21 TH REPORT OF THE MALAYSIAN DIALYSIS & TRANSPLANT REGISTRY 2013

Transcription

1 21 TH REPORT OF THE MALAYSIAN DIALYSIS & TRANSPLANT REGISTRY 2013 Sponsors: Malaysian Society Of Nephrology Association Of Dialysis Medical Assistants And Nurses The National Renal Registry Is Funded With Grants From: The Ministry Of Health Malaysia Roche AIN Medicare Baxter Healthcare Fresenius Medical Care Lucenxia i

2 June 2014 National Renal Registry, Malaysia ISSN Published by: The National Renal Registry Malaysian Society of Nephrology Suite 1604, Plaza Permata 6, Jalan Kampar Kuala Lumpur Malaysia Telephone. : (603) Direct Fax : (603) nrr@msn.org.my Web site : 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: BL Goh, LM Ong, YN Lim, (Eds) Twenty First Report of the Malaysian Dialysis and Transplant 2013, Kuala Lumpur This report is also published electronically on the website of the National Renal Registry at: 3. Hard copies of the report can be made available with donation of RM per copy to defray the cost of printing. ii

3 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 iii

4 NRR ADVISORY COMMITTEE MEMBERS 2012 to 2014 MEMBERS: MSN APPOINTMENT: FACILITIES Datuk Dr. Ghazali Ahmad Chairman Hospital Kuala Lumpur Prof. Dr. Abdul Halim Abdul Gafor University representative University Kebangsaan Malaysia Medical Centre Dr. S. Prasad Menon Private sector representative Sime Darby Medical Centre Subang Jaya Dato 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 Dr. Rosnawati Yahya MRRB sub-committee Chairperson Hospital Kuala Lumpur 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 iv

5 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). v

6 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. n-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 Demographics Age, 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 G H J Treatment Outcomes Economics Healthcare provider characteristics Modalities of RRT- haemodialysis, peritoneal dialysis; treatment of other uraemic complications; kidney transplantation Patient survival; death, date of death, cause of death Quality of Life/ Work rehabilitation status Source of funding for dialysis treatment, and immunosuppressive drug treatment for transplantation Sector providing dialysis treatment, (private, public or NGO), vi

7 PARTICPATING HAEMODIALYSIS CENTRES 2013 Haemodialysis Centre 801 Rumah Sakit Angkatan Tentera (Kuching) 94 Hospital Angkatan Tentera (Terendak) 96 Hospital Angkatan Tentera (Lumut) Afiat Dialysis Centre Aiman Dialysis Centre Al-Islam Specialist Hospital Alkom Bakti Dialysis Alor Gajah Dialysis Centre Alor Gajah Hospital Alor Setar Dialysis Centre AMD Rotary (Penang) Ampang Hospital Anggun Dialysis Centre Apex Club of Klang-NKF Charity Dialysis Centre Asia Renal Care (Sg Petani) Assunta Hospital Bakti-NKF Dialysis Centre Balik Pulau Hospital Baling Hospital Bangi Dialysis Centre Banting Hospital Batu Gajah Hospital Batu Pahat Rotary Bau Hospital BBA (Butterworth) Dialysis Centre BBA (Kota Kinabalu) Dialysis Centre BBA (Puchong) Dialysis Centre BBA (Tawau) Dialysis Centre Beaufort Hospital Beluran Hospital Bentong Hospital Bertam Dialysis Centre Besut Hospital Betong Hospital Bintulu Hospital Bintulu Specialist Hospital BP Renal Care (Batu Pahat) BP Renal Care (Kluang) BP Renal Care (Rengit) BP Renal Care (Segamat) BP Renal Care Simpang Renggam BP Renalcare (Yong Peng) Buddhist Tzu Chi Dialysis Centre (Butterworth) Buddhist Tzu Chi Dialysis Centre (Kedah) Buddhist Tzu Chi HD Centre (Penang) Bukit Mertajam Hospital C.S. Loo Kidney & Medical Specialist Centre Caring Dialysis Centre (Teluk Intan)* Caring Dialysis(Sandakan) CC# AR Haemodialysis Centre CC# AR AR AR AR Carlatan Dialysis Centre (Bukit Mertajam) Carlatan Dialysis Centre (Sungai Petani) Changkat Melintang Hospital Charis-NKF Dialysis Centre Che Eng Khor Centre Cheras Dialysis Centre CHKMUS-MAA Medicare Charity Dalat Hospital Damai Medical & Heart Clinic Damansara Specialist Hospital Davita Seri Setia Dialysis Centre DEMC Dialysis Centre D'kasih Hemodialisis DSS Dialysis Centre (Rawang) Duchess of Kent Hospital Dungun Hospital Eagles Dialysis Centre EAM Dialysis Centre Fatimah Hospital Fitra Med Fo Yi NKF Dialysis Centre (1) Fo Yi NKF Dialysis Centre (2) Gerik Hospital Giat Kurnia Dialysis Centre (Nilai) Gleneagles Medical Centre Golden Age Dialysis Centre Gua Musang Hospital Haemodialysis Association Klang Haemodialysis Bestari Kampar Happy Kid Nees Dialysis Centre Harmoni Dialysis (Damansara) Harmoni Dialysis (Sg Long) Harmony Sofia Dialysis Centre Healthcare Dialysis Centre Hemodialisis Yayasan Veteran ATM (S Kembangan) Hope Haemodialysis Society Ipoh Hospital Angkatan Tentera Tuanku Mizan Hospital Daerah Daro Hospital Enche' Besar Hajjah Khalsom Hospital Pakar Sultanah Fatimah (Muar) Hospital Queen Elizabeth II Hospital Sultanah Hajjah Kalsom Hospital Sultanah ra Ismail Hudaz Dialysis Centre Hudaz Tunjong Dialysis Centre Hulu Terengganu Hospital Ibnu Al-Nafis Dialysis Centre Iman Dialysis Imercy Dialysis Centre Island Hospital Jasin Hospital JB Lions MAA-Medicare Charity Dialysis Centre (1) AR te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return vii

