.
3. Monitor safety and harm of products and services used in the treatment of ESRD. the registry shall serve as an active
surveillance system for the occurrence of unexpected or harmful events for products and services.
4. Evaluating access to and quality of treatment services for ESRD. the registry shall assess differences between providers
or patient populations based on performance measures that compare treatments provided or outcomes achieved with “gold
standards” (e.g., evidence-based guidelines) or comparative benchmarks for specific health outcomes (e.g., risk-adjusted
survival rates). such programs may be used to identify disparities in access to care, demonstrate opportunities for improvement,
establish differentials for payment by third parties, or provide transparency through public reporting.
5. To maintain the national renal transplant waiting list electronically – the eMOSS or electronic Malaysian Organ Sharing
System. the dialysis registry shall maintain and update patients on dialysis who do not have contraindications to kidney
transplantation onto the national renal transplant waiting list according to published agreed criteria. this list is available on the
web for ready access by the transplant physicians any time a deceased kidney becomes available.
Registry design:
this is a multi-center, observational cohort study designed to evaluate the health outcomes of patients with esrD undergoing
treatment at participating clinical centres. patient inclusion criterion is deliberately broad and shall include any patient with a
confirmed diagnosis of esrD.
there is no prescribed study visits. patient shall attend the clinical site as and when required per the standard of care at the site.
required data shall be collected as they become available.
a clinical site shall notify all new patients to the registry, and shall continue to do so until the termination of the registry. patients
shall be follow-up for life.
participation. site shall notify the patients’ treatment to the registry in a calendar year of its participation. a site shall similarly
notify patients during each year of its participation in the registry.
Registry study population:the registry study population consists of male or female patients with esrD to be recruited from participating sites in Malaysia. participation in this study is voluntary. however, in accordance with the private health-care facilities act 1998 (aKta 586), all dialysis health facility are required to submit data to the Malaysian Dialysis and transplant registry (MDtr).
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all clinical centres or sites that satisfy the following selection criteria will be invited to participate:
1. this registry is opened to all clinical sites that provide rrt services for patients with esrD in Malaysia.
2. each site shall have a principal investigator who is also a licensed physician / surgeon and a qualified professional experienced
with esrD management.
3. each site shall appoint a site coordinator (sc). the sc is the person at the participating clinical site who is responsible for all
aspects of registry management and data collection at site, and who will liaise with the clinical registry Manager (crM) and
clinical registry assistant (cra) at the registry coordinating centre (rcc).
4. each site shall accept responsibility for data collection, as well as for ensuring proper record keeping and registry document
filing.
5. each site shall agree to comply with the registry procedures and shall be willing to be subjected to ongoing review of data by
crM or cra or other representative of MDtr. this may include one or more site visits by prior arrangement
Patient eligibility criteria:
all new patients with esrD undergoing treatment at a participating clinical site are eligible for entry into the registry.
in addition, a site may opt to enter existing patients on follow-up at the site into the registry.
Registry data:
the data elements to be collected by the registry shall be relevant and reliable with modest burden to sites, shall comply with
existing data standard where this exists, shall be compatible with established data set used by other existing registries, and shall
employ standard terminology (dictionary) where available.
Two datasets are defined:
core dataset: these are data elements that are needed to address the key questions for which the registry was created.
non-core dataset: these are speculative data elements included to provide an opportunity to generate hypotheses or to explore
other subsidiary questions not of primary interest to the registry.
the data domains and related specific data elements to be collected by this registry is tabulated below:
a Identifier name, nric number, other identifying document numbers, address, contact numbers
B Demographicsage, sex, ethnicity, educational attainment, occupation, household income group, Weight & height, use of tobacco, funding for treatment
c Medical history Medical history/ comorbidities, family history
D ESRD diagnosis Date of first diagnosis, Date re-entering each rrt.
e Laboratory investigations Date & time of tests, Blood chemistry, hematology, serology
f TreatmentModalities of rrt- haemodialysis, peritoneal dialysis; treatment of other uraemic complications; kidney transplantation
g Outcomespatient survival; death, date of death, cause of deathQuality of life/ Work rehabilitation status
h Economicssource of funding for dialysis treatment, and immunosuppressive drug treatment for transplantation
JHealthcare provider characteristics
sector providing dialysis treatment, (private, public or ngo),
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Johor Darul Takzim1. Batu Pahat Rotary2. BP Renal Care ( Rengit)3. BP Renal Care (Batu Pahat)4. BP Renal Care (Kluang)5. BP Renal Care (Segamat)6. BP Renal Care Simpang Renggam7. BP Renal Care (Yong Peng)8. Che Eng Khor Centre9. Hospital Enche’ Besar Hajjah Khalsom10. Hospital Pakar Sultanah Fatimah (Muar)11. Hospital Sultanah Nora Ismail12. JB Lions MAA-Medicare Charity Dialysis Centre (1)13. JB Lions MAA-Medicare Charity Dialysis Centre (2)14. JJ Lions Dialysis Centre15. Johor Quarries Association Dialysis Centre16. Johor Specialist Hospital17. Kota Tinggi Hospital18. KPJ Kluang Utama Specialist Hospital19. Mersing Hospital20. Mersing Rotary Centre21. Muar Dialysis22. Muar Lions Renal Centre23. Pelangi Haemodialysis Centre24. Persatuan Membaiki Akhlak-Che Luan Khor_NKF25. Pertubuhan Hemodialisis Muhibbah Segamat (Labis) 26. Pertubuhan Hemodialisis Muhibbah27. Pertubuhan Kebajikan Amitabha28. Pontian Hospital29. Pontian Rotary Haemodialysis Centre30. Premier Renal Care31. Prima Dialisis Lagenda Putra32. Prima Dialysis Kluang33. Prima Dialysis Masai34. Pusat Dialisis & Kesihatan Masjid Bandar Baru Uda35. Pusat Dialisis Nefro Utama (Johor Bahru)36. Pusat Dialisis Nefro Utama (Kota Tinggi)37. Pusat Dialisis Nefro Utama Pontian38. Pusat Dialisis Perbadanan Islam (Pontian)39. Pusat Dialisis Waqaf An-nur (Batu Pahat)40. Pusat Dialisis Waqaf An-nur (Pasir Gudang)41. Pusat Dialysis Ikhlas42. Pusat Dialysis Makmur (Senai)43. Pusat Haemodialisis Suria (Tangkak)44. Pusat Haemodialysis Amal Lexin45. Pusat Haemodialysis Majlis Agama Islam Negeri Johor46. Pusat Hemodialisis Ar-Raudhah47. Pusat Hemodialisis Bandar Mas48. Pusat Hemodialisis Darul Takzim (Batu Pahat)49. Pusat Hemodialisis Darul Takzim (Parit Raja)50. Pusat Hemodialisis Hidayah51. Pusat Hemodialisis Iman52. Pusat Hemodialisis Impian Kluang53. Pusat Hemodialisis MAIJ54. Pusat Hemodialisis Mawar (Yong Peng) HD Unit55. Pusat Hemodialisis Muar56. Pusat Hemodialisis Nour57. Pusat Hemodialisis Rotary Kota Tinggi58. Pusat Hemodialisis Rotary Kulai59. Pusat Hemodialisis Sejahtera (Batu Pahat)60. Pusat Hemodialisis Sejahtera Muar61. Pusat Hemodialisis Syifa (Bukit Gambir)62. Pusat Kesihatan Universiti (UTHO)63. Pusat Perubatan Perbadanan Islam (Segamat)64. Putera Bistari Dialysis Centre65. Puteri Specialist Hospital66. Segamat Hospital67. Sinar Haemodialysis (Batu Pahat)68. Sinar Haemodialysis (Parit Raja)69. Sultan Ismail Hospital (Paed)70. Sultan Ismail Hospital
71. Sultanah Aminah Hospital72. Tangkak Hospital73. Tangkak Lions Renal Centre74. Temenggong Seri Maharaja Tun Ibrahim Hospital75. The Rotary HD Centre (Johor Bahru)76. Total Kidney Care Haemodialysis77. Yayasan Pembangunan Keluarga Johor-NKF78. Yayasan Rotary Kluang79. Zhi En Dialysis Centre
Kedah Darul Aman80. Afiat Dialysis Centre81. Alor Setar Dialysis Centre82. Asia Renal Care (Penang) Kulim83. Baling Hospital84. Buddhist Tzu Chi Dialysis Centre (Kedah)85. Caring Dialysis (Gurun)86. Caring Dialysis (Sg. Petani-Selatan)87. Caring Dialysis (Sungai Petani-Utara)88. Caring Dialysis Centre (Pendang)89. Kuala Nerang Hospital90. Kulim Haemodialysis (CS Tan)91. Kulim Hospital92. Langkawi Hospital93. Metro Specialist Hospital94. Northern Dialysis Centre95. Pantai Hospital Sungai Petani96. Pertubuhan Bakti Fo En Bandar Kulim97. Pusat Dialisis Albukhary98. Pusat Dialisis Marjina99. Pusat Dialisis Mukmin Gurun100. Pusat Dialisis NKF-Kelab Lions Alor Star101. Pusat Dialyisis Ibnu Sina (Kuala Ketil)102. Pusat Dialysis K K Tan (Sg Petani)103. Pusat Haemodialisis Dr. Ismail104. Pusat Haemodialisis Zakat Kedah105. Pusat Hemodialisis Al Husna106. Pusat Hemodialisis Beng Siew107. Pusat Hemodialisis Dr Azhar Jitra108. Pusat Hemodialisis Mergong109. Pusat Hemodialisis S P110. Pusat Hemodialisis Seroja (Baling)111. Pusat Hemodialisis Seroja (Kulim 1)112. Pusat Hemodialisis Seroja (Kulim 2)113. Pusat Hemodialisis Syifa (Pendang)114. Pusat Kesihatan Jitra115. Pusat Pakar Dialisis Traktif (Jitra)116. Pusat Rawatan Dialisis Fazwinna117. Pusat Rawatan Hemodialisis Yayasan Emkay & Sultanah Bahiyah118. Putra Haemodialysis Centre119. Putra Medical Centre120. Renal Care (Kedah)121. Sik Hospital122. Sultan Abdul Halim Hospital123. Sultanah Bahiyah Hospital124. Superkids Trinity-NKF Dialysis Centre125. Yan Hospital
Kelantan Darul Naim126. Gua Musang Hospital127. Hudaz Dialysis Centre128. Jeli Hospital129. Kuala Krai Hospital130. Lions Club Kota Budaya Dialysis Centre131. MAA Charity Dialysis (Kota Bharu)132. Machang Hospital133. Nephrolife Dialysis Centre134. Pakar Perdana Hospital135. Pasir Mas Hospital136. Pusat Dialisis Renal Pure
pARTiCpATiNG hAEMODiALySiS CENTRES 2012
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137. Pusat Dialisis Yayasan Buah Pinggang Kebangsaan (Kota Bharu)138. Pusat Hemodialisis Berkat Seroja (Machang)139. Pusat Kelestarian Dialysis140. Pusat Perubatan Tentera (Kota Bharu)141. Pusat Rawatan Dialisis Islah (Kota Bharu)142. Raja Perempuan Zainab II Hospital143. Renal-Link (Kelantan)144. Tanah Merah Hospital145. Tengku Anis Hospital146. Tumpat Hospital147. Universiti Sains Malaysia Hospital
Negeri Melaka148. 94 Hospital Angkatan Tentera (Terendak)149. Alor Gajah Dialysis Centre150. Alor Gajah Hospital151. Damai Medical & Heart Clinic152. Jasin Hospital153. Mahkota Medical Centre154. Melaka Hospital155. Pantai Air Keroh Hospital156. Pertubuhan Kebajikan Hemodialisis Hospital Pakar Putra Melaka157. Pusat Dialisis Giat Kurnia (Masjid Tanah)158. Pusat Dialisis Giat Kurnia (Merlimau)159. Pusat Dialisis Nephrocare (Bukit Piatu)160. Pusat Dialysis Comfort161. Pusat HD SJAM Bacang Melaka162. Pusat Hemodialisis Impian163. Pusat Hemodialisis Krisda164. Pusat Hemodialisis Perkis165. Pusat Hemodialisis SJAM Pulau Sebang166. Pusat Hemodialisis Yayasan Toh Puan Zurina167. Pusat Hemodialysis Suria (Melaka)168. Pusat Rawatan Dialisis Nefro Utama (Masjid Tanah)169. Sinar Hemodialisis170. Tenang Haemodialysis Centre171. Tenang Haemodialysis Jasin172. Yakin Jaya Haemodialysis
