HAEMODIALYSIS GOVERNMENT CENTRES

Transcription

1 HAEMODIALYSIS IN GOVERNMENT CENTRES Stock and Flow Place of Haemodialysis and its Finance Death on Haemodialysis and Transfer to PD Government Haemodialysis Centres Haemodialysis Patient Characteristics Survival Analysis Work related rehabilitation and quality of life Haemodialysis practices Dyslipidaemia in HD patients Treatment of Renal Bone Disease Management of Blood Pressure Management of Anaemia Nutritional status Prevalence of anti-hcv and HbsAg 35

2 3. HAEMODIALYSIS IN MALAYSIA 3. HAEMODIALYSIS IN GOVERNMENT CENTRES 3.. STOCK AND FLOW Table 3..0: Stock and flow of Haemodialysis Patients, Government Centres New patients Died Transferred to PD Transplanted Lost to follow up On HD at 3 st December Figure 3..0: Stock and Flow HD patients, Government Centres New patients on RRT at 3 st December No. of patients

3 3..2 PLACE OF HAEMODIALYSIS AND ITS FINANCE Table 3..02: Place for HD, Government Centres New patients % Centre HD % Home HD 2 % Office HD On HD at 3st December % Centre HD % Home HD % Office HD Figure 3..02: Place of HD, Government Centres Proportion of patients 50 0 Centre HD Home HD Office HD Place of HD 37

4 Table 3..03: Finance for HD, Government Centres New patients Government funded % Self funded 0 2 % Employer subsidy % Charity on HD at 3 st December % Government funded % Self funded % Employer subsidy 0 % Charity Figure 3..03: Finance for new HD, Government Centres Proportion of patients 50 0 Government funded Self funded Employer subsidy Charity Funding for HD 38

5 3..3 DEATH ON HAEMODIALYSIS AND TRANSFER TO PERITONEAL DIALYSIS Table 3..04: HD Death Rate and Transfer to PD, Government Centres year No. at risk Deaths Death rate % Transfer to PD Transfer to PD rate % All Losses All Losses rate % Figure 3..04: Death Rate on HD, Government Centres Annual death rate 20 Death rate %

6 Table 3..05: Causes of Death on HD, Government Centres Cause of death No. % No. % No. % No. % Cardiovascular Died at home Sepsis GIT bleed Cancer Liver disease Others Unknown Total

7 3..4 GOVERNMENT HAEMODIALYSIS CENTRES Table 3..07: Centre Distribution of HD patients, Government Centres 2002 Centre No percent No. on RRT at 3 st December Rumah Sakit Angkatan Tentera, Kuching Rumah Sakit Angkatan Tentera, Sg Petani Rumah Sakit Angkatan Tentera, Majidee Rumah Sakit Angkatan Tentera, TUDM Hospital Angkatan Tentera, Terendak Hospital Angkatan Tentera, Kinrara Hospital Angkatan Tentera, Lumut 8 8 Alor Setar Hospital Baling Hospital Banting Hospital 24 Batu Pahat Hospital Beaufort Hospital 2 3 Besut Hospital 2 4 Bintulu Hospita 26 5 Bukit Mertajam Hospital 39 6 Butterworth Hospital Duchess of Kent Hospital Dungun Hospital 27 9 Ipoh Hospital Jerantut Hospital Kajang Hospital Kangar Hospital Kemaman Hospital Keningau Hospital Kluang Hospital Kota Bharu Hospital Kota Tinggi Hospital 5 28 Kuala Krai Hospital Kuala Lumpur Hospital