8 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre JB Lions MAA-Medicare Charity Dialysis Centre (2) Jelebu Hospital Jeli Hospital Jempol Hospital Jengka Hospital Jerantut Hospital Jerteh Dialysis Centre JJ Lions Dialysis Centre Johor Quarries Association Dialysis Centre Johor Specialist Hospital Kaizenbros Dialysis Centre Kajang Hospital Kampar Hospital Kanowit Hospital Kapit Hospital KAS-Rotary-NKF Kay Tee Dialisis Kelana Jaya Medical Centre* Keluarga Bahagia Haemodialisis Kemaman Hospital Keningau Hospital Kepala Batas Hospital Klinik Waqaf An-Nur (Ijok) Kota Belud Hospital Kota Kinabatangan Hospital Kota Marudu Hospital Kota Tinggi Hospital KPJ Ampang Puteri Specialist Hospital KPJ Kajang Specialist Hospital KPJ Klang Specialist Hospital KPJ Kluang Utama Specialist Hospital KPJ Penang Specialist Hospital KPJ Puteri Specialist Hospital KPJ Sabah Specialist Hospital KPJ Selangor Specialist Hospital Kuala Kangsar Hospital Kuala Krai Hospital Kuala Kubu Bharu Hospital Kuala Lipis Hospital Kuala Lumpur Hospital (Paed.) Kuala Lumpur Hospital Kuala Lumpur Lions Renal Centre Kuala Nerang Hospital Kuantan Clinical Diagnostic Centre Kuantan Dialysis Centre Kuantan Medical Centres Kuantan Specialist Centre Kuching Specialist Hospital Kudat Hospital Kulim Haemodialysis (CS Tan) Kulim Hospital Labuan Hospital CC# AR Haemodialysis Centre CC# AR AR AR Lahad Datu Hospital Lam Wah Ee Hospital Langkawi Hospital Lawas Hospital Likas Hospital (Paed) Likas Hospital Lim Boon Sho Dialysis Centre Limbang Hospital Lions Club Kota Budaya Dialysis Centre Lipis Dialysis Centre Loh Guan Lye Specialist Centre Lundu Hospital MAA Charity Dialysis (Kota Bharu) MAA-Medicare Charity (Butterworth) MAA-Medicare Charity (Kuala Lumpur) MAA-Medicare Charity (Mentakab) MAA-Medicare Charity (Sg Besi) MAA-Medicare Charity (Teluk Intan) MAA-Medicare Kidney (Kajang) Machang Hospital Mahkota Medical Centre MAIS Dialysis (Melawati) Marudi Hospital MB Star Rawatan Dialisis (Hutan Melintang) MB Star Rawatan Dialisis (Kelana Jaya) MB Star Rawatan Dialisis Melaka Hospital Mentakab Haemodialysis Unit Mersing Hospital Mersing Rotary Centre Metro Specialist Hospital Miri Hospital Miri Red Crescent Dialysis Centre Muadzam Shah Hospital Muar Dialysis Muar Lions Renal Centre Muhibah Renal Care Mukah Hospital Mynephro Dialysis Sdn Bhd Mysha Qasih Dialysis Centre Nefrol I-Care NEPH Dialysis Centre Sdn Bhd Neph Sdn Bhd (Sg Ara) Nephcare Dialysis Centre Nephrolife Dialysis Centre bel Dialysis Centre Tuaran bel Dialysis Centre rmah Medical Specialist Centre rthern Dialysis Centre Nucare Dialysis Centre Nur Dialysis Centre Nur Iman Dialysis Pahang te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return viii

9 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre Pahang Buddhist Association Pakar Perdana Hospital Pantai Air Keroh Hospital Pantai ARC Dialysis Services Pantai Hospital Ampang Pantai Hospital Penang Pantai Hospital Sungai Petani Papar Hospital Parit Buntar Hospital Pasir Mas Hospital Pekan Hospital Pelangi Haemodialysis Centre Pemodalan Negeri Selangor Dialisis Centre Penang Adventist Hospital Penang Caring Dialysis Society Persada Dialysis Centre Persatuan Amal Chin Malaysia Barat Persatuan Buah Pinggang Sabah Persatuan Dialisis Cahaya Kuching Persatuan Dialisis Kurnia PJ Persatuan Hemodialysis Kinabalu Sabah Persatuan Kebajikan Haemodialysis St Anne BM Persatuan Membaiki Akhlak-Che Luan Khor_NKF Pertubuhan Bakti Fo En Bandar Kulim Pertubuhan Dialisis Rotary-Satu Hati Pertubuhan Hemodialisis Muhibbah Segamat (Labis) Pertubuhan Hemodialisis Muhibbah Pertubuhan Hemodialisis SPS Pertubuhan Kebajikan Amitabha Pertubuhan Kebajikan Hemodialisis Hospital Pakar Putra Melaka Pertubuhan Perkhidmatan Haemodialisis Ar-Ridzuan Pertubuhan Perkhidmatan Hemodialisis AIXIN Kerian Peter Mole MAA-Medicare Charity Dialysis Centre Ping Rong-NKF PJCC Dialysis Centre PMA Chan Meng Khor-MAA Medicare Charity Dialysis Centre Pontian Hospital Pontian Rotary Haemodialysis Centre Port Dickson Hospital Premier Renal Care Prima Dialisis Lagenda Putra Prima Dialysis Kluang Prima Dialysis Masai Prince Court Medical Centre Province Wellesley Renal Medifund Pulau Pangkor Hospital Pulau Pinang Hospital (Paed) Pulau Pinang Hospital Pusat Dialisis & Kesihatan Masjid Bandar Baru Uda Pusat Dialisis Aiman (Shah Alam) Pusat Dialisis Airah Pusat Dialisis Albukhary te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return CC# AR Haemodialysis Centre CC# AR # AR Pusat Dialisis An'nur Seksyen 13 Pusat Dialisis An'nur Pusat Dialisis Bandar Sri Permaisuri Pusat Dialisis BMC Pusat Dialisis Cahaya Pusat Dialisis CAT Negeri Pulau Pinang Pusat Dialisis Darul Iltizam (Slim River) Pusat Dialisis Darul Iltizam (Taiping) Pusat Dialisis Ehsan Perak (Bagan Serai) Pusat Dialisis Ehsan Perak (Parit Buntar) Pusat Dialisis Ehsan Perak (Perda) Pusat Dialisis Giat Kurnia (Masjid Tanah) Pusat Dialisis Giat Kurnia (Merlimau) Pusat Dialisis Intan Pusat Dialisis Jasmine Pusat Dialisis Kuala Kangsar Pusat Dialisis LZS (Kapar) Pusat Dialisis LZS (Sg. Besar) Pusat Dialisis MAIDAM Pusat Dialisis MAIS (Shah Alam) Pusat Dialisis MAIS Pusat Dialisis Makmur (Batu Gajah) Pusat Dialisis Marjina Pusat Dialisis Mesra (Kuala Selangor) Pusat Dialisis MS* Pusat Dialisis Mukmin Gurun Pusat Dialisis Mukmin Ipoh Pusat Dialisis Mukmin Sikamat Pusat Dialisis Mukmin Simpang Ampat Pusat Dialisis Mukmin Telok Panglima Garang Pusat Dialisis Mukmin Temerloh Pusat Dialisis Murni Pusat Dialisis Mutiara (Ayer Tawar) Pusat Dialisis Mutiara Pusat Dialisis Myangkasa Pusat Dialisis Nefro Utama (Bangsar) Pusat Dialisis Nefro Utama (Johor Bahru) Pusat Dialisis Nefro Utama (Kota Tinggi) Pusat Dialisis Nefro Utama (Seberang Perai) Pusat Dialisis Nefro Utama Pontian Pusat Dialisis Nephrocare (Bukit Piatu) Pusat Dialisis Nephrocare (Klang) Pusat Dialisis NKF - Dato' Dr GA Sreenevasan Pusat Dialisis NKF-Kelab Lions Alor Star Pusat Dialisis NKF-Rotary Damansara Pusat Dialisis NKF-Sandakan Kidney Society Pusat Dialisis NKF-Sang Riang (Triang) Pusat Dialisis NKF-Yayasan Buah Pinggang Kemaman Pusat Dialisis NKF-Yayasan Dialisis Pertubuhan Pendidikan Akhlak Taiping Pusat Dialisis NKF-Yayasan Sultanah Bahiyah Pusat Dialisis Nuraeen Pusat Dialisis Pakar Medi-Nefron (Lestari) AR AR AR # ix