Negeri Sembilan Darul Khusus173. D’kasih Hemodialisis174. Giat Kurnia Dialysis Centre (Nilai)175. Haemodialysis Mawar Gemas176. Jelebu Hospital177. Jempol Hospital178. Persada Dialysis Centre179. Port Dickson Hospital180. Pusat Dialisis Mukmin Sikamat181. Pusat Dialisis Suria (Tampin)182. Pusat Dialisis Veteran ATM (Senawang)183. Pusat Dialysis Azalea184. Pusat Haemodialisis Bayu Caw. Taman Tasik185. Pusat Haemodialisis Bayu Rembau186. Pusat Haemodialisis Renalife187. Pusat Haemodialisis USIM188. Pusat Haemodialysis Suria (Senawang)189. Pusat Hemodialisis Bayu190. Pusat Hemodialisis Berkat Seroja (Kuala Pilah)191. Pusat Hemodialisis Gemencheh192. Pusat Hemodialisis Mawar (Kuala Pilah)193. Pusat Hemodialisis Mawar (Mantin)194. Pusat Hemodialisis Mawar N. Sembilan (Bahau)195. Pusat Hemodialisis Mawar N. Sembilan (Lukut)196. Pusat Hemodialisis Mawar N. Sembilan (Rantau)197. Pusat Hemodialisis Mawar N. Sembilan (Seremban)198. Pusat Hemodialsis Mutiara199. Pusat Pakar Dialisis Traktif (Kuala Pilah)
200. Pusat Waqaf An-nur (Senawang)201. Seremban Specialist Hospital202. Tampin Hospital203. Tuanku Ampuan Najihah Hospital204. Tuanku Ja’afar Hospital (Paed)205. Tuanku Ja’afar Hospital206. YKN Dialisis Kuala Pilah
Pahang Darul Makmur207. Bentong Hospital208. Caring Dialysis (Jerantut)209. Fitra Med210. Hospital Sultanah Hajjah Kalsom211. Jengka Hospital212. Jerantut Hospital213. Kuala Lipis Hospital214. Kuantan Clinical Diagnostic Centre215. Kuantan Medical Centres216. Kuantan Specialist Centre217. Lipis Dialysis Centre218. MAA-Medicare Charity (Mentakab)219. Mentakab Haemodialysis Unit220. Muadzam Shah Hospital221. Nur Iman Dialysis Pahang222. Pahang Buddhist Association223. Pekan Hospital224. Pusat Dialisis Mukmin Temerloh225. Pusat Hemodialisis Islam Makmur226. Pusat Hemodialisis Jerantut227. Pusat Hemodialysis Suria (Bentong)228. Pusat Hemodialysis Suria Kuantan229. Pusat Rawatan Dialisis Fitra (Kuantan)230. Pusat Rawatan Dialisis Tun Abdul Razak-NKF Kuantan231. Pusat Rawatan Fitra (Muadzam)232. Pusat Rawatan Hemodialisis Sang Riang Bera233. Raub Dialysis Centre234. Raub Hospital235. SJAM-KPS Haemodialysis Centre 9 (Raub)236. Sultan Haji Ahmad Shah Hospital237. Suria Dialysis Centre (Temerloh)238. Tengku Ampuan Afzan Hospital (Paed)239. Tengku Ampuan Afzan Hospital
Perak Darul Ridzuan240. 96 Hospital Angkatan Tentera (Lumut)241. Batu Gajah Hospital242. Bestari Haemodialysis Centre243. C.S. Loo Kidney & Medical Specialist Centre244. Caring Dialysis Centre (Sg Siput)245. Caring Dialysis Centre (Teluk Intan)246. Changkat Melintang Hospital247. Fatimah Hospital248. Gerik Hospital249. Harmony Sofia Dialysis Centre250. Hope Haemodialysis Society Ipoh251. Kampar Hospital252. Kuala Kangsar Hospital253. MAA-Medicare Charity (Teluk Intan)254. MB Star Rawatan Dialisis255. Nur Dialysis Centre256. Parit Buntar Hospital257. Persatuan Amal Chin Malaysia Barat258. Pertubuhan Perkhidmatan Haemodialisis Ar-Ridzuan259. Pertubuhan Perkhidmatan Hemodialisis AIXIN Kerian260. PMA Chan Meng Khor-MAA Medicare Charity Dialysis Centre261. Pulau Pangkor Hospital262. Pusat Dialisis Darul Iltizam (Slim River)
pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)
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263. Pusat Dialisis Darul Iltizam (Taiping)264. Pusat Dialisis Ehsan Perak (Bagan Serai)265. Pusat Dialisis Ehsan Perak (Parit Buntar)266. Pusat Dialisis Intan267. Pusat Dialisis Kuala Kangsar268. Pusat Dialisis Makmur (Batu Gajah)269. Pusat Dialisis Mukmin Ipoh270. Pusat Dialisis Mutiara (Ayer Tawar)271. Pusat Dialisis Mutiara272. Pusat Dialisis NKF-Yayasan Dialisis Pertubuhan
Pendidikan Akhlak Taiping273. Pusat Dialisis Penawar Permai274. Pusat Dialisis Setia (Ipoh)275. Pusat Dialisis Taiping (Kamunting)276. Pusat Dialisis Taiping (Kuala Kangsar)277. Pusat Dialisis Taiping (Parit Buntar)278. Pusat Dialisis Taiping279. Pusat Dialisis Tg Malim280. Pusat Dialysis Ibnu Sina (Bagan Serai)281. Pusat Dialysis Setia282. Pusat Hemodialisis Darul Iltizam (Ipoh)283. Pusat Hemodialisis Darul Iltizam (Tapah)284. Pusat Hemodialisis Felda285. Pusat Hemodialisis Kampar Yayasan Nanyang-SJAM286. Pusat Hemodialisis Manjung287. Pusat Hemodialisis Qaseh288. Pusat Hemodialysis Nyata Segar289. Pusat Rawatan Dialisis Ahmad Khalif290. Pusat Rawatan Dialisis Wan Nong291. Putri Haemodialysis Centre (Ipoh)292. Raja Permaisuri Bainun Hospital (Home)293. Raja Permaisuri Bainun Hospital294. Renal Care (Ipoh Specialist)295. Selama Hospital296. Seri Manjung Hospital297. Sg Siput Hospital298. SJ Dialysis Centre (Bidor)299. SJ Dialysis Centre (Ipoh)300. SJAM_KPS Pusat Hemodialisis Centre 15 (Ipoh)301. Slim River Hospital (Tanjong Malim)302. Taiping Hospital303. Taiping Medical Centre304. Tapah Hospital305. Teluk Intan Hospital306. Woh Peng Cheang Seah307. Yayasan Dialysis Pendidikan Akhlak Perak-NKF Ipoh
Perlis Indera Kayangan308. Caring Dialysis (Kangar)309. Pusat Dialysis Remedic310. Pusat Dialysis Tuanku Syed Putra_NKF311. Tuanku Fauziah Hospital
Penang312. Alkom Bakti Dialysis313. AMD Rotary (Penang)314. Anggun Dialysis Centre315. Asia Renal Care (Penang) BM316. Balik Pulau Hospital317. BBA (Butterworth) Dialysis Centre318. Bertam Dialysis Centre319. Buddhist Tzu Chi Dialysis Centre (Butterworth)320. Buddhist Tzu Chi HD Centre (Penang)321. Bukit Mertajam Hospital322. Carlatan Dialysis Centre323. Fo Yi NKF Dialysis Centre (1)324. Fo Yi NKF Dialysis Centre (2)
325. Gleneagles Medical Centre326. Happy Kid Nees Dialysis Centre327. Imercy Dialysis Centre328. Island Hospital329. K K Tan Specialist (BM)330. Kepala Batas Hospital331. KPJ Penang Specialist Hospital332. Lam Wah Ee Hospital333. Lim Boon Sho Dialysis Centre334. Loh Guan Lye Specialist Centre335. MAA-Medicare Charity (Butterworth)336. Muhibah Renal Care337. Neph Sdn Bhd (Sg Ara)338. NEPH Sdn Bhd339. Nucare Dialysis Centre340. Pantai Hospital Penang341. Penang Adventist Hospital342. Penang Caring Dialysis Society343. Persatuan Kebajikan Haemodialysis St Anne BM344. Pertubuhan Dialisis Rotary-Satu Hati345. Pertubuhan Hemodialisis SPS346. Province Wellesley Renal Medifund347. Pulau Pinang Hospital (Home)348. Pulau Pinang Hospital (Paed)349. Pulau Pinang Hospital350. Pusat Dialisis BMC351. Pusat Dialisis Ehsan Perak (Pedar)352. Pusat Dialisis Mukmin Simpang Amapat353. Pusat Dialisis Nefro Utama (Seberang Perai)354. Pusat Dialisis Prima 355. Pusat Dialisis SJ (Sg Bakap)356. Pusat Haemodialisis Zakat (Bayan Lepas)357. Pusat Haemodialisis Zakat (Jawi)358. Pusat Haemodialisis Zakat Tasek Gelugor359. Pusat Hemodialisis Bayan Baru360. Pusat Hemodialisis Sinona361. Pusat Hemodialisis Zakat (Balik Pulau)362. Pusat Hemodialisis Zakat (Bukit Mertajam)363. Pusat Hemodialisis Zakat (Butterworth)364. Pusat Hemodialisis Zakat (Kepala Batas)365. Pusat Hemodialisis Zakat (P. Pinang)366. Pusat Hemodialysis Bestari367. Pusat Rawatan Dialisis Lions-NKF (Penang)368. PWRM (BM) Dialysis Centre369. Renal Link (Penang)370. Seberang Jaya Hospital371. Seberang Perai (Bagan)372. SJ Dialysis Centre (Seberang Jaya)373. Sungai Bakap Hospital374. The Penang Community HD Society375. TSC Renal Care
Sabah376. BBA (Kota Kinabalu) Dialysis Centre377. BBA (Tawau) Dialysis Centre378. Beaufort Hospital379. Beluran Hospital380. Caring Dialysis Centre (Sandakan)381. Caring Dialysis Centre Kota Kinabalu382. Duchess of Kent Hospital383. Keningau Hospital384. Kota Belud Hospital385. Kota Kinabatangan Hospital386. Kota Marudu Hospital387. Kudat Hospital388. Labuan Hospital389. Lahad Datu Hospital390. Likas Hospital (Paed)
pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)
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391. Likas Hospital392. Nobel Dialysis Centre393. Papar Hospital394. Persatuan Buah Pinggang Sabah395. Persatuan Hemodialysis Kinabalu Sabah396. Peter Mole MAA-Medicare Charity Dialysis Centre397. Pusat Dialisis NKF-Sandakan Kidney Society398. Pusat Rawatan Dialisis NKF-MUIS399. Queen Elizabeth Hospital400. Ranau Hospital401. Sabah Medical Centre402. Semporna Hospital403. Sipitang Hospital404. Tambunan Hospital405. Tawau Hospital406. Tenom Hospital407. Tuaran Hospital
Sarawak408. 801 Rumah Sakit Angkatan Tentera (Kuching)409. Bau Hospital410. Betong Hospital411. Bintulu Hospital412. CHKMUS-MAA Medicare Charity413. Dalat Hospital414. Golden Age Dialysis Centre415. Hospital Daerah Daro416. Kanowit Hospital417. Kapit Hospital418. KAS-Rotary-NKF419. Kuching Specialist Hospital420. Lawas Hospital421. Limbang Hospital422. Lundu Hospital423. Marudi Hospital424. Miri Hospital425. Miri Red Crescent Dialysis Centre426. Mukah Hospital427. Normah Medical Specialist Centre428. Persatuan Dialisis Cahaya Kuching429. Pusat Dialisis Cahaya430. Pusat Dialisis Waqaf An-Nur (Sarawak)431. Pusat Hemodialisis KOPPES432. Rejang Medical Centre433. Renal Life Dialysis Centre434. Renal Therapy Services435. Saratok Hospital436. Sarawak General Hospital437. Sarikei Hospital438. Serian Hospital439. Sibu Hospital440. Sibu Kidney Foundation441. Simunjan Hospital442. SJAM_KPS Pusat Hemodialisis Centre 10 (Bintulu)443. SJAM-KPS Haemodialysis Centre 8 (Sibu)444. Sri Aman Hospital445. Timberland Medical Centre
Selangor Darul Ehsan446. 819 Rumah Sakit Angkatan Tentera447. Ampang Hospital448. Apex Club of Klang-NKF Charity Dialysis Centre449. Assunta Hospital450. Bakti-NKF Dialysis Centre451. Bangi Dialysis Centre452. Banting Hospital
453. BBA (Puchong) Dialysis Centre454. Caring Dialysis (Bangi)455. Caring Dialysis Centre (Batang Berjuntai)456. Caring Dialysis Centre (Cheras)457. Caring Dialysis Centre (Sabak Bernam)458. Caring Dialysis Centre (Sg. Besar)459. Caring Dialysis Centre (Tanjong Karang)460. Caring Dialysis Centre Andalas (Klang)461. Damansara Specialist Hospital462. DEMC Dialysis Centre463. DSS Dialysis Centre (Rawang)464. EAM Dialysis Centre465. Haemodialysis Association Klang466. Harmoni Dialysis (Damansara)467. Harmoni Dialysis (Sg Long)468. Healthcare Dialysis Centre469. Hemodialisis Yayasan Veteran ATM (S Kembangan)470. Ibnu Al-Nafis Dialysis Centre471. Jerteh Dialysis Centre472. Kajang Hospital473. Kelana Jaya Medical Centre474. KPJ Ampang Puteri Specialist Hospital475. KPJ Kajang Specialist Hospital476. KPJ Selangor Specialist Hospital477. Kuala Kubu Bharu Hospital478. MAA-Medicare Kidney (Kajang)479. MB Star Rawatan Dialisis (Kelana Jaya)480. Mynephro Dialysis Sdn Bhd481. Nefrol I-Care482. Persatuan Dialisis Kurnia PJ483. Ping Rong-NKF484. PJCC Dialysis Centre485. PNSB Dialisis Centre486. Pusat Dialisis Aiman (Shah Alam)487. Pusat Dialisis Airah488. Pusat Dialisis An’nur Seksyen 13489. Pusat Dialisis An’nur490. Pusat Dialisis LZS (Kapar)491. Pusat Dialisis LZS (Sg. Besar)492. Pusat Dialisis MAIS (Shah Alam)493. Pusat Dialisis MAIS Taman Melawati494. Pusat Dialisis MAIS495. Pusat Dialisis Mesra (Kuala Selangor)496. Pusat Dialisis MS497. Pusat Dialisis Mukmin Telok Panglima Garang498. Pusat Dialisis Nephrocare (Klang)499. Pusat Dialisis NKF - Dato’ Dr GA Sreenevasan500. Pusat Dialisis NKF-Rotary Damansara501. Pusat Dialisis Pakar Medi-Nefron (Lestari)502. Pusat Dialisis Pakar Medi-Nefron (Putra Permai)503. Pusat Dialisis Putra Jaya (Banting)504. Pusat Dialisis Putra Jaya (Kajang)505. Pusat Dialisis Rakyat Ampang506. Pusat Dialisis Rakyat Sementa507. Pusat Dialisis Rakyat Taman Medan508. Pusat Dialisis Sijangkang509. Pusat Dialisis Subang510. Pusat Dialisis Touch511. Pusat Dialisis Zara512. Pusat Dialysis Ibnu Sina (Cawangan Rawang)513. Pusat Dialysis Mesra (Kapar)514. Pusat Dialysis Mesra (Rahman Putra)515. Pusat Dialysis Putra Jaya (Semenyih)516. Pusat Haemodialysis Nilam (Seri Kembangan)517. Pusat Hemodialisis Fasa (Kg Medan)518. Pusat Hemodialisis Fasa (Sri Manja)519. Pusat Hemodialisis Kau Ong Yah Ampang520. Pusat Hemodialisis MAIWP-PICOMS
pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)
xi
521. Pusat Hemodialisis Mawar N. Sembilan (Sepang)522. Pusat Hemodialisis Mawar N. Sembilan (Seri Kembangan)523. Pusat Hemodialisis Nilam (Semenyih)524. Pusat Hemodialisis Permata525. Pusat Hemodialisis Shah Alam526. Pusat Hemodialisis Syifa (Batangkali)527. Pusat Hemodialysis Yayasan Veteran ATM (Batu Caves)528. Pusat Perubatan Dialisis Dengkil529. Pusat Perubatan Dialisis530. Pusat Perubatan Primier HUKM531. Pusat Rawatan Dialisis Farah Mahami532. Pusat Rawatan Dialisis Hidayah (Sepang)533. Pusat Rawatan Dialisis Hidayah534. Pusat Rawatan Dialisis Islah (Batu Caves)535. Pusat Rawatan Dialisis Islah (Prima Sri Gombak)536. Pusat Rawatan Dialisis Islah (Selayang)537. Pusat Rawatan Dialisis Mukmin538. Pusat Rawatan Dialisis Nefro Utama (Puchong)539. Pusat Rawatan Dialysis Nefro Utama (Kajang Prima)540. Pusat Rawatan Hemodialisis Felina541. Putrajaya Hospital542. Rawatan Dialysis Bukit Tinggi543. Renal Associates544. Renal Care Dialysis Services545. S.P. Menon Dialysis Centre (Klang)546. S.P. Menon Dialysis Centre (Petaling Jaya)547. Sayang Dialysis Selayang548. Selayang Hospital (Paed)549. Selayang Hospital550. Serdang Hospital551. Sime Darby Medical Centre Subang Jaya552. SJAM-KPS Haemodialysis Centre 1 (Raja Muda Musa)553. SJAM-KPS Haemodialysis Centre 11 (Shah Alam)554. SJAM-KPS Haemodialysis Centre 12 (Balakong)555. SJAM-KPS Haemodialysis Centre 2 (Klang)556. SJAM-KPS Haemodialysis Centre 3 (Banting)557. SJAM-KPS Haemodialysis Centre 5 (Rawang)558. SJAM-KPS Haemodialysis Centre 6 (Kuala Selangor)559. SJAM-KPS Pusat Hemodialisis Tasik Puteri560. Smartcare Dialysis Centre (Subang Jaya)561. Sri Kota Medical Centre562. Sungai Buloh Hospital563. Sunway Medical Centre (2)564. Sunway Medical Centre565. Suriya Dialysis Centre566. Syukur Dialisis (Petaling Jaya)567. Syukur Dialisis (Puchong)568. Syukur Dialisis (Shah Alam)569. Tanjung Karang Hospital570. Tengku Ampuan Jemaah Hospital571. Tengku Ampuan Rahimah Hospital572. Tulips Dialysis Centre573. Universiti Kebangsaan Malaysia Bangi574. Yayasan Kebajikan SSL (Puchong)575. Yayasan Kebajikan SSL (Petaling Jaya)
Terengganu Darul Iman576. Besut Hospital577. Dungun Hospital578. Hulu Terengganu Hospital579. Kemaman Hospital580. Pusat Dialisis MAIDAM581. Pusat Dialisis NKF-Yayasan Buah Pinggang Kemaman582. Pusat Dialisis Nuraeen583. Pusat Dialisis Terengganu/NKF584. Pusat Hemodialisis Nabilah
585. Pusat Pakar Dialisis Traktif (Besut)586. Pusat Rawatan Dialisis Islah (Kuala Terengganu)587. Setiu Hospital588. Sultanah Nur Zahirah Hospital589. YKN Dialisis (Terengganu)
wilayah Persekutuan Kuala Lumpur590. Aiman Dialysis Centre591. Al-Islam Specialist Hospital592. Caring Dialysis (Wangsa Maju)593. Charis-NKF Dialysis Centre594. Cheras Dialysis Centre595. Davita Seri Setia Dialysis Centre596. Hospital Angkatan Tentera Tuanku Mizan597. Kuala Lumpur Hospital (Home)598. Kuala Lumpur Hospital (Paed.)599. Kuala Lumpur Hospital (Unit 1)600. Kuala Lumpur Hospital (Unit 3)601. Kuala Lumpur Hospital (Unit 4)602. Kuala Lumpur Lions Renal Centre603. MAA-Medicare Charity (Kuala Lumpur)604. Pantai ARC Dialysis Services605. Pantai Hospital Ampang606. Poliklinik Komuniti Tanglin607. Prince Court Medical Centre608. Pusat Dialisis Amal MAA-Medicare (Sg Besi)609. Pusat Dialisis Bandar Sri Permaisuri610. Pusat Dialisis Nefro Utama (Bangsar)611. Pusat Hemodialisis Dato’ Lee Kok Chee612. Pusat Hemodialisis Desa Aman Puri613. Pusat Hemodialisis Felda614. Pusat Hemodialisis Harmoni (Cheras)615. Pusat Hemodialisis Harmoni (Shamelin)616. Pusat Hemodialisis Mawar N. Sembilan (Seputih)617. Pusat Hemodialisis PMKL618. Pusat Hemodialisis PUSRAWI619. Pusat Hemodialisis Waz Lian620. Pusat Hemodialysis Medipro Alliance621. Pusat Pakar Dialysis Traktif622. Pusat Pakar Tawakal623. Pusat Perubatan Universiti Kebangsaan Malaysia624. Pusat Rawatan Dialisis Fungates Superflow-NKF625. Pusat Rawatan Dialisis Good Health-NKF (Kg Pandan)626. Pusat Rawatan Dialisis Islah (KL)627. Pusat Rawatan Dialisis Nefro Utama (Setapak)628. Renal Dialysis Centre629. S.P. Menon Dialysis Centre (Kuala Lumpur)630. Sentosa Medical Centre631. Smartcare Dialysis Clinic (Cheras)632. The Kidney Dialysis Centre (1)633. The Kidney Dialysis Centre (2)634. The Nayang-NKF Dialysis Centre635. Tung Shin Hospital & Yayasan Nanyang Press636. Tung Shin Hospital637. University Malaya Medical Centre638. University Malaya Specialist Centre639. YKN Dialisis (Kuala Lumpur)
pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)
xii
pARTiCipATiNG pD CENTRES 2012
Johor Darul Takzim1. BP Renal Care (Batu Pahat)2. BP Renal Care (Segamat)3. Hospital Pakar Sultanah Fatimah (Muar)4. Sultan Ismail Hospital (Paed)5. Sultanah Aminah Hospital
Kedah Darul Aman6. Sultanah Bahiyah Hospital
Kelantan Darul Naim7. Raja Perempuan Zainab II Hospital8. Universiti Sains Malaysia Hospital
Negeri Melaka9. Melaka Hospital
Negeri Sembilan Darul Khusus10. Tuanku Ja’afar Hospital (Paed)11. Tuanku Ja’afar Hospital
Pahang Darul Makmur12. Tengku Ampuan Afzan Hospital (Paed)13. Tengku Ampuan Afzan Hospital
Perak Darul Ridzuan14. Raja Permaisuri Bainun Hospital15. Renal Care (Ipoh Specialist)
Penang16. Pulau Pinang Hospital (Paed)17. Pulau Pinang Hospital
Sabah18. Duchess of Kent Hospital19. Queen Elizabeth Hospital20. Sabah Medical Centre
Sarawak21. Sarawak General Hospital
Selangor Darul Ehsan22. Selayang Hospital (Paed)23. Selayang Hospital24. Serdang Hospital25. Tengku Ampuan Rahimah Hospital
Terengganu Darul Iman26. Kemaman Hospital27. Sultanah Nur Zahirah Hospital
wilayah Persekutuan Kuala Lumpur28. Kuala Lumpur Hospital (Paed.)29. Kuala Lumpur Hospital30. Prince Court Medical Centre31. Pusat Perubatan Universiti Kebangsaan Malaysia32. Renal Dialysis Centre33. University Malaya Medical Centre
xiii
pARTiCipATiNG TRANSpLANT fOLLOW-up CENTRES 2012
Johor Darul Takzim1. Batu Pahat Hospital2. Hospital Enche’ Besar Hajjah Khalsom3. Mersing Hospital4. Pakar Sultanah Fatimah Muar Hospital5. Pontian Hospital6. Segamat Hospital7. Sultan Ismail Hospital (Paed)8. Sultan Ismail Pandan Hospital9. Sultanah Aminah Hospital
Kedah Darul Aman10. Sultanah Bahiyah Hospital
Kelantan Darul Naim11. Raja Perempuan Zainab II Hospital12. Universiti Sains Malaysia Hospital
Negeri Melaka13. Mahkota Medical Centre14. Melaka Hospital
Negeri Sembilan Darul Khusus15. Tuanku Ja’afar Hospital
Pahang Darul Makmur16. Tg. Ampuan Afzan Hospital
Perak Darul Ridzuan17. Raja Permaisuri Bainun Hospital18. Renal Care (Ipoh Specialist)19. Taiping Hospital
Penang20. Pulau Pinang Hospital
Sabah21. Duchess of Kent Hospital22. Klinik Dr Choo & Liew23. Labuan Hospital24. Queen Elizabeth Hospital25. Sabah Medical Centre26. Tawau Hospital
Sarawak27. Bintulu Hospital28. Miri Hospital29. Sarawak General Hospital30. Sibu Hospital31. Timberland Medical Centre
Selangor Darul Ehsan32. Assunta Hospital33. Selayang Hospital34. Serdang Hospital35. Smartcare Dialysis Centre (Subang Jaya)36. Tan Medical Renal Clinic37. Tg. Ampuan Rahimah Hospital
Terengganu Darul Iman38. Dungun Hospital39. Kemaman Hospital40. Sultanah Nur Zahirah Hospital
wilayah Persekutuan Kuala Lumpur41. Fan Medical Renal Clinic42. Kuala Lumpur Hospital (Paed)43. Kuala Lumpur Hospital44. Prince Court Medical Centre45. Prince Court Medical Centre46. Pusat Perubatan Universiti Kebangsaan Malaysia47. University Malaya Medical Centre
xiv
CONTRibuTiNG AuThORSCHAPTER TITLE AuTHORS INSTITuTIONS
1ALL RENAL REPLACEMENT THERAPY IN MALAYSIA
Lim Yam Ngo Kuala Lumpur Hospital Ghazali B Ahmad Kuala Lumpur Hospital Goh Bak Leong Serdang HospitalLee Day Guat National Renal Registry
2 DIALYSIS IN MALAYSIA
Goh Bak Leong Serdang HospitalLim Yam Ngo Kuala Lumpur HospitalOng Loke Meng Penang HospitalGhazali B Ahmad Kuala Lumpur Hospital Lee Day Guat National Renal Registry
3 DEATH AND SuRvIvAL ON DIALYSISWong Hin Seng Selayang HospitalOng Loke Meng Penang Hospital
4QOL AND REHABILITATION OuTCOMES ON DIALYSIS PATIENT IN MALAYSIA
Liu Wen Jiun Sultanah Aminah HospitalChew Thian Fook Seremban Specialist HospitalChristopher Lim Thiam Seong University Putra MalaysiaTan Wee Ming Sunway Medical CentreYia @ Yeow Hua Jern Hospital Pakar Sultanah Fatimah
5PAEDIATRIC RENAL REPLACEMENT THERAPY
Lee Ming Lee Tuanku Ja’afar HospitalLim Yam Ngo Kuala Lumpur Hospital Lynster Liaw Chiew Tung Penang HospitalSusan Pee Sultan Ismail HospitalWan Jazilah Wan Ismail Selayang Hospital
6MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS
Philip N. Jeremiah KPJ Ampang Puteri Specialist HospitalBee Boon Cheak Selayang HospitalGhazali B Ahmad Kuala Lumpur Hospital Lim Soo Kun University Malaya Specialist CentreZawawi B Nordin Sultanah Nur Zahirah Hospital
7 NuTRITIONAL STATuS ON DIALYSIS
Winnie Chee Siew Swee International Medical UniversityAbdul Halim B Abd Gafor Pusat Perubatan Universiti Kebangsaan MalaysiaAhmad Fauzi B Abd Rahman Puteri Specialist HospitalKoh Keng Hee Sarawak General Hospital
Tilakavati Karupaiah Faculty of Allied Health Sciences University Kebangsaan Malaysia
8BLOOD PRESSuRE CONTROL AND DYSLIPIDAEMIA
S. Prasad Menon Sime Darby Medical Centre Subang JayaHooi Lai Seong Sultanah Aminah HospitalLee Wan Tin Sime Darby Medical Centre Subang JayaSunita Bavanandan Kuala Lumpur Hospital
9CHRONIC KIDNEY DISEASE - MINERAL AND BONE DISORDERS
Rozina Bt Ghazalli Pulau Pinang HospitalChing Chen Hua Sultanah Bahiyah HospitalFan Kin Sing Gleneagles Intan Medical CentreLiew Yew Fong Pulau Pinang Hospital
10 HEPATITIS ON DIALYSIS
Teo Sue Mei Putri Haemodialysis Centre (Ipoh)Chow Yok Wai Pantai Air Keroh HospitalClare Tan Hui Hong Sarawak General HospitalT. Thiruventhiran Sunway Medical CentreNg Eng Khim Kuala Lumpur Hospital
11 HEAEMODIALYSIS PRACTICES
Tan Chwee Choon Tengku Ampuan Rahimah HospitalNorleen Bt Zulkarnain Sim Tengku Ampuan Rahimah HospitalRafidah Abdullah Sultan Haji Ahmad Shah HospitalShahnaz Shah Firdaus Khan Tengku Ampuan Rahimah Hospital
12CHRONIC PERITONEAL DIALYSIS PRACTICES
Sunita Bavanandan Kuala Lumpur HospitalAnita Bhajan Manocha Hospital Seberang JayaLily Mushahar Tuanku Ja’afar Hospital
13 RENAL TRANSPLANTATION
Goh Bak Leong Serdang HospitalFan Kin Sing Gleneagles Intan Medical CentreRohan Malek Bin Dato’ Dr. Johan Selayang HospitalRosnawati Yahya Kuala Lumpur HospitalS. Prasad Menon Sime Darby Medical Centre Subang JayaTan Si Yen Prince Court Medical CentreWong Hin Seng Selayang Hospital
xv
20 years had lapsed since the first publication of the Malaysian Dialysis and Transplant Registry. Far from being a mere reporting of
dialysis and transplant activities in the Ministry of Health facilities as in its initial years , currently , nearly ALL the centres which provide
haemodialysis and peritoneal dialysis services nationwide transecting private, public and NGO sectors , contribute their datasets on
regular basis to the NRR office to enable timely publication and dissemination of the annual registry report which by now has become a
regular feature in the Annual Congress of the Malaysian Society of Nephrology. This year’ s return is provided by a total of 710 dialysis
centres out of which 670 are HD centres and the rest made up of PD centres .
