Chapter - 2 DIALYSIS IN MALAYSIA

Transcription

1 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Chapter - 2 DIALYSIS IN MALAYSIA Goh Bak Leong Lim Yam Ngo Ong Loke Meng Ghazali Ahmad Lee Day Guat

2 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 SECTION 2.1: PROVISION OF DIALYSIS IN MALAYSIA In 212, five thousand one hundred and twenty one new haemodialysis () cases were reported representing an acceptance rate of 175 per million population (Tables a & a). The number of increased to 26,67 in 212 or a prevalence rate of 889 per million population (Tables a & a). While in 212, there were 79 new peritoneal dialysis () cases reported, representing an acceptance rate of 24 per million population (Tables b & b). The number of increased to 2523 in 212 or a prevalence rate of 86 per million population (Tables b & b). (Data for 212 are preliminary since at the time of writing this report there were still many new yet to be notified to registry.) Over the last 2 years, the acceptance rate for has increased by more than eleven-fold and prevalence rate by nearly 14-fold. However over the last 5 years the year-on-year percentage rise has decreased for both acceptance rate (14% in 26 to 11% in 211) and prevalence rate (11% in 26 and 6% in 212). Over the last 2 years, both the acceptance rate and prevalence rate for has increased by more than eight-fold. However over the last 6 years the year-on-year percentage rise has decreased for acceptance rate (24% in 26 to 11% in 212) while the prevalence rate increased (11% in 26 and 13% in 212) for. Table 2.1.1(a): Stock and flow- Patients New Died Transplanted Lost to Follow-up Dialysing at 31 st December New Died Transplanted Lost to Follow-up Dialysing at 31 st December Table 2.1.1(b): Stock and flow- Patients New Died Transplanted Lost to Follow-up Dialysing at 31 st December New Died Transplanted Lost to Follow-up Dialysing at 31 st December Table 2.1.2(a): Treatment Rate per million population Acceptance rate Prevalence rate Acceptance rate Prevalence rate

3 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table 2.1.2(b): Treatment Rate per million population Acceptance rate Prevalence rate Acceptance rate Prevalence rate The dialysis treatment rate exceeded 2 per million population for most states in Malaysia except Kedah, Perlis, Kelantan, Sabah and Sarawak. In 211, Penang, Malacca and Johor exceeded a dialysis treatment rate of 3 per million population (Table 2.1.3), while Perak, Selangor, Negeri Sembilan and Wilayah Persekutuan had dialysis treatment rate in excess of 25. Table 2.1.3: Dialysis Treatment Rate by state, per million population State Pulau Pinang Melaka Johor Perak Selangor & Putrajaya WP Kuala Lumpur Negeri Sembilan Kedah Perlis Terengganu Pahang Kelantan Sarawak Sabah & WP Labuan State Pulau Pinang Melaka Johor Perak Selangor & Putrajaya WP Kuala Lumpur Negeri Sembilan Kedah Perlis Terengganu Pahang Kelantan Sarawak Sabah & WP Labuan

4 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 SECTION 2.2: DIALYSIS PROVISION IN MALAYSIA ( survey report) Dialysis centre surveys have been conducted in December of each year since This annual cross-sectional survey was carried out to describe the most current level and distribution of dialysis provision for both haemodialysis and peritoneal dialysis at the end of each year. This section reports the results of the centre survey carried out in December 212. This survey also collects data on available manpower in the dialysis centres. Dialysis provision is expressed in terms of number of centres, machines, treatment (one machine to 5 ) and number of : Growth in dialysis in Malaysia The number of centres for the whole of Malaysia increased from 181 in 2 to 418 in 26 and 67 in 212 (Table 2.2.1). The number of centres doubled from 17 in 2 to 4 in 212 while the number of quadrupled over the same period. Although there was also wide variation between prevalence rate by state, there was no obvious correlation with the economic status. centre rate had increased from 27 in 2 to 79 in 212 (Table 2.2.1). Utilisation of available is reflected by to patient ratio with better utilisation showing a lower ratio. to patient ratio has decreased over the last 1 years (Figure d). Table 2.2.1: Number of dialysis centres, machines and treatment, Malaysia machines machines : patient ratio All dialysis Dialysis treatment rate Figure 2.2.1(a): Number of dialysis centres, Figure 2.2.1(b): Numberof, Dialysis 4, 8 35, Dialysis centres , 25, 2, 15, 2 1, 5, ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 8