10 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre Pusat Dialisis Pakar Medi-Nefron (Putra Permai) Pusat Dialisis Palomar Pusat Dialisis Penawar Permai Pusat Dialisis Perbadanan Islam (Johor Bahru) Pusat Dialisis Perbadanan Islam (Mersing) Pusat Dialisis Perbadanan Islam (Pontian) Pusat Dialisis Persatuan Pesakit Buah Pinggang Trengganu Pusat Dialisis Prima Pusat Dialisis Putra Jaya (Banting) Pusat Dialisis Rakyat Ampang Pusat Dialisis Rakyat Lembah Keramat Pusat Dialisis Rakyat Sementa Pusat Dialisis Rakyat Taman Medan Pusat Dialisis Renal Pure Pusat Dialisis Setia (Ipoh) Pusat Dialisis Sijangkang Pusat Dialisis Simpang Renggam Pusat Dialisis SJ (Sg Bakap) Pusat Dialisis Subang Pusat Dialisis Taiping (Kamunting) Pusat Dialisis Taiping (Kuala Kangsar) Pusat Dialisis Taiping (Parit Buntar) Pusat Dialisis Taiping Pusat Dialisis Terengganu/NKF Pusat Dialisis Tg Malim Pusat Dialisis Touch Pusat Dialisis Veteran ATM (Senawang) Pusat Dialisis Veteran ATM (Seri Rampai) Pusat Dialisis Waqaf An-nur (Batu Pahat) Pusat Dialisis Waqaf An-nur (Pasir Gudang) Pusat Dialisis Waqaf An-Nur (Sarawak) Pusat Dialisis Yayasan Buah Pinggang Kebangsaan (Kota Bharu) Pusat Dialisis Zara Pusat Dialyisis Ibnu Sina (Kuala Ketil) Pusat Dialysis Comfort Pusat Dialysis Ibnu Sina (Bagan Serai) Pusat Dialysis Ibnu Sina (Cawangan Rawang) Pusat Dialysis Ikhlas Pusat Dialysis Makmur (Senai) Pusat Dialysis Mesra (Kapar) Pusat Dialysis Mesra (Rahman Putra) Pusat Dialysis Remedic Pusat Dialysis Setia Pusat Dialysis Tuanku Syed Putra_NKF Pusat Haemodialisis Bayu Caw. Taman Tasik Pusat Haemodialisis Bayu Rembau Pusat Haemodialisis Dr. Ismail Pusat Haemodialisis Renalife Pusat Haemodialisis Suria (Tangkak) Pusat Haemodialisis Zakat (Bayan Lepas) Pusat Haemodialisis Zakat (Jawi) Pusat Haemodialisis Zakat Kedah CC# AR Haemodialysis Centre CC# AR # AR Pusat Haemodialisis Zakat Tasek Gelugor Pusat Haemodialysis Amal Lexin Pusat Haemodialysis Majlis Agama Islam Negeri Johor Pusat Haemodialysis Nilam (Seri Kembangan) Pusat Haemodialysis Prihatin Tengku Besar Trengganu Pusat Haemodialysis Suria (Senawang) Pusat Haemoialisis Suria (Tampin) Pusat HD SJAM Bacang Melaka Pusat Hemodialisis Al Husna Pusat Hemodialisis Ar-Raudhah Pusat Hemodialisis Bandar Mas Pusat Hemodialisis Bayan Baru Pusat Hemodialisis Bayu Pusat Hemodialisis Beng Siew Pusat Hemodialisis Berkat Seroja (Kuala Pilah) Pusat Hemodialisis Berkat Seroja (Machang) Pusat Hemodialisis Darul Iltizam (Ipoh) Pusat Hemodialisis Darul Iltizam (Tapah) Pusat Hemodialisis Darul Takzim (Batu Pahat) Pusat Hemodialisis Darul Takzim (Parit Raja) Pusat Hemodialisis Dato' Lee Kok Chee Pusat Hemodialisis Desa Aman Puri Pusat Hemodialisis Dr Azhar Jitra Pusat Hemodialisis Dr Azhar Pusat Hemodialisis Fasa (Kg Medan) Pusat Hemodialisis Fasa (Sri Manja) Pusat Hemodialisis Felda Pusat Hemodialisis Gemencheh Pusat Hemodialisis Harmoni (Cheras) Pusat Hemodialisis Harmoni (Shamelin) Pusat Hemodialisis Hidayah Pusat Hemodialisis Impian Kluang Pusat Hemodialisis Impian Pusat Hemodialisis Islam Makmur Pusat Hemodialisis Jerantut Pusat Hemodialisis Kampar Yayasan Nanyang-SJAM Pusat Hemodialisis Kau Ong Yah Ampang Pusat Hemodialisis KOPPES Pusat Hemodialisis Krisda Pusat Hemodialisis MAIJ Pusat Hemodialisis MAIWP-PICOMS (Jln Pahang) Pusat Hemodialisis MAIWP-PICOMS Pusat Hemodialisis Manjung Pusat Hemodialisis Mawar (Kuala Pilah) Pusat Hemodialisis Mawar (Mantin) Pusat Hemodialisis Mawar (Yong Peng) HD Unit Pusat Hemodialisis Mawar Gemas Pusat Hemodialisis Mawar Kuching Pusat Hemodialisis Mawar N. Sembilan (Bahau) Pusat Hemodialisis Mawar N. Sembilan (Lukut) Pusat Hemodialisis Mawar N. Sembilan (Rantau) Pusat Hemodialisis Mawar N. Sembilan (Sepang) AR AR # AR te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return x