With continuing rise in the number of dialysis units operating across the country, the administrative tasks of the NRR secretariat do
increase substantially. Additionally, the uncertainty of continuous funding of the registry financial needs becomes increasingly more
obvious lately. Recent developments in the Division of Health Informatics , which partly oversee the operation of the Clinical Research
Centres in Ministry of Health hospitals, has led to the possibility of further curtailment in the partial registry funding for the Information
System component in addition to the possible changes in the way the national clinical registry operates. A good piece of welcome news
is the decision by the Malaysian Society of Nephrology recently to procure a strategically placed property in Jalan Pahang Kuala Lumpur
to house the NRR office which until now operates from rented premises .
As a part of the transition strategy, to ensure not just continuity but also further enhancements of the registry reports , a new editorial
team has taken over this year led by Dr Goh Bak Leong from Hospital Serdang , working closely with the co editor Dr Ong Loke Meng
from Hospital Pulau Pinang. With immense experience behind her sterling long years of service, the outgoing Chief Editor Dr Lim Yam Ngo
will continue to provide a helping hand to ensure orderliness and quality reporting which many of us are so used to by now.
On behalf of the registry Advisory Committee, I wish to express my utmost appreciation to all the sponsors especially Roche Malaysia
Sdn Bhd which had shown their continued generosity and commitment to support NRR, all the Source Data Providers which had diligently
and consistently submit useful and quality data without fail , members of the Expert Committee who persevered in their volunteerism ,
provide important and relevant commentaries and last but not least the experienced and committed NRR administrators under the able
leadership of Staff Nurse Lee Day Guat who work tirelessly and enthusiastically to ensure a high return to the requested data from all
the service providers as well as timely completion of all the necessary tasks to see yet again the publication of this year’s report ready
for dissemination by the time we meet in this year’s Annual Congress of Malaysian Society of Nephrology.
Datuk Dr. Ghazali AhmadChairmanAdvisory Committee 2012-2014National Renal Registry
fOREWORD
xvi
Acknowledgement iii NRR Advisory Board Members iv About The Malaysian Dialysis and Transplant Registry (MDTR v Participating Haemodialsyis Centres vii Participating Chronic Peritoneal Dialsysis Centres xiiParticipating Transplant Follow-up Centres xiiiContributing Editors xiv Foreword xv Contents xvi List of Tables xix List of Figures xxv Executive Summary xxx Abbreviations xxxi
CHAPTER 1: ALL RENAL REPLACEMENT THERAPY IN MALAYSIA 1
Section 1.1: Stock and flow 2
Section 1.2: Treatment provision rate 3
CHAPTER 2: DIALYSIS IN MALAYSIA 5
section 2.1: provision of dialysis in Malaysia (registry report) 6
Section 2.2: Dialysis provision in Malaysia (Centre survey report) 8
2.2.1: Growth in dialysis in Malaysia by state and sector 8
2.2.2: Geographic distribution 9
2.2.3: Growth in dialysis provision by sector 12
Section 2.3: Distribution of dialysis Treatment 14
2.3.1: Gender distribution 14
2.3.2: Age distribution 15
2.3.3: Method and location of dialysis 17
2.3.4: Funding for dialysis treatment 18
2.3.5: Distribution of dialysis patients by sector 19
Section 2.4: Primary renal disease 20
CHAPTER 3: DEATH AND SuRvIvAL ON DIALYSIS 21
Section 3.1: Death on dialysis 22
Section 3.2: Patient survival on dialysis 24
3.2.1: patient survival by type of dialysis modality 24
3.2.2: Patient survival by year of starting dialysis 25
3.2.3: Patient survival by age at starting dialysis 26
3.2.4: Patient survival by diabetic status 28
Section 3.3: Survival of incident dialysis patients by centre 29
3.3.1: Survival of incident haemodialysis patients 1993-2011 by centre 29
3.3.2: Survival of incident PD patients by centre 30
Section 3.4: Adusted mortality of dialysis patient 31
3.4.1: Adjusted hazard ratio for mortality of dialysis patients 31
3.4.2: Adjusted hazard ratio for mortality of haemodialysis patients 34
3.4.3: Adjusted hazard ratio for mortality of peritoneal dialysis patients 36
3.4.4: Risk adjusted mortality rate for haemodialysis patients by haemodialysis centres 38
3.4.5: Risk Adjusted Mortality Rate by PD centres 38
CONTENTS
xvii
CHAPTER 4: QuALITY OF LIFE AND REHABILITATION OuTCOMES OF DIALYSIS PATIENTS IN MALAYSIA 39
Section A: QoL Index score 40
Section B: Work related rehabilitation 43
Summary
CHAPTER 5: PAEDIATRIC RENAL REPLACEMENT THERAPY 45
Section A: RRT provision for paediatric patients 46
Section B: Distribution of paediatric dialysis patients 48
Section C: Primary renal disease 51
Section D: Types of renal transplantation 51
Section E: Survival analysis 52
Section F: Haemodialysis practice 55
Section G: Anaemia treatment 56
Report Summary 57
CHAPTER 6: MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS 59
Section 6.1: Treatment for anaemia in patient on Dialysis 60
Section 6.2: Iron status on dialysis 65
Section 6.3: Haemoglobin outcomes on dialysis 74
CHAPTER 7: NuTRITIONAL STATuS ON DIALYSIS 83
Section 7.1: Serum albumin levels on dialysis 84
Section 7.2: Body Mass Index (BMI) on dialysis 88
Section 7.3: Nutritional parameters 92
CHAPTER 8: BLOOD PRESSuRE CONTROL AND DYSLIPIDAEMIA 93
Section 8.1: Blood Pressure Control on dialysis 94
Section 8.2: Dyslipidaemia in dialysis patients 103
CHAPTER 9: CHRONIC KIDNEY DISEASE - MINERAL BONE DIORDERS 111
Section 9.1: Treatment of hyperphosphateamia 112
Section 9.2: Serum calcium and phosphate control 114
Section 9.3: Serum parathyroid hormone control 124
Section 9.4: Renal bone disease among dialysis patients 130
Conclusion 132
CHAPTER 10: HEPATITIS ON DIALYSIS 133
Section A: Prevalence 134
Section B: Centre variation 134
Section C: Seroconversion risks 137
Conclusion 138
CONTENTS (CONT.)
xviii
CHAPTER 11: HAEMODIALYSIS PRACTICES 139
Section 11.1: Vascular access and its complications 140
Section 11.2: HD prescription 142
Section 11.3: Technique survival on dialysis 153
CHAPTER 12: PERITONEAL DIALYSIS PRACTICES 159
Section 12.1: Modalities and prescription of PD 160
Section 12. 2: Achievement of solute clearance and peritoneal transport 161
Section 12.3: Technique survival on PD 163
Section 12.4: PD Peritonitis 170
CHAPTER 13: RENAL TRANSPLANTATION 175
Section 13.1: Stock and flow 176
Section 13.2: Recipients' charateristics 178
Section 13.3: Transplant practices 180
13.3.1: Type of transplant 180
13.3.2: Place of transplant 181
Section 13.4: Transplant outcomes 182
13.4.1: Post ransplant complications 182
13.4.2: Biochemical outcome 183
13.4.3: Death and graft loss 184
13.4.4: Causes of death and graft loss 185
Section 13.5: Patient and graft survival 187
13.5.1: Patient and graft survival 187
13.5.2: Survival according to type of transplant 189
13.5.3: Outcome of living related renal transplantation 190
13.5.4: Outcome of commercial cadaveric transplantation 191
Section 13.6: Used of immunosuppressions and non immunosuppressive medication 193
13.6.1: Immunosuppresion medications 193
13.6.2: Non immunosuppression medications 194
Section 13.7: Cardiovascular risk in renal transplant recipients 195
13.7.1: Risk factors for ischaemic heart disease 195
13.7.2: Blood pressure classification according to JNC VIII criteria, 2004-2012 197
13.7.3: Level of allograft function 198
13.7.4: Body mass Index 198
13.7.5: Lipid profile 199
13.7.6: Blood pressure control 200
Section 13.8: Influence of immunosuppression on outcome and cardiovascular risk factors 202
Section 13.9: QoL index score in renal transplant recipients 207
APPENDIX I: DATA MANAGEMENT I-iv
APPENDIX II: ANALYSIS SETS, STATISTICAL METHODS AND DEFINITIONS v-IX
CONTENTS (CONT.)