8 30 Kuala Lumpur Hospital (Paed.) Kuala Nerang Hospital Kuala Pilah Hospital Kuala Terengganu Hospital Kuching Hospital Kulim Hospital 9 36 Labuan Hospital Lahad Datu Hospital Langkawi Hospital 8 39 Melaka Hospital Mentakab Hospital Miri Hospital Muar Hospital Pasir Mas Hospital Pontian Hospital 8 45 Port Dickson Hospital 0 46 Pulau Pinang Hospital Pusat Hemodialisis KEMENTAH 4 48 Pusat Kesihatan Jitra Pusat Perubatan Angkatan Tentera (KB) 0 50 Putrajaya Hospital 34 5 Queen Elizabeth Hospital Raub Hospital Sarikei Hospital Segamat Hospital Selayang Hospital Seremban Hospital Seri Manjung Hospital Serian Hospital Sibu Hospital Sik Hospital 4 6 Sri Aman Hospital 9 62 Sultanah Aminah Hospital Sungai Bakap Hospital

9 64 Sungai Petani Hospital Taiping Hospital Tanah Merah Hospital Tanjung Karang Hospital Tanjung Malim Hospital Tawau Hospital Teluk Intan Hospital 29 7 Tengku Ampuan Jemaah Hospital, Sabak Bernam 0 72 Tengku Ampuan Afzan Hospital, Kuantan Tengku Ampuan Rahimah Hospital, Klang Universiti Kebangsaan Malaysia Hospital Universiti Sains Malaysia Hospital University Malaya Medical Centre Yan Hospital

10 3. HAEMODIALYSIS PATIENTS CHARACTERISTICS Table 3..08: Age Distribution of HD patients, Government Centres New patients % -4 years 0 % 5-24 years % years % years % years % years % >65 years Dialysing at 3 st December % -4 years % 5-24 years % years % years % years % years % >65 years Table 3..09: HD Patient Characteristics, Government Centres New patients Mean age + sd % Male % Diabetic % HbsAg % Anti-HCV

11 3..6 SURVIVAL ANALYSIS GOVERNMENT CENTRES Table 3..0: HD patient Survival related to of Entry, Government Centres Interval % survival SE No % survival SE No % survival SE No (months) Interval % survival SE No % survival SE No % survival SE No (months) No. = number at risk SE = standard error Figure 3..0: HD patient Survival related to of Entry, Government Centres Kaplan-Meier survival estimates, by.00 Yr 2002 Cumulative survival 0 00 Yr 200 Yr 2000 Yr 998 Yr Duration in months 45

12 Table 3..: HD Technique Survival related to of Entry, Government Centres Interval % survival SE No % survival SE No % survival SE No Interval % survival SE No % survival SE No % survival SE No No. = number at risk SE = standard error Figure 3..: HD Technique Survival by of Entry, Government Centres Kaplan-Meier survival estimates, by.00 Yr 2002 Cumulative survival 0 00 Yr 200 Yr 2000Yr 998 Yr Duration in months 46

13 3..7 WORK RELATED REHABILITATION AND QUALITY OF LIFE ON HAEMODIALYSIS, GOVERNMENT CENTRES Table 3..2: Work Related Rehabilitation on HD, Government Centres REHABILITATION STATUS No. % No. % No. % No. % Full time work for pay Part time work for pay Able to work but unable to get a job Able to work but not yet due to dialysis schedule Able but disinclined to work Home maker Full time student Age<5 years Retired Age>65 years Unable to work due to poor health Total

14 Table 3..3: Quality of Life on Haemodialysis, Government Centres QOL Index Summated Score No. % No. % No. % No. % 0 (Worst QOL) (Best QOL) Total

15 3..8 HAEMODIALYSIS PRACTICES IN GOVERNMENT CENTRES Table 3..4: Vascular Access on Haemodialysis, Government Centres Access types No % No % No % No % Wrist AVF BCF* Venous graft Artificial graft PERMCATH Temporary CVC* Total * BCF = Brachiocephalic fistula * CVC = Central venous catheter Table 3..5: Difficulties reported with Vascular Access, Government Centres Access difficulty No % No % No % No % Difficulty with needle placement Difficulty in obtaining desired blood flow rate Other difficulty No difficulty Total