11 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre Pusat Hemodialisis Mawar N. Sembilan (Seputih) Pusat Hemodialisis Mawar N. Sembilan (Seremban) Pusat Hemodialisis Mawar N. Sembilan (Seri Kembangan) Pusat Hemodialisis Mergong Pusat Hemodialisis Muar Pusat Hemodialisis Nabilah Pusat Hemodialisis Nilam (Semenyih) Pusat Hemodialisis ur Pusat Hemodialisis Perkis Pusat Hemodialisis Permata Pusat Hemodialisis PMKL Pusat Hemodialisis PUSRAWI Pusat Hemodialisis Qaseh Pusat Hemodialisis Rotary Kota Tinggi Pusat Hemodialisis Rotary Kulai Pusat Hemodialisis S P Pusat Hemodialisis Sejahtera (Batu Pahat) Pusat Hemodialisis Sejahtera Muar Pusat Hemodialisis Seroja (Baling) Pusat Hemodialisis Seroja (Kulim 1) Pusat Hemodialisis Seroja (Kulim 2) Pusat Hemodialisis Shah Alam Pusat Hemodialisis Sinona Pusat Hemodialisis SJAM Pulau Sebang Pusat Hemodialisis Syifa (Batangkali) Pusat Hemodialisis Syifa (Bukit Gambir) Pusat Hemodialisis Syifa (Pendang) Pusat Hemodialisis Waz Lian Pusat Hemodialisis Yayasan Toh Puan Zurina Pusat Hemodialisis Zakat (Balik Pulau) Pusat Hemodialisis Zakat (Bukit Mertajam) Pusat Hemodialisis Zakat (Butterworth) Pusat Hemodialisis Zakat (Kepala Batas) Pusat Hemodialisis Zakat (P. Pinang) Pusat Hemodialsis Mutiara Pusat Hemodialysis Bestari Pusat Hemodialysis Medipro Alliance Pusat Hemodialysis Suria (Bentong) Pusat Hemodialysis Suria (Melaka) Pusat Hemodialysis Suria Kuantan Pusat Hemodialysis Yayasan Veteran ATM (Batu Caves) Pusat Jantung Hospital Umum Sarawak Pusat Kelestarian Dialysis Pusat Kesihatan Jitra Pusat Kesihatan Universiti (UTHO) Pusat Pakar Dialisis Traktif (Besut) Pusat Pakar Dialisis Traktif (Jitra) Pusat Pakar Dialisis Traktif (Kuala Pilah) Pusat Pakar Dialisis Traktif (Seremban) Pusat Pakar Dialysis Traktif Pusat Pakar Tawakal Pusat Perbadanan Islam (Segamat) CC# AR Haemodialysis Centre CC# AR AR Pusat Perkhidmatan Haemodialisis USIM Pusat Perubatan Dialisis (Bangi) Pusat Perubatan Dialisis Dengkil Pusat Perubatan Dialisis Semenyih Pusat Perubatan Primier HUKM Pusat Perubatan Universiti Kebangsaan Malaysia Pusat Rawatan Dialisis Ahmad Khalif Pusat Rawatan Dialisis Farah Mahami Pusat Rawatan Dialisis Fazwinna Pusat Rawatan Dialisis Fitra (Kuantan) Pusat Rawatan Dialisis Fitra (Maran) Pusat Rawatan Dialisis Fungates Superflow-NKF Pusat Rawatan Dialisis Good Health-NKF (Kg Pandan) Pusat Rawatan Dialisis Hidayah (Sepang) Pusat Rawatan Dialisis Hidayah Pusat Rawatan Dialisis Islah (Batu Caves) Pusat Rawatan Dialisis Islah (KL) Pusat Rawatan Dialisis Islah (Kota Bharu) Pusat Rawatan Dialisis Islah (Kuala Terengganu) Pusat Rawatan Dialisis Islah (Prima Sri Gombak) Pusat Rawatan Dialisis Islah (Selayang) Pusat Rawatan Dialisis Lions-NKF (Penang) Pusat Rawatan Dialisis MUIS-NKF Pusat Rawatan Dialisis Mukmin Pusat Rawatan Dialisis Nefro Utama (Masjid Tanah) Pusat Rawatan Dialisis Nefro Utama (Puchong) Pusat Rawatan Dialisis Nefro Utama (Setapak) Pusat Rawatan Dialisis Tun Abdul Razak-NKF Kuantan Pusat Rawatan Dialysis Nefro Utama (Kajang Prima) Pusat Rawatan Fitra (Muadzam) Pusat Rawatan Haemodialisis Wan ng Pusat Rawatan Hemodialisis Felina Pusat Rawatan Hemodialisis Sang Riang Bera* Pusat Rawatan Hemodialisis Tunku Sarina Pusat Rawatan Perbadanan Islam (Kota Tinggi) Pusat Waqaf An-nur (Senawang) Putera Bistari Dialysis Centre Putra Haemodialysis Centre Putra Medical Centre Putrajaya Hospital Putri Haemodialysis Centre (Ipoh) PWRM (BM) Dialysis Centre Quality Dialysis (Batang Berjuntai) Quality Dialysis Care (Bangi) Quality Dialysis Care (Cheras) Quality Dialysis Care (Gurun) Quality Dialysis Care (Jerantut) Quality Dialysis Care (Kangar) Quality Dialysis Care (Kota Kinabalu) Quality Dialysis Care (Meru) Quality Dialysis Care (Pendang) Quality Dialysis Care (Sabak Bernam) AR AR AR te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return xi

12 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre CC# AR Quality Dialysis Care (Sg Besar) Quality Dialysis Care (Sg. Petani Selatan) Quality Dialysis Care (Sg. Petani Utara) Quality Dialysis Care (Sg. Siput) Quality Dialysis Care (Tanjung Karang) Quality Dialysis Care (Wangsa Maju) Queen Elizabeth Hospital Raja Perempuan Zainab II Hospital Raja Permaisuri Bainun Hospital Ranau Hospital Raub Dialysis Centre Raub Hospital Rawatan Dialisis Bukit Tinggi Rejang Medical Centre Renal Associates Renal Care (Ipoh Specialist) Renal Care (Kedah) Renal Care Dialysis Services Renal Dialysis Centre Renal Life Dialysis Centre Renal Link (Penang) Renal Therapy Services Renal-Link (Kelantan) S.P. Menon Dialysis Centre (Klang) S.P. Menon Dialysis Centre (Kuala Lumpur) S.P. Menon Dialysis Centre (Petaling Jaya) Saratok Hospital Sarawak General Hospital Sarikei Hospital Sayang Dialysis Selayang Seberang Jaya Hospital Seberang Perai (Bagan) Segamat Hospital Selama Hospital Selayang Hospital (Paed) Selayang Hospital Semporna Hospital Sentosa Medical Centre Serdang Hospital Seremban Specialist Hospital Seri Benut Dialysis Seri Manjung Hospital Serian Hospital Setiu Hospital Sg Siput Hospital Sibu Hospital Sibu Kidney Foundation Sik Hospital Sime Darby Medical Centre Parkcity Sime Darby Medical Centre Subang Jaya Simunjan Hospital Sinar Haemodialysis (Batu Pahat) AR AR Haemodialysis Centre CC# AR Sinar Haemodialysis (Parit Raja) Sinar Hemodialisis Sipitang Hospital SJ Dialysis Centre (Bidor) SJ Dialysis Centre (Ipoh) SJ Dialysis Centre (Seberang Jaya) SJAM_KPS Pusat Hemodialisis Centre 10 (Bintulu) SJAM_KPS Pusat Hemodialisis Centre 15 (Ipoh) SJAM-KPS Haemodialysis Centre 1 (Raja Muda Musa) SJAM-KPS Haemodialysis Centre 11 (Shah Alam) SJAM-KPS Haemodialysis Centre 12 (Balakong) SJAM-KPS Haemodialysis Centre 2 (Klang) SJAM-KPS Haemodialysis Centre 3 (Banting) SJAM-KPS Haemodialysis Centre 5 (Rawang) SJAM-KPS Haemodialysis Centre 6 (Kuala Selangor) SJAM-KPS Haemodialysis Centre 8 (Sibu) SJAM-KPS Haemodialysis Centre 9 (Raub) SJAM-KPS Pusat Hemodialisis Tasik Puteri Slim River Hospital (Tanjong Malim) Smartcare Dialysis Centre (Subang Jaya) Smartcare Dialysis Clinic (Cheras) Sri Aman Hospital Sri Kota Medical Centre Subang Dialysis Centre Sultan Abdul Halim Hospital Sultan Haji Ahmad Shah Hospital Sultan Ismail Hospital (Paed) Sultan Ismail Hospital Sultanah Aminah Hospital Sultanah Bahiyah Hospital Sultanah Nur Zahirah Hospital Sungai Bakap Hospital Sungai Buloh Hospital Sunway Medical Centre (2) Sunway Medical Centre Superkids Trinity-NKF Dialysis Centre Suria Dialysis Centre (Temerloh) Suriya Dialysis Centre Systemic Dialysis Centre (2) Systemic Dialysis Centre Syukur Dialisis (Petaling Jaya) Syukur Dialisis (Puchong) Syukur Dialisis (Shah Alam) Taiping Hospital Taiping Medical Centre Tambunan Hospital Tampin Hospital Tan Sri Muhyiddin Charity Dialysis Centre Tanah Merah Hospital Tangkak Hospital Tangkak Lions Renal Centre Tanjung Karang Hospital te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return xii