xix
Table 1.1: Stock and flow of RRT, Malaysia 1993-2012 2
Table 1.2: New dialysis acceptance rate and new transplant rate per million population 1993-2012 3
Table 1.3: RRT prevalence rate per million population 1993-2012 3
Table 2.1.1(a): Stock and flow- HD Patients 1993-2012 6
Table 2.1.1(b): Stock and flow- PD Patients 1993-2012 6
Table 2.1.2(a): HD Treatment Rate per million population 1993-2012 6
Table 2.1.2(b): PD Treatment Rate per million population 1993-2012 7
Table 2.1.3: Dialysis Treatment Rate by state, per million population 1993-2012 7
Table 2.2.1: Number of dialysis centres, HD machines and treatment capacity, 2000-2012 8
Table 2.2.2(a): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2003
9
Table 2.2.2(b): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2007
10
Table 2.2.2(c): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2012
10
Table 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 12
Table 2.2.3(b): Number of dialysis centres, HD machines and treatment capacity by sector, 2000-2012 13
Table 2.3.1(a): Dialysis Treatment Rate by Gender, per million male or female population 1993-2012 14
Table 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 15
Table 2.3.2(a): Dialysis Treatment Rate by Age Group, per million age group population 1993-2012 15
Table 2.3.2: Percentage Age Distribution of Dialysis Patients 1993-2012 16
Table 2.3.3: Method and Location of Dialysis Patients 1993-2012 17
Table 2.3.4: Funding for Dialysis Treatment 1993-2012 18
Table 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 19
Table 2.4.1: Primary Renal Diseases 1993-2012 20
Table 3.1.1: Deaths on dialysis 1993-2012 22
Table 3.1.2(a): Causes of death on HD dialysis 1994-2012 23
Table 3.1.2(b): Causes of death on PD dialysis 1993-2012 23
Table 3.2.1(a): HD Patient survival (censored for change of modality) 24
Table 3.2.1(b): PD Patient survival (censored for change of modality) 24
Table 3.2.1(c): HD Patient survival (not censored for change of modality) 24
Table 3.2.1(d): PD Patient survival (not censored for change of modality) 24
Table 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012 25
Table 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012 25
Table 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012 26
Table 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012 27
Table 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012 28
Table 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012 28
Table 3.4.1: Adjusted hazard ratio for mortality of dialysis patients (not censored for change of modality (1993-2012) ) 31
Table 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality (1993-2012 cohort) 34
Table 3.4.3: Adjusted hazard ratio for mortality of PD patients uncensored for change of modality (1993-2012 cohort) 36
Table 4.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, all dialysis patients 1993-2012 40
Table 4.2: Cumulative distribution of QoL-Index score in relation to DM, all dialysis patients 1993-2012 40
Table 4.3: Cumulative distribution of QoL-index score in relation to gender, all dialysis patients 1993-2012 40
Table 4.4: Cumulative distribution of QoL-index score in relation to age, all dialysis patients 1993-2012 41
Table 4.5: Cumulative distribution of QoL-Index score in relation to year of entry, HD patients 1993-2012 41
Table 4.6: Cumulative distribution of QoL-Index score in relation to year of entry, PD patients 1993-2012 42
Table 4.7: Work related rehabilitation in relation to modality, dialysis patients, 1993-2012 43
Table 4.8: Work related rehabilitation in relation to year of entry, HD patients 1993-2012 43
Table 4.9: Work related rehabilitation in relation to year of entry, PD patients 1993-2012 43
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Table 5.1: Stock and flow of Paediatric Renal Replacement Therapy (RRT) 1993-2012 46
Table 5.2: Paediatric dialysis and transplant rates per million age-group population 1993-2012 47
Table 5.3(a): Dialysis treatment rate by state, per million state age group populations, 1993-2012 48
Table 5.3(b): New dialysis patients by state, 1993-2012 48
Table 5.4: Number of new dialysis and transplant patients by gender 1993-2012 48
Table 5.5: New RRT rate, per million age related population by age group 1993-2012 49
Table 5.6: New dialysis by treatment modality 1993-2012 50
Table 5.7: New dialysis by sector 1993-2012 50
Table 5.8: Primary renal disease by sex, 1993-2012 51
Table 5.9: Types of renal transplantation, 1993-2012 51
Table 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality) 52
Table 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality) 52
Table 5.11: Causes of death in dialysis patients, 1993-2012 53
Table 5.12: Dialysis technique survival by modality, 1993-2012 53
Table 5.13: Reasons for drop-out from PD program, 1993-2012 54
Table 5.14: Transplant graft survival, 1993-2012 54
Table 5.15: Causes of graft loss 54
Table 5.16: Vascular access on haemodialysis, 1997-2012 55
Table 5.17(a): Distribution of prescribed Kt/V, HD patients 2006-2012 55
Table 5.17(b): Distribution of delivered Kt/V, HD patients 2006-2012 55
Table 5.17(c): Distribution of URR, HD patients 2006-2012 55
Table 5.18: Treatment for anaemia, HD patients 1997-2012 56
Table 5.20: Distribution of transferrin saturation on Erythropoietin, PD patients, 1997-2012 56
Table 5.21: Distribution of ESA dose (u/wk) 1997-2012 57
Table 6.1.1: Treatment for anaemia, HD patients 1997-2012 60
Table 6.1.2: Treatment for anaemia, PD patients 1997-2012 60
Table 6.1.3: Variation in Erythropoiesis-Stimulating Agents (ESAs) utilization (% patients) among HD centres, 1997-2012 61
Table 6.1.4: Variation in ESAs utilization (% patients) among PD centres, 1997-2012 61
Table 6.1.5: Variation in mean weekly ESAs dose (u/week) among HD centres, 1997-2012 62
Table 6.1.6: Variation in mean weekly ESAs dose (u/week) among PD centres, 1997-2012 63
Table 6.1.7: Variation in use of blood transfusion (% patients) among HD centres, 1997-2012 63
Table 6.1.8: Variation in use of blood transfusion (% patients) among PD centres, 1997-2012 64
Table 6.2.1: Distribution of serum ferritin without ESAs, HD patients 1997-2012 65
Table 6.2.2: Distribution of serum ferritin without ESAs, PD patients 1997-2012 66
Table 6.2.3: Distribution of serum ferritin on ESAs, HD patients 1997-2012 66
Table 6.2.4: Distribution of serum ferritin on ESAs, PD patients 1997-2012 67
Table 6.2.5: Distribution of transferrin saturation without ESAs, HD patients, 1997-2012 67
Table 6.2.6: Distribution of transferrin saturation without ESAs, PD patients, 1997-2012 68
Table 6.2.7: Distribution of transferrin saturation on ESAs, HD patients, 1997-2012 68
Table 6.2.8: Distribution of transferrin saturation on ESAs, PD patients, 1997-2012 69
Table 6.2.9(a): Variation in Medium serum ferritin among patients on ESAs, HD centres 1997-2012 69
Table 6.2.9(b): Proportion of patients on ESAs with serum ferritin ≥100 ng/ml, HD centres 70
Table 6.2.9(c): Median transferrin saturation among patients on ESAs, HD centres 70
Table 6.2.9(d): Proportion of patients on ESAs with transferrin saturation ≥ 20%, HD centres 71
Table 6.2.10(a): Variation in medium serum ferritin among patients on ESAs, PD centres 1997-2012 71
Table 6.2.10(b): Proportion of patients on ESAs with serum ferritin ≥100 ng/ml, PD centres 72
Table 6.2.10(c): Median transferrin saturation among patients on ESAs, PD centres 72
Table 6.2.10(d): Proportion of patients on ESAs with transferring saturation ≥ 20%, PD centres 73
Table 6.3.1: Distribution of haemoglobin concentration without ESAs, HD patients 1997-2012 74
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Table 6.3.2: Distribution of haemoglobin concentration without ESAs, PD patients 1997-2012 74
Table 6.3.3(a): Distribution of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75
Table 6.3.3(b): Distribution of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76
Table 6.3.4(a): Distribution of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 76
Table 6.3.4(b): Distribution of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77
Table 6.3.5(a): Proportion in median haemoglobin level among patients on ESAs, HD centres 1997-2012 78
Table 6.3.5(b): Proportion of patients on ESAs with haemoglobin level > 10g/dL, HD centres 78
Table 6.3.6(a): Proportion in Median haemoglobin level among patients on ESAs, PD centres 1997-2012 79
Table 6.3.6(b): Proportion of patients on ESAs with haemoglobin level > 10g/dL, PD centres 79
Table 6.3.7: Distribution of haemoglobin concentration on ESAs, HD patients 1997-2012 80
Table 6.3.8: Distribution of haemoglobin concentration on ESAs, PD patients 1997-2012 81
Table 7.1.1: Distribution of serum albumin, HD patients, 1997-2012 84
Table 7.1.2: Distribution of serum albumin, PD patients, 1997-2012 85
Table 7.1.3: Variation in proportion of patients with serum albumin ≥ 40g/L among HD centres 1997-2012 86
Table 7.1.4: Variation in proportion of patients with serum albumin ≥40g/L among PD centres 1997-2012 87
Table 7.2.1: Distribution of BMI, HD patients, 1997-2012 88
Table 7.2.2: Distribution of BMI, PD patients 1997-2012 89
Table 7.2.3: Variation in proportion of patients with BMI ≥ 18.5 among HD centres 1997-2012 90
Table 7.2.4: Variation in proportion of patients with BMI ≥ 18.5 among PD centres1997-2012 90
Table 7.2.5: Variation in proportion of patients with BMI ≥ 18.5 and serum albumin ≥ 40 g/dL among HD centres 1997-2012 91
Table 7.2.6: Variation in proportion of patients with BMI ≥ 18.5 and serum albumin ≥ 40 g/dL among PD centres 1997-2012 91
Table 7.3.1(a): Nutritional parameters between HD patients, 2012 92
Table 7.3.1(b): Nutritional parameters between PD patients, 2012 92
Table 7.3.2(a): Nutritional parameters between diabetic and non- diabetic HD patients, 2012 92
Table 7.3.2(b): Nutritional parameters between diabetic and non-diabetic PD patients, 2012 92
Table 7.3.3(a): Distribution of serum albumin and BMI by duration of dialysis among HD patients, 1997-2012 92
Table 7.3.3(b): Distribution of serum albumin and BMI by duration of dialysis among PD patients, 1997-2012 92
Table 8.1.1: Distribution of pre dialysis systolic blood pressure, HD patients 1997-2012 94
Table 8.1.2: Distribution of pre dialysis systolic blood pressure, PD patients 1997-2012 95
Table 8.1.3: Distribution of pre dialysis diastolic blood pressure, HD patients 1997-2012 96
Table 8.1.4: Distribution of pre dialysis diastolic blood pressure, PD patients 1997-2012 97
Table 8.1.5(a): Median systolic blood pressure among HD patients, HD centres 98
Table 8.1.5(b): Median diastolic blood pressure among HD patients, HD centres 99
Table 8.1.5(c): Proportion of HD patients with pre dialysis blood pressure < 140/90 mmHg, HD centres 100
Table 8.1.6(a): Median systolic blood pressure among PD patients, PD centres 101
Table 8.1.6(b): Median diastolic blood pressure among PD patients, PD centres 102
Table 8.1.6(c): Proportion of PD patients with pre dialysis blood pressure < 140/90 mmHg, PD centres 102
Table 8.2.1: Distribution of serum cholesterol, HD patients 1997-2012 103
Table 8.2.2: Distribution of serum cholesterol, PD patients 1997-2012 104
Table 8.2.3: Distribution of serum triglyceride, HD patients 1997-2012 105
Table 8.2.4: Distribution of serum triglyceride, PD patients 1997-2012 105
Table 8.2.5(a): Median serum cholesterol level among HD patients, HD centres 106
Table 8.2.5(b): Proportion of HD patients with serum cholesterol < 5.3mmol/L, HD centres 107
Table 8.2.5(c): Median serum triglyceride level among HD patients, HD centres 107
Table 8.2.5(d): Proportion of HD patients with serum triglyceride < 2.1mmol/L, HD centres 108
Table 8.2.6(a): Median serum cholesterol level among PD patients, PD centres 109
Table 8.2.6(b): Proportion of PD patients with serum cholesterol < 5.3mmol/L, PD centres 109
Table 8.2.6(c): Median serum triglyceride level among PD patients, PD centres 110
Table 8.2.6(d): Proportion of PD patients with serum triglyceride < 2.1mmol/L, PD centres 110
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Table 9.1.1: Phosphate Binder in HD patients, 1997-2012 112
Table 9.1.2: Phosphate Binder in PD patients, 1997-2012 112
Table 9.1.3: Phosphate Binders by Sector in HD patients 113
Table 9.2.1: Distribution of corrected serum calcium, HD patients, 1997-2012 114
Table 9.2.2: Distribution of corrected serum calcium, PD patients, 1997-2012 114
Table 9.2.3: Distribution of serum phosphate, HD patients, 1997-2012 115
Table 9.2.4: Distribution of serum phosphate, PD patients, 1997-2012 115
Table 9.2.5: Distribution of corrected calcium x phosphate product, HD patients 1997-2012 116
Table 9.2.6: Distribution of corrected calcium x phosphate product, PD patients 1997-2012 116
Table 9.2.7(a): Variation in corrected median serum calcium level among HD centres 1997-2012 117
Table 9.2.8(a): Variation in corrected median serum calcium level among PD centres 1997-2012 117
Table 9.2.7(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 1997-2012 118
Table 9.2.8(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres 118
Table 9.2.9(a): Variation in median serum phosphate level among HD centres, 2002- 2012 119
Table 9.2.10(a): Variation in median serum phosphate levels among PD centres 1997-2012 119
Table 9.2.9(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres, 1997-2012 120
Table 9.2.10(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 1997-2012 120
Table 9.2.9(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres, 2012 121