16 Table 3..6: Complications reported with Vascular Access, Government Centres Complication No. % No. % No. % No. % thrombosis bleed aneurysmal dilatation swollen limb access related infection, local/systemic distal limb ischaemia venous outflow obstruction carpal tunnel other no complication Total Table 3..7: Blood Flow Rates in Government HD Units Blood flow rates No. % No. % No. % No. % <50 ml/min ml/min ml/min ml/min ml/min > 350 ml/min Total

17 Table 3..8: Number of HD Sessions per week, Government HD Units HD sessions Per week No. % No. % No. % No. % Total Table 3..9: Duration of HD in Government Units Duration of HD per session No. % No. % No. % No. % <3 hours hours hours hours hours >5 hours Total Table 3..20: Dialyser membrane types in Government HD Units Dialyser membrane No. % No. % No. % No. % Cellulosic Cellulose acetate Synthetic Total

18 Table 3..2: Dialyser Reuse Frequency in Government HD Units Dialyser reuse frequency No. % No. % No. % No. % * > Total * is single use i.e. no reuse Table 3..22: Dialysate Buffer used in Government HD Units Dialysate buffer No. % No. % No. % No. % Acetate Bicarbonate Total

19 Table 3..23: Distribution of Prescribed KT/V, Government Centres Median LQ UQ % > Figure 3..23: of Prescribed KT/V by year Kt/v 53

20 3..9 DYSLIPIDAEMIA IN HD PATIENTS, GOVERNMENT CENTRES Table 3..24: Distribution of serum Cholesterol Levels (mmol/l), HD patients, Government Centres Median LQ UQ % Patients < 5.3 mmol/l Figure 3..24: of serum cholesterol concentration by year Serum cholesterol (mmol/l) 54

21 Table 3.: Distribution of serum Triglyceride (mmol/l), HD patients, Government Centres Median LQ UQ % Patients < 3 mmol/l Figure 3.: of serum triglyceride concentration by year Serum triglyceride (mmol/l) 55

22 Table 3..26: Distribution of serum LDL (mmol/l), HD patient, Government Centres Median LQ UQ % Patients <5 mmol/l Figure : of serum LDL concentration by year Serum LDL concentration (mmol/l) 56

23 Table 3..27: Distribution of serum HDL (mmol/l), HD patient, Government Centres Median LQ UQ % Patients < 2mmol/L Figure 3..27: of serum HDL by year Serum HDL concentration (mmol/l) 57

24 3..0 MANAGEMENT OF RENAL BONE DISEASE, GOVERNMENT CENTRES Table 3..28: Treatment for Renal Bone Disease, HD patients, Government Centres % on CaCO 3 % on Al(OH) 3 % on Vit D Table 3..29: Distribution of serum Phosphate (mmol/l), HD patients, Government Centres Median LQ UQ % Patients <.6 mmol/l Figure 3..29: of serum Phosphate by year Serum phosphate (mmol/l) 58

25 Table 3..30: Distribution of serum Calcium (mmol/l), HD patients, Government Centres Median LQ UQ % Patients > 2.2 & <2.6 mmol/l Figure 3..30: of serum Calcium by year Serum calcium (mmol/l) 59

26 Table 3..3: Distribution of serum ipth (ng/l), HD patients, Government Centres Median LQ UQ % Patients > 00 & < 250 ng/l Figure 3..3: of serum ipth by year Serum intact PTH (ng/l) 60

27 3.. MANAGEMENT OF BLOOD PRESSURE, GOVERNMENT CENTRES Table 3..32: Treatment for hypertension, HD patients, Government Centres No. % on antihypertensives % on antihypertensives % on 2 antihypertensives % on 3 antihypertensives Table 3..33: Distribution of Systolic BP without anti-hypertensives, HD patients, Government Centres Median LQ UQ % Patients < 60 mmhg Figure 3..33: of Systolic BP without anti-hypertensives by year Systolic BP (mmhg) 6

28 Table 3..34: Distribution of Diastolic BP without anti-hypertensives HD patients Government Centres Median LQ UQ % Patients < 90 mmhg Figure 3..34: of Diastolic BP without anti hypertensives by year Diastolic BP (mmhg) 62