13 PARTICPATING HAEMODIALYSIS CENTRES 2013 (con t) Haemodialysis Centre CC# AR Haemodialysis Centre CC# AR Tapah Hospital Tawau Hospital Teluk Intan Hospital Temenggong Seri Maharaja Tun Ibrahim Hospital Tenang Haemodialysis Centre Tenang Haemodialysis Jasin Tengku Ampuan Afzan Hospital (Paed) Tengku Ampuan Afzan Hospital Tengku Ampuan Jemaah Hospital Tengku Ampuan Rahimah Hospital Tengku Anis Hospital Tenom Hospital The Kidney Dialysis Centre (1) The Kidney Dialysis Centre (2) The Nayang-NKF Dialysis Centre The Penang Community HD Society The Rotary HD Centre (Johor Bahru) Timberland Medical Centre Total Kidney Care Haemodialysis TSC Renal Care Tuanku Ampuan Najihah Hospital Tuanku Fauziah Hospital Tuanku Ja'afar Hospital (Paed) Tuanku Ja'afar Hospital Tuaran Hospital Tulips Dialysis Centre Tumpat Hospital Tung Shin Hospital & Yayasan Nanyang Press Tung Shin Hospital Unit Hemodialisis Komuntiti Kodiang Universiti Kebangsaan Malaysia Bangi Universiti Sains Malaysia Hospital University Malaya Medical Centre University Malaya Specialist Centre Woh Peng Cheang Seah Yakin Jaya Haemodialysis Yan Hospital Yayasan Dialysis Pendidikan Akhlak Perak-NKF Ipoh Yayasan Kebajikan SSL Puchong Yayasan Kebajikan SSL Yayasan Pembangunan Keluarga Johor-NKF Yayasan Rotary Kluang YKN Dialisis (Kuala Lumpur)* YKN Dialisis Kota Bharu YKN Dialisis Kuala Pilah YKN Dialisis Rompin Zhi En Dialysis Centre PARTICIPATING PD CENTRES 2013 Peritoneal dialysis centre CC# AR Peritoneal dialysis centre CC# AR 96 Hospital Angkatan Tentera (Lumut) Besut Hospital BP Renal Care (Batu Pahat)* Duchess of Kent Hospital Hospital Pakar Sultanah Fatimah (Muar) Kemaman Hospital Kuala Lumpur Hospital (Paed.) Kuala Lumpur Hospital Likas Hospital (Paed) Melaka Hospital rmah Medical Specialist Centre Pantai Hospital Batu Pahat Prince Court Medical Centre Pulau Pinang Hospital (Paed) Pulau Pinang Hospital Pusat Perubatan Universiti Kebangsaan Malaysia Queen Elizabeth Hospital Raja Perempuan Zainab II Hospital Raja Permaisuri Bainun Hospital AR Renal Dialysis Centre Sarawak General Hospital Selayang Hospital (Paed) Selayang Hospital Serdang Hospital Sultan Haji Ahmad Shah Hospital Sultan Ismail Hospital (Paed) Sultanah Aminah Hospital Sultanah Bahiyah Hospital Sultanah Nur Zahirah Hospital Tawau Hospital Tengku Ampuan Afzan Hospital (Paed) Tengku Ampuan Afzan Hospital Tengku Ampuan Rahimah Hospital Tuanku Ja'afar Hospital (Paed) Tuanku Ja'afar Hospital Universiti Sains Malaysia Hospital University Malaya Medical Centre AR te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return xiii

14 PARTICIPATING TRANSPLANT FOLLOW-UP CENTRES 2013 Renal transplant follow-up centre CC# AR Renal transplant follow-up centre CC# AR Assunta Hospital Bintulu Hospital Duchess of Kent Hospital Dungun Hospital Fan Medical Renal Clinic Hospital Enche' Besar Hajjah Khalsom Hospital Sultanah ra Ismail Klinik Dr Choo & Liew KPJ Sabah Specialist Hospital Kuala Lumpur Hospital (Paed) Kuala Lumpur Hospital Labuan Hospital Mahkota Medical Centre Melaka Hospital Mersing Hospital Miri Hospital Pakar Sultanah Fatimah Muar Hospital Pontian Hospital Prince Court Medical Centre Pulau Pinang Hospital Pusat Perubatan Universiti Kebangsaan Malaysia AR AR AR Queen Elizabeth Hospital Raja Perempuan Zainab II Hospital Raja Permaisuri Bainun Hospital Sarawak General Hospital Segamat Hospital Selayang Hospital Serdang Hospital Sibu Hospital Sultan Ismail Hospital (Paed) Sultan Ismail Pandan Hospital Sultanah Aminah Hospital Sultanah Bahiyah Hospital Sultanah Nur Zahirah Hospital Taiping Hospital Tan Medical Renal Clinic Tawau Hospital Tg. Ampuan Afzan Hospital Tg. Ampuan Rahimah Hospital Tuanku Ja'afar Hospital Universiti Sains Malaysia Hospital University Malaya Medical Centre te: *=Ceased 2013, CC# =Award of Compliance Certificate, AR=annual treatment return xiv