Table 9.2.10(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres, 2012 121
Table 9.2.11(a): Variation in corrected median calcium x phosphate product HD centres 1997-2012 122
Table 9.2.12(a): Variation in corrected median calcium x phosphate product PD centres 1997-2012 122
Table 9.2.11(b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, HD centres 123
Table 9.2.12(b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, PD 123
Table 9.3.1(a): Treatment of hyperparathyroidism in HD patients, 1997-2012 124
Table 9.3.1(b): Treatment of hyperparathyroidism in PD patients, 1997-2012 124
Table 9.3.2(a): Distribution of iPTH, HD patients, 1997-2012 125
Table 9.3.2(b): Distribution of iPTH, diabetic HD patients, 1997-2012 125
Table 9.3.2(c): Distribution of iPTH, non-diabetic HD patients, 1997-2012 126
Table 9.3.3(a): Distribution of iPTH, PD patients, 1997-2012 126
Table 9.3.3(b): Distribution of iPTH, diabetic PD patients, 1997-2012 127
Table 9.3.3(c): Distribution of iPTH, non diabetic PD patients, 1997-2012 127
Table 9.3.4(a): Variation in iPTH among HD centres 1997-2012 128
Table 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 1997-2012 128
Table 9.3.5(a): Variation in median iPTH among PD patients 1997-2012 129
Table 9.3.5(b): Proportion of patients with iPTH 150-300pg/ml 129
Table 9.4.1: Low turnover bone disease vs high turnover bone disease in dialysis patient, 1997-2012 130
Table 9.4.2: Low turnover bone disease vs high turnover bone disease by gender, 1997-2012 130
Table 9.4.3: Low turnover bone disease vs high turnover bone disease by age group, 1997-2012 131
Table 9.4.4: Low turnover bone disease vs high turnover bone disease by diabetes status, 1997-2012 131
Table 10.1: Prevalence of positive HBsAg and positive Anti-HCV at annual survey, HD patients 1993-2012 134
Table 10.2: Prevalence of positive HBsAg and positive Anti-HCV at annual survey, PD patients 1993-2012 134
Table 10.3: Variation in Proportion of patients with positive HBsAg at annual survey among HD centres, 1993-2012 135
Table 10.4: Variation in proportion of patients with positive HBsAg at annual survey among PD centres, 1993-2012 135
Table 10.5: Variation in proportion of patients with positive anti-HCV at annual survey among HD centres, 1993-2012 136
Table 10.6: Variation in proportion of patients with positive anti-HCV at annual survey among PD centres, 1993-2012 136
Table 10.7(a): Risk factors in relation to HD practices for seroconversion to anti-HCV positive among sero-negative patients 1993-2012 137
Table 10.7(b): Risk factors for seroconversion to anti-HCV positive among sero-negative patients in PD 1993-2012 138
Table 11.1.1: Vascular access on haemodialysis, 1997-2012 140
Table 11.1.2: Difficulties report with vascular access, 1997-2012 140
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Table 11.1.3: Complications reported with vascular access, 1997-2012 141
Table 11.2.1: Blood flow rates in HD centers, 1997-2012 142
Table 11.2.2: Number of HD sessions per week, 1997-2012 143
Table 11.2.3: Duration of HD, 1997-2012 143
Table 11.2.4: Dialyser membrane types in HD centres, 1997-2012 144
Table 11.2.5: Frequency of Dialyser use in HD centres, 1997-2012 145
Table 11.2.6(a): Distribution of prescribed Kt/V, HD patients 1997-2012 146
Table 11.2.6(b): Distribution of delivered Kt/V, HD patients 2006-2012 146
Table 11.2.6(c): Distribution of URR, HD patients 2006-2012 147
Table 11.2.7(a): Variation in median blood flow rates in HD patients, HD centres, 1997-2012 148
Table 11.2.7(b): Proportion of patients with blood flow rates > 300 ml/min, HD centres 1997-2012 148
Table 11.2.7(c): Proportion of patients with 3 HD sessions per week, HD centres 1997-2012 149
Table 11.2.7(d): Median prescribed Kt/V in HD patients, HD centres 1997-2012 149
Table 11.2.7(e): Proportion of patients with prescribed Kt/V ≥ 1.3, 1997-2012 150
Table 11.2.7(f): Median delivered Kt/V in HD patients, HD centres 2006-2012 150
Table 11.2.7(g): Proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2006-2012 151
Table 11.2.7(h): Median URR among HD patients, HD centres 2006-2012 151
Table 11.2.7(i): Proportion of HD patients with URR ≥ 65%, HD centres 2006-2012 152
Table 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 153
Table 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1993-2012 154
Table 11.3.2(a): Unadjusted technique survival by age, 1993-2012 156
Table 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1993-2012 157
Table 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 158
Table 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 158
Table 12.1.1: Peritoneal dialysis regimes, 1997-2012 160
Table 12.1.2: PD System, 1997-2012 160
Table 12.1.3(a): CAPD Number of Exchanges per day, 1997-2012 160
Table 12.1.3(b): APD dwell volumes per day, 1997-2012 161
Table 12.2.1: Distribution of delivered Kt/V, PD patients 2003-2012 161
Table 12.2.2: Variation in proportion of patients with Kt/V >1.7 per week among PD centres, 1997-2012 162
Table 12.2.3: Peritoneal transport status by PET D/P creatinine at 4 hours, new PD patients 2004-2012 162
Table 12.2.4: Peritoneal Transport Status (PET) with dialysis vintage 162
Table 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012 163
Table 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012 164
Table 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012 165
Table 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012 165
Table 12.3.3(a): Unadjusted technique survival by diabetes status (uncensored for death and transplant), 1997-2012 166
Table 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012 166
Table 12.3.4: Unadjusted technique survival by Kt/V, 1997-2012 167
Table 12.3.5: Adjusted hazard ratio for change of modality, 1997-2012 167
Table 12.3.6: Reasons for drop-out from PD program, 2003-2012 168
Table 12.3.7: Drop-out rate from PD program with time on treatment, 2003-2012 168
Table 12.3.8: Time on PD (1997-2012) 168
Table 12.4.1: Variation in peritonitis rate (patient-month/episode) among PD centres, 1997-2012 170
Table 12.4.2: Causative organism in PD peritonitis, 2003-2012 171
Table 12.4.3(a): Outcome of peritonitis by causative organism, 1993-2002 172
Table 12.4.3(b): Outcome of peritonitis by causative organism, 2003-2012 173
Table 12.4.4: Risk factors influencing peritonitis rate, 1993-2012 174
Table 13.1.1: Stock and flow of renal transplantation, 1993-2012 176
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Table 13.1.2: New transplant rate per million population (pmp), 1993-2012 176
Table 13.1.3: Transplant prevalence rate per million population (pmp), 1993-2012 177
Table 13.2.1: Renal transplant recipients’ characteristics, 1993-2012 178
Table 13.2.2: Primary causes of end stage renal failure, 1993-2012 179
Table 13.3.1: Type of renal transplantation, 1993-2012 180
Table 13.3.2: Place of transplantation, 1993-2012 181
Table 13.4.1: Post-transplant complications, 1993-2012 182
Table 13.4.2: Biochemical data, 2004-2012 183
Table 13.4.3: Transplant patients’ death rate and graft loss, 1993-2012 184
Table 13.4.4(a): Causes of death in transplant recipients, 1993-2012 185
Table 13.4.4(b): Causes of graft failure, 1993-2012 186
Table 13.5.1.1: Patient survival, 1993-2012 187
Table 13.5.1.2: Risk factors for transplant patient survival 1993-2012 187
Table 13.5.1.3: Graft survival, 1993-2012 188
Table 13.5.1.4: Risk factors for transplant graft survival 1993-2012 188
Table 13.5.2.1: Unadjusted patient survival by type of transplant, 1993-2012 189
Table 13.5.2.2: Graft survival by type of transplant, 1993-2012 190
Table 13.5.3.1: Patient survival by year of transplant (Living related transplant, 1993-2012) 190
Table13.5.3.2: Graft survival by year of transplant (Living related transplant, 1993-2012) 191
Table 13.5.4.1: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2012) 191
Table 13.5.4.2: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192
Table 13.6.1: Medication data, 2004-2012 193
Table 13.6.2: Use of antihypertensives 194
Table 13.7.1: Risk factors for IHD in renal transplant recipients at year 2004-2012 195
Table 13.7.2(a): Systolic BP, 2004-2012 197
Table 13.7.2(b): Diastolic BP, 2004-2012 197
Table 13.7.3: CKD stages, 2004-2012 198
Table 13.7.4: BMI, 2004-2012 198
Table 13.7.5(a): LDL, 2004-2012 199
Table 13.7.5(b): Total cholesterol, 2004-2012 199
Table 13.7.5(c): HDL, 2004-2012 200
Table 13.7.6(a): Treatment for hypertension, 2004-2012 200
Table 13.7.6(b): Distribution of systolic BP without anti-hypertensive, 2004-2012 201
Table 13.7.6(c): Distribution of diastolic BP without anti-hypertensive, 2004-2012 201
Table 13.7.6(d): Distribution of systolic BP on anti-hypertensives, 2004-2012 201
Table 13.7.6(e): Distribution of diastolic BP on anti-hypertensives, 2004-2012 201
Table 13.8.3.1: Allograftraft and patient survival, Azathioprine vs Mycophenolic Acid 1993-2012 202
Table 13.8.3.2: Graft and patient survival, CsA vs Tacrolimus 203
Table 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012 203
Table 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012 203
Table 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 2004-2012 204
Table 13.8.3.6: Incidence of post transplant diabetes mellitus, CsA vs Tacrolimus, 2004-2012 204
Table 13.9.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, transplant recipient patients 1993-2012 204
Table 13.9.2: Cumulative distribution of QoL-Index score in relation to diabetes mellitus, transplant recipient patients 1993-2012 205
Table 13.9.3: Cumulative distribution of QoL-Index score in relation to gender, transplant recipient patients 1993-2012 205
Table 13.9.4: Cumulative distribution of QoL-Index score in relation to age, transplant recipient patients 1993-2012 205
Table 13.9.5: Cumulative distribution of QoL-Index score in relation to year of entry, transplant recipient patients 1993-2012 206
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Figure 1.1: Stock and flow of RRT, Malaysia 1993-2012 2
Figure 1(a): New dialysis and transplant patients 2
Figure 1(b): Patients dialysing and with functioning transplant at 31st December 1993-2012 2
Figure 1.2: New dialysis acceptance and new transplant rate 1993-2012 3
Figure 1.3: Dialysis and transplant prevalence rate per million population 1993-2012 3
Figure 2.2.1(a): Distribution of dialysis centres, 1993-2012 8
Figure 2.2.1(b): Distribution of HD capacity, 1993-2012 8
Figure 2.2.1(c): Distribution of dialysis patients, 1993-2012 9
Figure 2.2.1(d): HD capacity to patient ratio, 1993-2012 9
Figure 2.2.2(a): Distribution of hemodialysis centres by State, 2003-2012 11
Figure 2.2.2(c): Distribution of patients/million population by State, 2003-2012 11
Figure 2.2.2(b): Distribution of dialysis patients by State, 2003-2012 11
Figure 2.2.2(d): HD capacity to patient ratio by State, 2003-2012 11
Figure 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 12
Figure 2.2.3(b)(i): Distribution of dialysis centres by Sector, 1993-2012 14
Figure 2.2.3(b)(ii): Distribution of HD capacity by Sector, 1993-2012 14
Figure 2.2.3(b)(iii): Distribution of dialysis patients by Sector, 1993-2012 14
Figure 2.2.3(b)(iv): HD capacity to patient ratio by Sector, 1993-2012 14
Figure 2.3.1(a): Dialysis Treatment Rate by Gender 1993-2012 14
Figure 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 15
Figure 2.3.2(a): Dialysis Treatment Rate by Age Group 1993-2012 16
Figure 2.3.2(b): Age Distribution of New Dialysis Patients 1993-2012 17
Figure 2.3.3: Method and Location of Dialysis Patients 1993-2012 17
Figure 2.3.4: Funding for Dialysis Treatment 1993-2012 18
Figure 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 19
Figure 2.4.1: Primary Renal Diseases for New Dialysis Patients 1993-2012 20
Figure 3.1.1: Death rates on dialysis 1993-2012 22
Figure 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012 25
Figure 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012 25
Figure 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012 26
Figure 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012 27
Figure 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012 28
Figure 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012 28
Figure 3.3.1(a): Variation in patient survival at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011 29
Figure 3.3.1(b): Funnel plot for adjusted age at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011cohor 29
Figure 3.3.1(c): Variation in patient survival at 5-years among HD centres adjusted for age and diabetes mellitus status, 1993-2007 29
Figure 3.3.1(d): Funnel plot for patient survival at 5-years among HD centres adjusted age and diabetes mellitus, 1993-2007cohort 29
Figure 3.3.2(a): Variation in patient survival at 1-year among PD centres adjusted for age and diabetes mellitus, 1993-2011 30
Figure 3.3.2(b): Funnel plot of 1-year patient survival from the 90th day of dialysis adjusted for age and diabetes mellitus among PD centres, 1993-2011 cohort 30
Figure 3.3.2(c): Variation in patient survival at 5-years among PD centres adjusted for age and diabetes mellitus, 1993-2007 30
Figure 3.3.2(d): Funnel plot of 5-years patient survival from 90 day of dialysis adjusted for age and diabetes mellitus among PD centres, 1993-2007 cohort 30
Figure 3.4.1(a): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by diastolic blood pressure (1993-2012 cohort) 33
Figure 3.4.1(b): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by serum phosphate (1993-2012 cohort) 33