5 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Figure 2.2.1(c): Number of dialysis, , Dialysis Patients Figure 2.2.1(d): to patient ratio, Dialysis Patients 25, 2, 15, 1, : patient ratio , ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 ' ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 : patient ratio 2.2.2: Geographic distribution (centre survey) The economically advantaged states had dialysis treatment rates above pmp particularly for year 212 (Table a, b & c). The ratio of prevalence rates between the state with highest provision Kuala Lumpur and the state with the lowest treatment rate (Sabah) had steadily deduced form 7-fold in 23, to 5-fold in 27, to only 3.5-fold in 212 (Table a, b & c). Although the numbers of centres and seemed to vary widely between the economically advantaged states versus less advantaged states, the to patient ration did not vary much between these different states (Figure a, b & c). Table 2.2.2(a): Number of dialysis centers, number of machines and treatment, to ratio and number of dialysis by state, 23 State machines machines : patient ratio All dialysis Dialysis treatment rate Kuala Lumpur Melaka Pulau Pinang Johor Perak Selangor Sarawak Kedah Terengganu Negeri Sembilan Pahang Kelantan Sabah Perlis Malaysia

6 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Table 2.2.2(b): Number of dialysis centers, number of machines and treatment, to ratio and number of dialysis by state, 27 State machines machines : patient ratio All dialysis Dialysis treatment rate Kuala Lumpur Pulau Pinang Melaka Johor Negeri Sembilan Perak Selangor Perlis Kedah Terengganu Sarawak Pahang Kelantan Sabah Malaysia Table 2.2.2(c): Number of dialysis centers, number of machines and treatment, to ratio and number of dialysis by state, 212 State machines machines : patient ratio All dialysis Dialysis treatment rate Kuala Lumpur Pulau Pinang Johor Negeri Sembilan Melaka Perak Selangor Kedah Terengganu Pahang Sarawak Perlis Kelantan Sabah Malaysia

7 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Figure 2.2.2(a): Distribution of haemodialysis centres by State, Figure 2.2.2(b): Distribution of dialysis by State, Figure 2.2.2(c): Distribution of per million State population, Figure 2.2.2(d): to patient ratio by State,

8 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry : Growth in dialysis provision by sector The increased in were mainly contributed by the private haemodialysis centres which had quadrupled from 2 to 212. NGO and public centres had doubled the over the same period of time. In fact, the growth in public centre had plateau since 26. Most of the increases in the private occurred in the more economically developed west coast states of Malaysian Peninsula. Public sectors still provides most of the in the economically disadvantage states (Table and Figures 2.2.3a). The public sector had the lowest ratio followed by private sector and NGO (Figure 2.2.3(b)(iv)). Table 2.2.3(a): Growth in and in Private, NGO and Public sectors, Private NGO Public Sector Cumulative Cumulative Cumulative Cumulative Cumulative Cumulative Figure 2.2.3(a): Growth in and in Private, NGO and Public sectors,

9 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table (b): Number of dialysis centres, machines and treatment by sector, Public centre machines : ratio centre All Dialysis NGO centre machines : ratio centre All Dialysis Private (PRV) centre machines : ratio centre All Dialysis University (UNI) centre machines : ratio centre All Dialysis Armed Force (AF) centre machines : ratio centre All Dialysis

10 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Figure 2.2.3(b)(i): Distribution of dialysis centres by Sector, Figure 2.2.3(b)(ii): Distribution of by Sector, MOH NGO Private University Armed Force MOH NGO Private University Armed Force % of Dialysis ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 % of ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 Figure 2.2.3(b)(iii): Distribution of dialysis by Sector, Figure 2.2.3(b)(iv): to patient ratio by Sector, % of Dialysis Patients MOH NGO Private University Armed Force ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 : patient ratio ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 MOH NGO Private University Armed Force SECTION 2.3: DISTRIBUTION OF DIALYSIS TREATMENT 2.3.1: Gender distribution The treatment gap between men and women accepted for dialysis has remained consistent over the years, suggesting this is a true reflection of the difference in ESRD incidence between genders. Since 21 the male to female prevalent dialysis had remained the same at 55 to 45% respectively. Table 2.3.1(a): Dialysis Treatment Rate by Gender, per million male or female population Gender Male Female Figure 2.3.1(a): Dialysis Treatment Rate by Gender

11 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table 2.3.1(b): Gender Distribution of Dialysis Patients New Dialysis % Male % Female Dialysing at 31 st December % Male % Female New Dialysis % Male % Female Dialysing at 31 st December % Male % Female Figure 2.3.1(b): Gender Distribution of Dialysis Patients (i) New Dialysis (ii) Dialysing at 31 st December 2.3.2: Age distribution The treatment rate for 55 years and older have shown rapid increase over the last 2 years (Table & Figure (a)). In 212, 57% of new dialysis were at least 55 years old at the onset of dialysis. Table 2.3.2(a): Dialysis Treatment Rate by Age Group, per million age group population Age groups (years) Age groups (years)