15 CONTRIBUTING AUTHORS CHAPTER TITLE ALL RENAL REPLACEMENT THERAPY IN MALAYSIA DIALYSIS IN MALAYSIA DEATH AND SURVIVAL ON DIALYSIS QOL AND REHABILITATION OUTCOMES ON DIALYSIS PATIENT IN MALAYSIA PAEDIATRIC RENAL REPLACEMENT THERAPY MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS AUTHORS Kuala Lumpur Hospital Ong Loke Meng Pulau Pinang Hospital Goh Bak Leong Serdang Hospital Lee Day Guat National Renal Registry Goh Bak Leong Serdang Hospital Lim Yam Ngo Kuala Lumpur Hospital Ong Loke Meng Penang Hospital Ghazali B Ahmad Kuala Lumpur Hospital Lee Day Guat National Renal Registry Wong Hin Seng Selayang Hospital Ong Loke Meng Penang Hospital Liu Wen Jiun Sultanah Aminah Hospital Chew Thian Fook Seremban Specialist Hospital Christopher Lim Thiam Seong University Putra Malaysia Tan Wee Ming Sunway Medical Centre Yeow Hua Jern Hospital Pakar Sultanah Fatimah Lee Ming Lee Tuanku Ja'afar Hospital Lim Yam Ngo Kuala Lumpur Hospital Lynster Liaw Chiew Tung Penang Hospital Susan Pee Sultan Ismail Hospital Wan Jazilah Wan Ismail Selayang Hospital Yap Yoke Chin Kuala Lumpur Hospital Philip N. Jeremiah KPJ Ampang Puteri Specialist Hospital Bee Boon Cheak Selayang Hospital Ghazali B Ahmad Kuala Lumpur Hospital Lim Soo Kun University Malaya Specialist Centre Zawawi B rdin Winnie Chee Siew Swee Sultanah Nur Zahirah Hospital Pusat Perubatan Universiti Kebangsaan Malaysia International Medical University Tilakavati Karupaiah Faculty of Allied Health Sciences University Kebangsaan Malaysia Koh Keng Hee Sarawak General Hospital Ahmad Fauzi B Abd Rahman Puteri Specialist Hospital S. Prasad Menon Sime Darby Medical Centre Subang Jaya Abdul Halim B Abdul Gafor NUTRITIONAL STATUS ON DIALYSIS BLOOD PRESSURE CONTROL AND DYSLIPIDAEMIA CHRONIC KIDNEY DISEASE MINERAL AND BONE DISORDERS HEPATITIS ON DIALYSIS HEAEMODIALYSIS PRACTICES CHRONIC PERITONEAL DIALYSIS PRACTICES RENAL TRANSPLANTATION INSTITUTIONS Lim Yam Ngo Hooi Lai Seong Sultanah Aminah Hospital Lee Wan Tin Sime Darby Medical Centre Subang Jaya Sunita Bavanandan Kuala Lumpur Hospital Kok Lai Sun Bukit Mertajam Hospital Rozina Bt Ghazalli Pulau Pinang Hospital Ching Chen Hua Sultanah Bahiyah Hospital Fan Kin Sing Gleneagles Intan Medical Centre Liew Yew Fong Pulau Pinang Hospital Clare Tan Hui Hong Sarawak General Hospital Teo Sue Mei Putri Haemodialysis Centre (Ipoh) Chow Yok Wai Pantai Air Keroh Hospital Thiruventhiran Thilaganathan Sunway Medical Centre Ng Eng Khim TAR University Shahnaz Shah Firdaus Khan Tengku Ampuan Rahimah Hospital Tan Chwee Choon Tengku Ampuan Rahimah Hospital rleen Bt Zulkarnain Sim Tengku Ampuan Rahimah Hospital Rafidah Abdullah Sultan Haji Ahmad Shah Hospital Sunita Bavanandan Kuala Lumpur Hospital Lily Mushahar Tuanku Ja'afar Hospital Anita Bhajan Manocha Hospital Seberang Jaya Rosnawati Yahya Kuala Lumpur Hospital Goh Bak Leong Serdang Hospital Fan Kin Sing Gleneagles Intan Medical Centre S. Prasad Menon Sime Darby Medical Centre Subang Jaya Tan Si Yen Prince Court Medical Centre Wong Hin Seng Rohan Malek Bin Dato' Dr. Johan Selayang Hospital Selayang Hospital xv

16 FOREWORD Despite many uncertainties in many areas in health sector in this country, the production of the Annual Report of the Malaysian Dialysis and Transplant Registry will be an exception as uninterrupted annual publication now enters its 21st year of existence. twithstanding the challenges associated with the ever growing number of incident and prevalent patients with CKD5D and CKDT as well as the number of SDPs which totaled 780 last year, the dedication and enthusiasm of various individuals and parties did ensure that we reach the readers and MDTR users once again in a timely manner. As usual, the latest MDTR reports are expected to be used and cited by many interested parties including clinicians, health industry, policy makers, health planners, health regulators and even lawmakers. At the international front, MDTR data made its way, as in its past years, to USRDS and the Global Report on Transplantation for the World Health Organisation. For these reasons, it becomes a paramount importance for the NRR to ensure that the data reported in the annual MDTR achieve a high degree of credibility. Even though data submission by the data providers started on voluntary basis and remained so for many years, the requirements under the Private Healthcare and Facilities Regulations 2006 and the Accreditation of Haemodialysis Services by the Malaysian Society for Quality in Health, Malaysia 2013, made it incumbent on the 600 odd haemodialysis units in the country, both public and private, to submit various data in the form of Annual Returns, Patient and Outcome tification and Annual Surveys to the registry. In the near future, it is expected that some form of checks and audits will be performed on the data submitted by the SDPs to verify their accuracy. On a longer term basis, it is possible that further transparency will be demanded by the public as well as the funding agencies to get the dialysis centres performance to be published and the respective centres be identified openly for comparisons. This practice is already taking place in several European countries and is just a matter of time before its application locally. On behalf of the registry Advisory Committee, I wish to express my utmost appreciation to all the financial sponsors, in particular Roche Malaysia Sdn Bhd, which had shown their continued generosity and commitment to support NRR. The Source Data Providers who had diligently and consistently submit useful and quality data annually, continue to encourage us to persist with the registry works despite all its challenges. The Expert Committee members who persevered in their volunteerism provided important and relevant commentaries on the important observations associated with the registry data and trends remain an all important part of the registry contributors. The new Editorial Board led jointly by Dr. Goh Bak Leong and Dato Dr. Ong Loke Meng had been able to take on the challenges to get the` jobs done and completed. The unsurpassed commitments and perseverance of the NRR administrators led by Staff Nurse Lee Day Guat will not go unnoticed, worthy of special mention and are definitely appreciated. Thank you all. Datuk Dr. Ghazali Ahmad Chairman Advisory Committee National Renal Registry xvi