Figure 3.4.1(c): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by hemoglobin (1993-2012 cohort) 33
Figure 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality by Delivered Kt/V (1993-2012 cohort) 35
Figure 3.4.4(a): Variations in RAMR by HD centre, 2011 38
Figure 3.4.4(b): Funnel plot of RAMR by HD centre, 2011 38
Figure 3.4.5(a): Variations in RAMR by PD centres, 2011 38
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Figure 3.4.5(b): Funnel plot for RAMR by PD centres, 2011 38
Figure 4.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, all dialysis patients 1993-2012 40
Figure 4.2: Cumulative distribution of QoL-Index score in relation to DM, All Dialysis patients, 1993-2012 40
Figure 4.3: Cumulative distribution of QoL-Index score in relation to gender, all dialysis patients, 1993-2012 40
Figure 4.4: Cumulative distribution of QoL-Index score in relation to age, all dialysis patients, 1993-2012 41
Figure 4.5: Cumulative distribution of QoL-Index score in relation to year of entry, HD patients 1993-2012 42
Figure 4.6: Cumulative distribution of QoL-Index score in relation to year of entry, PD patients 1993-2012 42
Figure 5.1(a): Incidence cases of RRT by modality in children under 20 years old, 1993-2012 46
Figure 5.1(b): Prevalence cases of RRT by modality in children under 20 years old, 1993-2012 46
Figure 5.2: Incidence and prevalence rate per million age related population years old on RRT, 1993-2012 47
Figure 5.4: Number of new dialysis and transplant patients by gender 1993-2012 49
Figure 5.5: New RRT rate by age group 1993-2012 49
Figure 5.6: New dialysis by treatment modality 1993-2012 50
Figure 5.7: New dialysis by sector 1993-2012 50
Figure 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality) 52
Figure 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality) 52
Figure 5.12: Dialysis technique survival by modality, 1993-2012 53
Figure 5.14: Transplant graft survival, 1993-2012 54
Figure 6.1.3(a): Variation in ESAs utilization (% patients) among HD centres, 2012 61
Figure 6.1.3(b): Median of ESA utilisation (% patients) among HD centres, 1997-2012 61
Figure 6.1.4(a): Variation in ESAs utilization (% patients) among PD centres, 2012 62
Figure 6.1.4(b): Median of ESA utilisation (% patients) among PD centres, 1997-2012 62
Figure 6.1.5(a): Variation in mean weekly ESAs dose (u/week) among HD centres 2012 62
Figure 6.1.5(b): Median of mean weekly ESAs dose (u/week) among HD centres, 1997-2012 62
Figure 6.1.6(a): Variation in mean weekly ESAs dose (u/week) among PD centres 2012 63
Figure 6.1.6(b): Median of mean weekly ESAs dose (u/week) among PD centres, 1997-2012 63
Figure 6.1.7(a): Variation in use of blood transfusion (% patients) among HD centres, 2012 64
Figure 6.1.7(b): Median of use of blood transfusion (% patients) among HD centres, 1997-2012 64
Figure 6.1.8(a): Variation in use of blood transfusion (% patients) among PD centres, 2012 64
Figure 6.1.8(b): Median of use of blood transfusion (% patients) among PD centres, 1997-2012 64
Figure 6.2.1: Cumulative Distribution of serum ferritin without ESAs, HD patients 1997-2012 65
Figure 6.2.2: Distribution of serum ferritin without ESAs, PD patients 1997-2012 66
Figure 6.2.3: Cumulative distribution of serum ferritin on ESAs, HD patients 1997-2012 66
Figure 6.2.4: Cumulative distribution of serum ferritin on ESAs, PD patients 1997-2012 67
Figure 6.2.5: Cumulative distribution of transferrin saturation without ESAs, HD patients 1997-2012 67
Figure 6.2.6: Cumulative distribution of transferrin saturation without ESAs, PD patients 1997-2012 68
Figure 6.2.7: Cumulative distribution of transferrin saturation on ESAs, HD patients 1997-2012 68
Figure 6.2.8: Cumulative distribution of transferrin saturation on ESAs, PD patients 1997-2012 69
Figure 6.2.9(a): Variation in medium serum ferritin among patients on ESAs, HD centres 2012 69
Figure 6.2.9(b): Variation in proportion of patients on ESAs with serum ferritin ≥ 100 ng/ml, HD centres 2012 70
Figure 6.2.9(c): Variation in median transferring saturation among patients on ESAs HD centres, 2012 70
Figure 6.2.9(d): Variation in proportion of patients on ESAs with transferring saturation ≥ 20%, HD centres, 2012 71
Figure 6.2.10(a): Variation in medium serum ferritin among patients on ESAs, PD centres 2012 71
Figure 6.2.10(b): Variation in proportion of patients on ESAs with serum ferritin ≥ 100ng/ml, PD centres 2012 72
Figure 6.2.10(c): Variation in median transferrin saturation among patients on ESAs, PD centres 2012 72
Figure 6.2.10(d): Variation in proportion of patients on ESAs with transferrin saturation ≥ 20 %, PD centres 2012 73
Figure 6.3.1(a): Cumulative distribution of haemoglobin concentration without ESAs, HD patients 1997-2012 74
Figure 6.3.1(b): Mean of haemoglobin concentration without ESAs, HD patients 1997-2012 74
Figure 6.3.2(a): Cumulative distribution of haemoglobin concentration without ESAs, PD patients 1997-2012 75
Figure 6.3.2(b): Mean of haemoglobin concentration without ESAs, PD patients 1997-2012 75
Figure 6.3.3(a)(i): Cumulative distribution of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75
Figure 6.3.3(a)(ii): Mean of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75
Figure 6.3.3(b)(i): Cumulative distribution of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76
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Figure 6.3.3(b)(ii): Mean of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76
Figure 6.3.4(a)(i): Cumulative distribution of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 77
Figure 6.3.4(a)(ii): Mean of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 77
Figure 6.3.4(b)(i): Cumulative distribution of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77
Figure 6.3.4(b)(ii): Mean of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77
Figure 6.3.5(a): Variation in median haemoglobin level among patients on ESAs, HD centres 2012 78
Figure 6.3.5(b): Variation in proportion of patients on ESAs with haemoglobin level > 10g/dL, HD centres 2012 78
Figure 6.3.6(a): Variation in median haemoglobin level among patients on ESAs, PD centres 2012 79
Figure 6.3.6(b): Variation in proportion of patients on ESAs with haemoglobin level > 10g/dL, PD centres, 2012 79
Figure 6.3.7(a): Cumulative distribution of haemoglobin concentration on ESAs, HD patients 1997-2012 80
Figure 6.3.7(b): Mean of haemoglobin concentration on ESAs, HD patients 1997-2012 80
Figure 6.3.8(a): Cumulative distribution of haemoglobin concentration on ESAs, PD patients 1997-2012 81
Figure 6.3.8(b): Mean of haemoglobin concentration on ESAs, PD patients 1997-2012 81
Figure 7.1.1: Cumulative distribution of serum albumin, HD patients 1997-2012 84
Figure 7.1.2: Cumulative distribution of serum albumin, PD patients 1997-2012 85
Figure 7.1.3: Variation in proportion of patients with serum albumin >40g/L, HD centres 2012 86
Figure 7.1.4: Variation in proportion of patients with serum albumin >40g/L, PD centres 2012 87
Figure 7.2.1(a): Cumulative distribution of BMI, HD patients 1997-2012 88
Figure 7.2.1(b): mean BMI, HD patients 1997-2012 88
Figure 7.2.2(a): Cumulative distribution of BMI, PD patients 1997-2012 89
Figure 7.2.2(b): mean BMI, PD patients 1997-2012 89
Figure 7.2.3: Variation in proportion of patients with BMI >18.5 among HD centres 2012 90
Figure7.2.4: Variation in proportion of patients with BMI> 18.5 among PD centres 2012 90
Figure 7.2.5: Variation in proportion of patients with BMI >18.5 and serum albumin > 40 g/dL among HD centres 2012 91
Figure 7.2.6: Variation in proportion of patients with BMI >18.5 and serum albumin >40 g/dL among PD centres 2012 91
Figure 8.1.1(a): Cumulative distribution of pre dialysis systolic blood pressure, HD patients 1997-2012 94
Figure 8.1.1(b): Mean of pre dialysis systolic blood pressure, HD patients 1997-2012 94
Figure 8.1.2(a): Distribution of pre dialysis systolic blood pressure, PD patients 1997-2012 95
Figure 8.1.2(b): Mean of pre dialysis systolic blood pressure, PD patients 1997-2012 95
Figure 8.1.3(a): Cumulative Distribution of pre dialysis diastolic blood pressure, HD patients 1997-2012 96
Figure 8.1.3(b): Mean of pre dialysis diastolic blood pressure, HD patients 1997-2012 96
Figure 8.1.4(a): Cumulative Distribution of pre dialysis diastolic blood pressure, PD patients 1997-2012 97
Figure 8.1.4(b): Mean of pre dialysis diastolic blood pressure, PD patients 1997-2012 97
Figure 8.1.5(a): Variation in median systolic blood pressure among HD patients, HD centres 2012 98
Figure 8.1.5(b): Variation in median diastolic blood pressure among HD patients, HD centres 2012 99
Figure 8.1.5(c): Variation in proportion of HD patients with pre dialysis blood pressure < 140/90 mmHg, HD centres 2012 100
Figure 8.1.6(a): Variation in median systolic blood pressure among PD patients, PD centres 2012 101
Figure 8.1.6(b): Variation in median diastolic blood pressure among PD patients, PD centres 2012 102
Figure 8.1.6(c): Variation in proportion of PD patients with pre dialysis blood pressure ≤140/90 mmHg, PD centres 2012 102
Figure 8.2.1: Cumulative distribution of cholesterol, HD patients 1997-2012 103
Figure 8.2.2: Cumulative distribution of cholesterol (mmol/L), PD patients 1997-2012 104
Figure 8.2.3: Cumulative distribution of serum triglyceride, HD patients 1997-2012 105
Figure 8.2.4: Cumulative distribution of serum triglyceride, PD patients 1997-2012 105
Figure 8.2.5(a): Variation in median serum cholesterol level among HD patients, HD centres 2012 106
Figure 8.2.5(b): Variation in proportion of patients with serum cholesterol < 5.3mmol/L, HD centres 2012 107
Figure 8.2.5(c): Variation in median serum triglyceride level among HD patients, HD centers 2012 107
Figure 8.2.5(d): Variation in proportion of patients with serum triglyceride < 2.1mmol/L, HD centers 2012 108
Figure 8.2.6(a): Variation in median serum cholesterol level among PD patients, PD centres 2012 109
Figure 8.2.6(b): Variation in proportion of patients with serum cholesterol < 5.3mmol/L, PD centres 2012 109
Figure 8.2.6(c): Variation in median serum triglyceride level among PD patients, PD centres 2012 110
Figure 8.2.6(d): Variation in proportion of patients with serum triglyceride < 2.1mmol/L, PD centres 2012 110
Figure 9.2.1: Cumulative distribution of corrected serum calcium, HD patients, 1997-2012 114
Figure 9.2.2: Cumulative distribution of corrected serum calcium, PD patients, 1997-2012 114
Figure 9.2.3: Cumulative distribution of serum phosphate, HD patients, 1997-2012 115
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Figure 9.2.4: Cumulative distribution of serum phosphate, PD patients, 1997-2012 115
Figure 9.2.5: Cumulative distribution of corrected calcium x phosphate product, HD patients 1997-2012 116
Figure 9.2.6: Cumulative distribution of corrected calcium x phosphate product, PD patients 1997-2012 116
Figure 9.2.7(a): Variation in median serum calcium among HD patients, HD centres, 2012 117
Figure 9.2.8(a): Variation in median serum calcium level among PD patients, PD centres, 2012 117
Figure 9.2.7(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 2012 118
Figure 9.2.8(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres, 2012 118
Figure 9.2.9(a): Variation in median serum phosphate level among HD patients, HD centres, 2012 119
Figure 9.2.10(a): Variation in median serum phosphate level among PD patients, PD centres 2012 119
Figure 9.2.9(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres, 2012 120
Figure 9.2.10(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 2012 120
Figure 9.2.9(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres, 2012 121
Figure 9.2.10(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres 2012 121
Figure 9.2.11(a): Variation in median corrected calcium x phosphate product among HD patients, HD centres, 2012 122
Figure 9.2.12(a): Variation in median corrected calcium x phosphate product among PD centres, to 2012 122
Figure 9.2.11(b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, HD centres 2012 123
Figure 9.2.12(b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, PD centres, 2012 123
Figure 9.3.2(a): Cumulative distribution of iPTH, HD, 1997-2012 125
Figure 9.3.2(b): Cumulative distribution of iPTH, diabetic HD patients, 1997-2012 125
Figure 9.3.2(c): Cumulative distribution of iPTH, non-diabetic HD patients, 1997-2012 126
Figure 9.3.3(a): Cumulative distribution of iPTH, PD patients, 1997-2012 126
Figure 9.3.3(b): Cumulative distribution of iPTH, diabetic PD patients, 1997-2012 127
Figure 9.3.3(c): Cumulative distribution of iPTH, non diabetic PD patients, 1997-2012 127
Figure 9.3.4(a): Variation in median iPTH among HD patients, HD centres 2012 128
Figure 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 2012 128
Figure 9.3.5(a): Variation in median iPTH among PD patients, PD centres, 2012 129
Figure 9.3.5(b): Variation in proportion of patients with iPTH 150-300pg/ml, PD centres 2012 129
Figure 10.3: Variation in proportion of patients with positive HBsAg among HD centres, 2012 135
Figure 10.4: Variation in proportion of patients with positive HBsAg among PD centres, 2012 135
Figure 10.5: Variation in proportion of patients with positive anti-HCV among HD centres, 2012 136
Figure 10.6: Variation in proportion of patients with positive anti-HCV among PD centres, 2012 136
Figure 11.2.1: Blood flow rates in HD centers, 1997-2012 142
Figure 11.2.4: Dialyser membrane types in HD centres, 1997-2012 144
Figure 11.2.6(a): Cumulative distribution of prescribed Kt/V, HD patients 1997-2012 146