12 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Figure 2.3.2(a): Dialysis Treatment Rate by Age Group Treatment rateper million population '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 year Age group 1-14 years Age group years Age group years Age group >=65 years Age group years Age group years Age group years Table (b): Percentage Age Distribution of Dialysis Patients New Dialysis % 1-14 years % years % years % years % years % years % >=65 years Dialysing at 31 st December % 1-14 years % years % years % years % years % years % >=65 years New Dialysis % 1-14 years % years % years % years % years % years % >=65 years Dialysing at 31 st December % 1-14 years % years % years % years % years % years % >=65 years

13 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Figure 2.3.2(b): Age Distribution of New Dialysis Patients (i) New Dialysis Patients (ii) Dialysing at 31st December Age group 1-24 years Age group years Age group years Age group years Age group years Age group >=65 years Age group 1-24 years Age group years Age group years Age group years Age group years Age group >=65 years Proportion of Proportion of '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 ' : Method and Location of dialysis 87% of new were accepted into centre haemodialysis program in 212. The proportion of new accepted into chronic program has remained static about 1-12% over the last few years and only accounted for 8% of prevalent dialysis. This is due to a small number of in the private sector and none in the NGO sector. There were still a handful of new accepted into the home and office programme. (Table & Figure 2.3.5) Table 2.3.3: Method and Location of Dialysis Patients New Dialysis % % Home and office % Dialysing at 31 st December % % Home and office % New Dialysis % % Home and office % Dialysing at 31 st December % % Home and office % Figure 2.3.3: Method and Location of Dialysis Patients (i) New Dialysis Patients (ii) Dialysing at 31 st December 17

14 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry : Funding for Dialysis Treatment In Malaysia, there are multiple sources of funding for dialysis. The government continues to be the main payer for dialysis therapy for new and existing. These funds are channeled not only to the government dialysis centres but also as subsidies to NGO centres and payment of dialysis treatment for civil servants and their dependents in private centres. Out of pocket payment i.e. self-funding for dialysis was about 28% in 212. Funding from NGO bodies has maintained over the years. (Table & Figure 2.3.4) Table 2.3.4: Funding for Dialysis Treatment New Dialysis % by Government % by Charity % self funded % subsidized by Employer % Others Dialysing at 31 st December % by Government % by Charity % self funded % subsidized by Employer % Others New Dialysis % by Government % by Charity % self funded % subsidized by Employer % Others Dialysing at 31 st December % by Government % by Charity % self funded % subsidized by Employer % Others Figure 2.3.4: Funding for Dialysis Treatment (i) New Dialysis Patients (ii) Dialysing at 31 st December Government funded Charity Self funded Employer subsidy Others Government funded Charity Self funded Employer subsidy Others Proportion of Proportion of '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 18

15 2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia 2.3.5: Distribution of dialysis by sector The proportion of new dialysis accepted into private dialysis centres continue to increase while that in Public and NGO centres seem to show a decrease. Since 28 the private sector is the largest provider of dialysis. In 212, the private sector provided dialysis to 53% of new and 45% of prevalent. Table 2.3.5: Distribution of Dialysis Patients by Sector New Dialysis % Public centre % NGO centre % Private centre Dialysing at 31 st December % Public centre % NGO centre % Private centre New Dialysis % Public centre % NGO centre % Private centre Dialysing at 31 st December % Public centre % NGO centre % Private centre Figure 2.3.5: Distribution of Dialysis Patients by Sector (i) New Dialysis Patients (ii) Dialysing at 31 st December 19

16 Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 SECTION 2.4: PRIMARY RENAL DISEASE Diabetes mellitus accounted for more than half of the primary renal disease of new dialysis since 23. In 212, 58% of new had diabetes mellitus as the primary renal disease. Hypertension was the primary renal disease in 11% of new. Glomerulonephritis was reported as the primary renal disease in only 4% of new. SLE on its own accounted for 1% of all new dialysis. The percentage of with unknown primary renal disease remains high at 25% despite the increase in the number of nephrologists. Table 2.4: Primary Renal Diseases New Dialysis % Unknown cause % Diabetes Mellitus % GN/SLE % Polycystic kidney % Obstructive Nephropathy % Toxic Nephropathy % Hypertension % Others New Dialysis % Unknown cause % Diabetes Mellitus % GN/SLE % Polycystic kidney % Obstructive Nephropathy % Toxic Nephropathy % Hypertension % Others Figure 2.4: Primary Renal Diseases for New Dialysis Patients Diabetes Mellitus Toxic Nephropathy, Hypertension and Others Polycystic kidney Unknown cause GN and SLE Obstructive Nephropathy 9 Proportion of '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 2