29 Table 3..35: Distribution of systolic BP on anti-hypertensives, HD patients, Government Centres Median LQ UQ % Patients < 60 mmhg Figure 3..35: of systolic BP on anti-hypertensives by year Systolic BP (mmhg) 63

30 Table 3..36: Distribution of diastolic BP on anti-hypertensives, HD patients, Government Centres Median LQ UQ % Patients < 90 mmhg Figure 3..36: of diastolic BP on anti-hypertensives by year Diastolic BP (mmhg) 64

31 3..2 TREATMENT OF ANAEMIA, GOVERNMENT HD CENTRES Table 3..37: Treatment for Anaemia, HD patients, Government Centres No % on rhuepo % received blood transfusion % on oral Iron % received parenteral Iron Table 3..38: Distribution of rhuepo dose per week, HD patients, Government Centres No. of patients % on 2000 u/week % on u/week % on u/week % on u/week % on u/week % on >2000 u/week

32 Table 3..39: Distribution of serum Iron without rhuepo, HD patients, Government Centres Median LQ UQ % Patients > 0 umol/l Figure 3..39: Cumulative Distribution of serum Iron without rhuepo by year Serum iron (umol/l) 66

33 Table 3..40: Distribution of serum Iron on rhuepo,hd patients, Government Centres Median LQ UQ % Patients > 0 umol/l Figure 3..40: Cumulative Distribution of serum Iron on rhuepo by year Serum iron (umol/l) 67

34 Table 3..4: Distribution of Transferrin Saturation without rhuepo, HD patients, Government Centres Median LQ UQ % Patients > 20% Figure 3..4: of serum Transferrin Saturation without rhuepo by year Serum transferrin saturation (%) 68

35 Table 3..42: Distribution of Transferrin Saturation on rhuepo, HD patients, Government Centres Median LQ UQ % Patients > 20% Figure 3..42: of serum Transferrin Saturation on rhuepo by year Serum transferrin saturation (%) 69

36 Table 3..43: Distribution of serum Ferritin without rhuepo, HD patients, Government Centres Median LQ UQ % Patients > 00 ug/l Figure 3..43: of serum Ferritin without rhuepo by year Serum ferritin (ug/l) 70

37 Table 3..44: Distribution of serum Ferritin on rhuepo, HD patients, Government Centres Median LQ UQ % Patients > 00 ug/l Figure 3..44: of serum Ferritin on rhuepo by year Serum ferritin (ug/l) 7

38 Table 3..45: Distribution of Haemoglobin concentration without rhuepo, HD patients, Government Centres Median LQ UQ % Patients <0 g/dl % Patients >0 & <2 g/dl % Patients >2 g/dl Figure 3..45: of Haemoglobin concentration without rhuepo by year Hb (g/dl) 72

39 Table 3..46: Distribution of Haemoglobin concentrationon rhuepo, HD patients, Government Centres Median LQ UQ % Patients <0 g/dl % Patients >0 & <2 g/dl % Patients >2 g/dl Figure 3..46: of Haemoglobin concentration on rhuepo, by year Hb (g/dl) 73

40 3..3 NUTRITIONAL STATUS OF HD PATIENTS GOVERNMENT CENTRES Table 3..47: Distribution of serum Albumin (g/l), HD patients, Government Centres Median LQ UQ % Patients >40g/L Figure 3..47: of serum Albumin by year Serum albumin (g/l) 74

41 Table 3..48: Distribution of Body Mass Index, HD patients, Government Centres Median LQ UQ % Patients <8 % Patients >8 & <25 % Patients > Figure 3..48: of BMI by year BMI (Kg/M 2 ) 75

42 3..4 SEROLOGICAL STATUS, HD PATIENTS GOVERNMENT CENTRES Table 3..49: Prevalence of positive anti-hcv and HbsAg, HD patients, Government Centres No % HbsAg positive % anti-hcv positive Figure 3..49: Prevalence of positive anti-hcv and HbsAg, HD patients, Government Centres HBsAg anti-hcv Prevalence %