Figure 11.2.6(b): Cumulative distribution of delivered Kt/V, HD patients 2006-2012 146
Figure 11.2.6(c): Cumulative distribution of URR, HD patients 2006-2012 147
Figure 11.2.7(a): Variation in median blood flow rates in HD patients among centres 2012 148
Figure 11.2.7(b): Variation in Proportion of patients with blood flow rates >= 300 ml/min among HD centres 2012 148
Figure 11.2.7(c): Variation in proportion of patients with 3 HD sessions per week among HD centres 2012 149
Figure 11.2.7(d): Variation in median prescribed Kt/V in HD patients among HD centres 2012 149
Figure 11.2.7(e): Variation in proportion of patients with prescribed Kt/V ≥ 1.3 among HD centres 2012 150
Figure 11.2.7(f): Variation in median delivered Kt/V in HD patients among HD centres 2012 150
Figure 11.2.7(g): Variation in proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2012 151
Figure 11.2.7(h): Variation in median URR among HD patients, HD centres 2012 151
Figure 11.2.7(i): Variation in proportion of patients with URR ≥ 65% among HD centres 2012 152
Figure 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 154
Figure 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1997-2012 155
Figure 11.3.2(a): Unadjusted technique survival by age, 1997-2012 156
Figure 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1997-2012 157
Figure 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 158
Figure 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 158
Figure 12.2.1: Cumulative distribution of delivered Kt/V, PD patients 1997-2012 161
Figure 12.2.2: Variation in proportion of patients with Kt/V > 1.7 per week among PD centres 162
Figure 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012 164
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Figure 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012 164
Figure 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012 165
Figure 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012 165
Figure 12.3.3(a): Unadjusted technique survival by Diabetes status (uncensored for death and transplant), 1997-2012 166
Figure 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012 166
Figure 12.3.4: Unadjusted technique survival by Kt/V, 1997-2012 167
Figure 12.4.1: Variation in peritonitis rate among PD centres, 2012 170
Figure12.4.2: Causative organism in PD peritonitis, 2001-2012 171
Figure 12.4.3(a): Outcome of peritonitis by causative organism, 2012 172
Figure 12.4.3(b): Outcome of peritonitis by causative organism, 1993-2002 172
Figure 12.4.3(c): Outcome of peritonitis by causative organism, 2003-2012 173
Figure 12.4.3(d): Comparing outcome of peritonitis by causative organism in 1993-2002 vs 2003-2012 174
Figure 13.1.1: Stock and flow of renal transplantation, 1993-2012 176
Figure 13.1.2: New transplant rate, 1993-2012 176
Figure 13.1.3: Transplant prevalence rate, 1993-2012 177
Figure 13.4.3(a): Transplant recipient death rate, 1993-2012 184
Figure 13.4.3(b): Transplant recipient graft loss rate, 1993-2012 184
Figure 13.5.1.1: Patient survival, 1993-2012 187
Figure 13.5.1.3: Graft survival, 1993-2012 188
Figure 13.5.2.1: Patient survival by type of transplant, 1993-2012 189
Figure 13.5.2.2: Graft survival by type of transplants, 1993-2012 190
Figure 13.5.3.1: Patient survival by year of transplant (Living related transplant, 1993-2012) 191
Figure 13.5.3.2: Graft survival by year of transplant (Living related transplant, 1993-2012) 191
Figure 13.5.4.1: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192
Figure 13.5.4.2: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192
Figure 13.6.1(a)(i): Calcineurin inhibitors - Cyclosporin vs Tacrolimus 194
Figure 13.6.1(a)(ii): Antimetabolites - Azathioprine vs Mycophenolic Acid 194
Figure 13.7.1(a): Venn diagram for pre and post transplant complications (%) at year 2004 195
Figure 13.7.1(b): Venn diagram for pre and post transplant complications (%) at year 2006 195
Figure 13.7.1(c): Venn diagram for pre and post transplant complications (in %) at year 2008 196
Figure 13.7.1(d): Venn diagram for pre and post transplant complications (%) at year 2010 196
Figure 13.7.1(e): Venn diagram for pre and post transplant complications (%) at year 2012 196
Figure 13.7.2(a): Systolic BP, 2004-2012 197
Figure 13.7.2(b): Diastolic BP, 2004-2012 197
Figure 13.7.3: CKD stages by year 198
Figure 13.7.4: BMI, 2004-2012 198
Figure 13.7.5(a): LDL, 1993-2012 199
Figure 13.7.5(b): Total cholesterol, 2004-2012 199
Figure 13.7.5(c): HDL, 2004-2012 200
Figure 13.8.3.1(a): Graft survival, Azathioprine vs Mycophenolic Acid 1993-2012 202
Figure 13.8.3.1(b): Patient survival, Azathioprine vs Mycophenolic Acid, 1993-2012 202
Figure 13.8.3.2(a): Graft survival, CsA vs Tacrolimus, 1993-2012 203
Figure 13.8.3.2(b): Patient survival, CsA vs Tacrolimus, 1993-2012 203
Figure 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012 203
Figure 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012 203
Figure 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 1993-2012 204
Figure 13.8.3.6: Cumulative incidence of post transplant diabetes, CsA vs Tacrolimus, 2004-2012 204
Figure 13.9.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, transplant recipient patients 1993-2012 204
Figure 13.9.2: Cumulative distribution of QoL-Index score in relation to diabetes mellitus, transplant recipient patients 1993-2012 205
Figure 13.9.3: Cumulative distribution of QoL-Index score in relation to gender, transplant recipient patients 1993-2012 205
Figure 13.9.4: Cumulative distribution of QoL-Index score in relation to age, transplant recipient patients 1993-2012 205
Figure 13.9.5: Cumulative distribution of QoL-Index score in relation to year of entry, transplant recipient patients 1993-2012 206
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In 2012, there were 28,590 patients receiving dialysis in Malaysia, and this reflects an exponential increase from a mere 1,396 in 1993. While the new intake of dialysis patients was only 358 in 1993, this has shown a steep increase to 5,830 in 2012. The equivalent incidence and prevalence rate of patients on dialysis were 199 and 975 per million populations in 2012. Vast majority (92%) of these patients were on haemodialysis (HD), only 8% were on peritoneal dialysis (PD). The increase in the dialysis population was mainly contributed by the rapid growth in private haemodialysis in the last 20 years. There is also significant demographic changes in dialysis population in Malaysia as patients more than 65 years old made up 26% of all new dialysis patients in 2012 versus a mere 10% in 1993. A staggering 58% of end stage kidney disease was reported to be caused by diabetes mellitus in 2012, versus 20% in 1993.
The increase in HD capacity was mainly contributed by the private dialysis centres which had quadrupled over the last 12 years. NGO centres and Public had only doubled the HD capacity over the same period of time. In fact, the growth in MOH had plateaued since 2006. Most of the increases in the private occurred in the more economically developed west coast states of Malaysian Peninsula. Although the public, NGO and private sector provided 30%, 25% and 45% of overall dialysis treatment in 2012 respectively, the government provided 58% of total funding for dialysis. However, 83% of new dialysis patients younger than 20 years of age were on government-funded dialysis programmes.
The annual death rate on dialysis in 2012 was 11.2%. In 2012, the death rate was 10.9% among haemodialysis patients while peritoneal dialysis patients had an annual death rate of 15.2%. The trend for death rate among haemodialysis patients had gradually increased over the past 2 decades. Annual death rate on PD in the past two decades has maintained around 15-18%, and the gap between HD and PD has narrowed in recent years. HD patients who commenced dialysis recently seemed to fare less well than those started in the early years, while this is reversed in PD patients as PD patients started in the last 4 years has better survival in comparison to those who commenced in the 1990’s. Majority of dialysis patients died due to cardiovascular disease and this is probably due to the increasing number of elderly and diabetic patients undergoing dialysis. Death from infection remained as the second commonest cause of death (excluding unknown). Despite attempts at adjusting for multiple variables contributing to death, there were wide variations in adjusted mortality rates between dialysis centres.
91% of HD patients and 80% of PD patients received Erythropoeisis Stimulating Agents (ESAs) in 2012. However, the concern is substantial percentage of these patients still received blood transfusions (14 to 18%). More than 70% of dialysis patients achieved calcium-phosphate-product < 4.5 mmol2/L2. However, about 43-48% of dialysis patients were at risk of low bone turn over disease with iPTH <150pg/ml. Majority (90%) of patients were on calcium based phosphate binders. The use of non-calcium based phosphate binders remained low at less than 3%.
We have achieved improvement over the years in terms of achieving target haemoglobin, control of calcium-phosphate-product <4.5mmol2/L2, and dyslipidaemia, however, malnutrition and blood pressure control still need further improvement. There were also suggestions that nutritional markers such as low serum albumin, extremely low phosphate levels, low BMI and very low cholesterol levels seems to predict worse outcome. Interestingly these parameters can also reflect chronic inflammation. There were also demonstrable variations in the achievement of these various targets between dialysis centres. The contributing factors may be case mix, adequacy of funding for the different medications required, and adequacy of dialysis and medical care.
HD patients run the risk of Hepatitis infection due to nosocomial transmission. However, over the years, we have seen an encouraging decline in its prevalence with lower seroconversion rates. This is largely due to constant surveillance and strict implementation of infection control protocols within HD facilities around the country. PD patients consistently have lower HCV prevalence compare to HD.
Despite the rapid increase in dialysis population, the number of kidney transplantation performed in patients has remained very low. There was only 49 live related and 22 deceased donor kidney transplantation done in 2012. The transplantation rate has dropped to the lowest rate of 3 per million population compared to 6-7 per million in the previous 20 years. The patient survival rates were 95% and 88% at 1- year and 5-years respectively. Graft survival rate at 1-year was 92%, and at 5-years 80%. Those patients underwent transplantation in the recent years seem to do better than those in the previous decades (excluding cadaver transplant), and this may be attributed to the use of newer immunosuppression (newer anti-metabolite) in the recent years. Different CNIs do not seem to affect patient and graft survival, but they do differ in cardiovascular risk profile such as blood pressure, eGFR and cholesterol.
EXECuTivE SuMMARy
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AIIRB Angiotensin II Receptor Blockers
ACE Angiotensin-Converting Enzyme
ADPKD Adult polycystic kidney disease
ALT Alanine transaminase
APD Automated Peritoneal Dialysis
BMI Body Mass Index
BP Blood pressure
CAPD Continuous Ambulatory Peritoneal Dialysis
CCPD/APD Continuous cycling peritoneal dialysis/automated peritoneal dialysis
CI Concentration Index
CKD Chronic kidney disease
CNI calcineurin inhibitors
CRA Clinical Registry Assistant
CRC Clinical Research Centre
CRF Case report form
CRM Clinical Registry Manager
CsA Cyclosporine
CvD Cardiovascular Disease
DAPD Daytime Ambulatory Peritoneal Dialsysis
DM Diabetes Mellitus
DOQI Dialysis Outcome Quality Initiative
DRI Direct Renin Inhibitors
eMOSS Malaysian Organ Sharing System (Renal)
ESRD End Stage Renal Disease
FMC Fresenius Medical Care
GDP Gross domestic product
GN Glomerulonephritis
GNI Gross National Income
Hb Haemoglobin
HbsAg Hepatitis B antigen
HCv Hepatitis C virus
HD Haemodialysis
HDL High-density lipoprotein cholesterol
HKL Kuala Lumpur Hospital
HPT Hypertension
AbbREviATiONS
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HR Hazard Ratio
ITT Intention to treat
iPTH Intact parathyroid hormone
JNC Joint National Committee on management of hypertension
KDIGO Kidney Disease Improving Global Outcomes
Kt/v Number used to quantify hemodialysis and peritoneal dialysis treatment adequacy
LDL Low-density lipoprotein cholesterol
LQ Lower quartile
MDTR Malaysian Dialysis and Transplant Registry
MOH Ministry of Health, Malaysia
MRRB Malaysian Registry of Renal Biopsy
MSN Malaysian Society of Nephrology
NGO Non-governmental organization
NODAT New onset of diabetes after transplantation
NRIC National Registration Identity Card
NRR National Renal Registry, Malaysia
PD Peritoneal dialysis
PET D/P peritoneal transport status dialysate and plasma (D/P ratio)
pmp per million population
PPuKM Pusat Perubatan Universiti Kebangsaan Malaysia
pmarp per million age related population
QoL Quality of Life
ref Reference
RCC Registry coordinating centre
RRT Renal replacement therapy
SC Site coordinator
SDP Source data producer
SE standard error
SLE Systemic Lpus Eythematosus
SMR Standardised Mortality Ratio
Tx transplant
uMMC University Malaya Medical Centre,
uQ Upper quartile
uRR Urea reduction rate
AbbREviATiONS (CONT.)