17 CONTENTS Acknowledgement NRR Advisory Board Members About The Malaysian Dialysis and Transplant Registry (MDTR Participating Haemodialsyis Centres Participating Chronic Peritoneal Dialsysis Centres Participating Transplant Follow-up Centres Contributing Editors Foreword Chapters & Sections List of Tables List of Figures Executive Summary Abbrevation iii iv v vii - xiii xiii xiv xv xvi xvii - xiv xx - xxv xxvi - xxx xxxi xxxii 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) : Dialysis treatment provision : Geographic distribution : Gender distribution : Age distribution : Method and location of dialysis : Funding for dialysis treatment : Distribution of dialysis patients by sector : Primary renal disease 11 DIALYSIS PROVISION IN MALAYSIA (Centre survey report) : Growth in dialysis in Malaysia by state and sector : Manpower in dialysis centres 28 CHAPTER 3: DEATH AND SURVIVAL ON DIALYSIS 31 SECTION 3.1: DEATH ON DIALYSIS 32 SECTION 3.2: PATIENT SURVIVAL ON DIALYSIS : Patient survival by type of dialysis modality : Patient survival by year of starting dialysis : Patient survival by age at starting dialysis : Patient survival by diabetic status 38 SURVIVAL OF INCIDENCE PATIENTS BY CENTRE : Survival of incident haemodialysis patients by centre : Survival of incident PD patients by centre 40 ADJUSTED MORTALITY OF DIALYSIS PATIENT : Adjusted hazard ratio for mortality of dialysis patients : Adjusted hazard ratio for mortality of haemodialysis patients : Adjusted hazard ratio for mortality of peritoneal dialysis patients : Risk adjusted mortality rate for haemodialysis patients by haemodialysis centres : Risk Adjusted Mortality Rate by PD centres 48 SECTION 2.2: SECTION 3.3: SECTION 3.4: xvii

18 CONTENTS (CONT.) QUALITY OF LIFE AND REHABILITATION OUTCOMES OF DIALYSIS PATIENTS IN MALAYSIA 49 SECTION A: QoL INDEX SCORE 50 SECTION B: WORK RELATED REHABILITATION 52 PAEDIATRIC RENAL REPLACEMENT THERAPY 53 SECTION A: RRT PROVISION FOR PAEDIATRIC PATIENTS 54 SECTION B: DISTRIBUTION OF PAEDIATRIC DIALYSIS PATIENTS 56 SECTION C: PRIMARY RENAL DISEASE 58 SECTION D: TYPES OF RENAL TRANSPLANTATION 58 SECTION E: SURVIVAL ANALYSIS 59 SECTION F: HAEMODIALYSIS PRACTICE 61 SECTION G: ANAEMIA TREATMENT 62 CHAPTER 6: MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS 65 SECTION 6.1: TREATMENT FOR ANAEMIA IN PATIENT ON DIALYSIS 66 SECTION 6.2: IRON STATUS ON DIALYSIS 70 SECTION 6.3: HAEMOGLOBIN OUTCOMES ON DIALYSIS 78 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 86 SECTION 7.3: NUTRITIONAL PARAMETERS 89 CHAPTER 8: BLOOD PRESSURE CONTROL AND DYSLIPIDAEMIA 91 SECTION 8.1: BLOOD PRESSURE CONTROL ON DIALYSIS 92 SECTION 8.2: DYSLIPIDAEMIA IN DIALYSIS PATIENTS 100 CHAPTER 9: CHRONIC KIDNEY DISEASE - MINERAL BONE DISORDER 111 SECTION 9.1: TREATMENT OF HYPERPHOSPHATEMIA 112 SECTION 9.2: SERUM CALCIUM AND PHOSPHATE CONTROL 114 SECTION 9.3 SERUM PARATHYROID HORMONE CONTROL 124 HEPATITIS ON DIALYSIS 131 SECTION A: PREVALENCE 132 SECTION B: CENTRE VARIATION 132 CHAPTER 11: HAEMODIALYSIS PRACTICES 135 SECTION 11.1: VASCULAR ACCESS AND ITS COMPLICATIONS 136 SECTION 11.2: HD PRESCRIPTION 138 SECTION 11.3: TECHNIQUE SURVIVAL ON DIALYSIS 148 CHAPTER 4: CHAPTER 5: CHAPTER 10: xviii

19 CONTENTS (CONT.) CHAPTER 12: PERITONEAL DIALYSIS PRACTICES 153 SECTION 12.1 MODALITIES AND PRESCRIPTION OF PD 154 SECTION ACHIEVEMENT OF SOLUTE CLEARANCE AND PERITONEAL TRANSPORT 157 SECTION 12.3 TECHNIQUE SURVIVAL ON PD 159 SECTION 12.4 PD PERITONITIS 167 CHAPTER 13: RENAL TRANSPLANTATION 171 SECTION 13.1: STOCK AND FLOW 172 SECTION 13.2: RECIPIENTS' CHARATERISTICS 175 SECTION 13.3: TRANSPLANT PRACTICES 176 SECTION 13.4: TRANSPLANT OUTCOMES : Post ransplant complications : Deaths and graft loss 181 SECTION 13.5: PATIENT AND GRAFT SURVIVAL 194 SECTION 13.6: CARDIOVASCULAR RISK IN RENAL TRANSPLANT RECIPIENTS : Risk factors for ischaemic heart disease : Blood pressure classification according to JNC VI criteria, : Level of allograft function : Body mass Index : LDL Cholesterol : Blood pressure control 194 QoL INDEX SCORE IN RENAL TRANSPLANT RECIPIENTS 196 APPENDIX I: DATA MANAGEMENT I - IV APPENDIX II: ANALYSIS SETS, STATISTICAL METHODS AND DEFINITIONS V - IX SECTION 13.7: xiv

20 LIST OF TABLES Table 1.1: Table 1.2: Table 1.3: Table 2.1.1(a): Table 2.1.1(b): Table 2.1.1(c): Table 2.1.1(d): Table 2.1.2: Table 2.1.3(a): Table 2.1.3(b): Table (a): Table (b): Table 2.1.5: Table 2.1.6: Table 2.1.7: Table 2.1.8: Table 2.2.1: Table 2.2.2: Table 2.2.3: Table 2.2.4: Table 2.2.5: Table 2.2.6: Table 2.2.7: Table 2.2.8: Table 2.2.9: Table 3.1.1: Table 3.1.2: Table 3.2.1(a): Table 3.2.1(b): Table 3.2.2: Table 3.2.3: Table 3.2.4: Table 3.4.1: Table 3.4.2: Table 3.4.3: Table 4.1: Table 4.2: Table 4.3: Table 4.4: Table 4.5: Table 4.6: Table 4.7: Table 4.8: Table 4.9: Table 5.1: Table 5.2: Table 5.3(a): Table 5.3(b): Table 5.4: Table 5.5: Table 5.6: Table 5.7: Stock and flow of RRT, Malaysia New dialysis acceptance rate and new transplant rate per million population, RRT prevalence rate per million population, Stock and flow-haemodialysis Patients Stock and flow- Chronic PD Patients Haemodialysis Treatment Rate per million population Chronic PD Treatment Rate per million population Dialysis Treatment Rate by state, per million population Dialysis Treatment Rate by Gender, per million male or female population Gender Distribution of Dialysis Patients Dialysis Treatment Rate by Age Group, per million age group population Percentage Age Distribution of Dialysis Patients Method and Location of Dialysis Patients Funding for Dialysis Treatment Distribution of Dialysis Patients by Sector Primary Renal Diseases Number and density of Dialysis Centres in Malaysia by State and Sector, Year 2004 to 2013 Number and density of HD centres in Malaysia by State and Sector, Number and density of PD centres in Malaysia by State and Sector, Number and density of HD machines in Malaysia by State and Sector, Number and Prevalence Rate of Dialysis Patients (HD & PD) in Malaysia by State and Sector, Number and Prevalence Rate of Hemodialysis Patients in Malaysia by State and Sector, Number and Prevalence Rate of PD Patients in Malaysia by State and Sector, HD Capacity to Patient Ratio among HD Centres in Malaysia by State and Sector, Number & density of Certified Dialysis Nurses/ Medical technicians in Malaysia by State and Sector, Deaths on dialysis Causes of death on dialysis Patient survival by dialysis modality analysis (censored for change of modality) Patient survival by dialysis modality analysis (not censored for change of modality) Unadjusted patient survival by year of entry, Unadjusted patient survival by age, Unadjusted patient survival by diabetes mellitus status, Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality ( ) Adjusted hazard ratio for mortality of HD patients uncensored for change of modality ( cohort) Adjusted hazard ratio for mortality of PD patients uncensored for change of modality ( cohort) Cumulative distribution of QoL-Index score in relation to dialysis modality, all dialysis patients Cumulative distribution of QoL-Index score in relation to DM, all dialysis patients Cumulative distribution of QoL-index score in relation to gender, all dialysis patients Cumulative distribution of QoL-index score in relation to age, all dialysis patients Cumulative distribution of QoL-Index score in relation to year of entry, HD patients Cumulative distribution of QoL-Index score in relation to year of entry, PD patients Work related rehabilitation in relation to modality, dialysis patients, Work related rehabilitation in relation to year of entry, HD patients Work related rehabilitation in relation to year of entry, PD patients Stock and flow of Paediatric Renal Replacement Therapy (RRT), Paediatric dialysis and transplant rates per million age related population, Dialysis treatment rate by state, per million state age related population, New dialysis patients by state, Number of new dialysis and transplant patients by gender, New RRT rate, per million age related population by age group, New dialysis by treatment modality, New dialysis by sector, xx

21 LIST OF TABLES Table 5.8: Table 5.9: Table 5.10(a): Table 5.10(b): Table 5.11: Table 5.12: Table 5.13: Table 5.14: Table 5.15: Table 5.16: Table 5.17(a): Table 5.17(b): Table 5.17(c): Table 5.18: Table 5.19: Table 5.20: Table 5.21: Table 6.1.1: Table 6.1.2: Table 6.1.3: Table 6.1.4: Table 6.1.5: Table 6.1.6: Table 6.1.7: Table 6.1.8: Table 6.2.1: Table 6.2.2: Table 6.2.3: Table 6.2.4: Table 6.2.5: Table 6.2.6: Table 6.2.7: Table 6.2.8: Table 6.2.9(a): Table 6.2.9(b): Table 6.2.9(c): Table 6.2.9(d): Table (a): Table (b): Table (c): Table (d): Table 6.3.1: Table 6.3.2: Table 6.3.3(a): Table 6.3.3(b): Table 6.3.4(a): Table 6.3.4(b): Table 6.3.5(a): Table 6.3.5(b): Table 6.3.6(a): Table 6.3.6(b): Table 7.1.1: (CONT.) Primary renal disease by sex among new dialysis patients, Types of renal transplantation, Patient survival by dialysis modality analysis (not censored with change of modality), Patient survival by dialysis modality analysis (censored with change of modality), Dialysis technique survival by modality, Transplant graft survival, Reasons for drop-out from PD program, Transplant graft survival, Causes of graft loss, Vascular access on haemodialysis, Distribution of prescribed Kt/V, HD patients Distribution of delivered Kt/V, HD patients Distribution of URR, HD patients Treatment for anaemia, HD patients Distribution of transferrin saturation on Erythropoietin, HD patients Distribution of transferrin saturation on Erythropoietin, PD patients Distribution of ESA dose (u/kg/wk), Treatment for anaemia, HD patients Treatment for anaemia, PD patients Variation in Erythropoiesis-Stimulating Agents (ESAs) utilization (% patients) among HD centres, Variation in ESAs utilization (% patients) among PD centres, Variation in mean weekly ESAs dose (u/week) among HD centres, Variation in mean weekly ESAs dose (u/week) among PD centres, Variation in use of blood transfusion (% patients) among HD centres, Variation in use of blood transfusion (% patients) among PD centres, Distribution of serum ferritin without ESAs, HD patients Distribution of serum ferritin without ESAs, PD patients Distribution of serum ferritin on ESAs, HD patients Distribution of serum ferritin on ESAs, PD patients Distribution of transferrin saturation without ESAs, HD patients, Distribution of transferrin saturation without ESAs, PD patients, Distribution of transferrin saturation on ESAs, HD patients, Distribution of transferrin saturation on ESAs, PD patients, Variation in Medium serum ferritin among patients on ESAs, HD centres Proportion of patients on ESAs with serum ferritin 100 ng/ml, HD centres Median transferrin saturation among patients on ESAs, HD centres Proportion of patients on ESAs with transferrin saturation 20%, HD centres Variation in medium serum ferritin among patients on ESAs, PD centres Proportion of patients on ESAs with serum ferritin 100 ng/ml, PD centres Median transferrin saturation among patients on ESAs, PD centres Proportion of patients on ESAs with transferring saturation 20%, PD centres Distribution of haemoglobin concentration without ESAs, HD patients Distribution of haemoglobin concentration without ESAs, PD patients Distribution of haemoglobin concentration on ESAs, diabetes HD patients Distribution of haemoglobin concentration on ESAs, non-diabetes HD patients Distribution of haemoglobin concentration on ESAs, diabetes PD patients Distribution of haemoglobin concentration on ESAs, non-diabetes PD patients Variation in median haemoglobin level among patients on ESAs, HD centres Proportion of patients on ESAs with haemoglobin level > 10g/dL, HD centres Variation in Median haemoglobin level among patients on ESAs, PD centres Proportion of patients on ESAs with haemoglobin level >10g/dL, PD centres Distribution of serum albumin, HD patients, xxi