Chapter - 2 DIALYSIS IN MALAYSIA

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

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 2.1.1.a & 2.1.2.a). The number of increased to 26,67 in 212 or a prevalence rate of 889 per million population (Tables 2.1.1.a & 2.1.2.a). While in 212, there were 79 new peritoneal dialysis () cases reported, representing an acceptance rate of 24 per million population (Tables 2.1.1.b & 2.1.2.b). The number of increased to 2523 in 212 or a prevalence rate of 86 per million population (Tables 2.1.1.b & 2.1.2.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 1993-212 New 295 42 545 759 97 1133 1366 1648 1823 266 Died 79 16 121 16 243 36 41 515 711 832 Transplanted 35 43 29 48 49 48 56 94 116 124 Lost to Follow-up 2 2 2 6 4 5 7 14 Dialysing at 31 st December 124 1495 191 2477 3198 44 4945 636 759 8181 New 2259 261 283 3277 3552 43 4359 474 5316 5121 Died 117 1164 1334 1643 1756 1915 2275 2664 2881 2719 Transplanted 17 145 11 96 72 91 97 9 87 65 Lost to Follow-up 1 15 15 39 18 18 42 56 12 136 Dialysing at 31 st December 9339 178 12166 1374 1555 17587 1962 21618 23924 2667 Table 2.1.1(b): Stock and flow- Patients 1993-212 New 63 114 154 212 184 147 196 25 291 39 Died 23 41 58 67 77 77 12 95 141 129 Transplanted 2 3 7 8 1 12 13 12 11 19 Lost to Follow-up 1 1 1 2 1 Dialysing at 31 st December 192 247 332 444 56 544 65 666 779 926 New 37 291 315 397 515 569 548 539 614 79 Died 197 156 182 177 231 277 321 349 363 356 Transplanted 12 13 22 25 18 21 15 12 17 14 Lost to Follow-up 6 1 4 3 5 3 5 6 4 2 Dialysing at 31 st December 166 1124 1173 1317 1548 1749 188 198 2167 2523 Table 2.1.2(a): Treatment Rate per million population 1993-212 Acceptance rate 15 21 26 36 45 51 6 7 76 84 Prevalence rate 61 74 92 117 147 179 216 257 293 331 Acceptance rate 89 11 17 122 131 146 156 167 186 175 Prevalence rate 369 413 459 512 57 639 73 765 838 889 6

2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table 2.1.2(b): Treatment Rate per million population 1993-212 Acceptance rate 3 6 7 1 8 7 9 9 12 13 Prevalence rate 1 12 16 21 23 24 26 28 32 37 Acceptance rate 15 11 12 15 19 21 2 19 22 24 Prevalence rate 42 43 44 49 57 64 67 7 76 86 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 1993-212 State 1993 1994 1995 1996 1997 1998 1999 2 21 22 Pulau Pinang 16 3 72 7 83 18 119 13 122 157 Melaka 34 66 72 79 92 84 139 15 173 Johor 27 46 42 57 79 7 13 13 135 146 Perak 24 3 29 58 62 65 78 17 14 115 Selangor & Putrajaya 25 34 5 66 55 57 74 84 94 11 WP Kuala Lumpur 41 45 75 92 12 14 124 158 186 168 Negeri Sembilan 3 39 48 74 72 94 95 114 19 131 Kedah 12 19 19 23 52 46 59 66 63 89 Perlis 15 2 2 45 64 49 53 72 14 12 Terengganu 17 15 2 3 4 38 41 43 76 91 Pahang 12 13 22 17 47 37 49 49 53 51 Kelantan 5 7 1 6 13 18 3 36 59 61 Sarawak 13 21 2 37 46 33 44 5 66 59 Sabah & WP Labuan 4 12 13 2 18 28 37 3 35 37 State 23 24 25 26 27 28 29 21 211 212 Pulau Pinang 143 211 196 211 218 2 246 265 32 281 Melaka 183 26 167 197 27 231 225 257 36 228 Johor 145 155 167 214 199 255 248 24 32 26 Perak 127 148 169 188 181 25 221 24 252 231 Selangor & Putrajaya 118 124 136 155 173 181 27 229 261 236 WP Kuala Lumpur 19 21 193 211 243 257 281 31 289 276 Negeri Sembilan 145 155 157 151 218 251 269 279 296 28 Kedah 15 98 111 119 134 173 161 16 24 195 Perlis 128 94 12 127 13 141 122 137 165 121 Terengganu 67 81 14 17 18 148 156 193 191 227 Pahang 68 75 9 124 118 146 142 178 179 224 Kelantan 74 65 78 78 94 85 112 99 124 146 Sarawak 62 73 72 86 16 118 123 119 13 126 Sabah & WP Labuan 43 47 44 62 68 96 94 94 13 96 7

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 1999. 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. 2.2.1: 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 2.2.1.d). Table 2.2.1: Number of dialysis centres, machines and treatment, 2-212 Malaysia machines machines : patient ratio All dialysis Dialysis treatment rate 2 181 1851 79 9255 394 5997 255 1.54 17 626 27 6623 282 21 24 2265 94 11325 469 6824 283 1.66 21 778 32 762 315 22 233 275 19 13525 547 812 328 1.67 23 932 38 934 365 23 261 3139 124 15695 62 7999 316 1.96 22 181 43 98 359 24 321 363 139 1815 695 1258 396 1.76 25 1111 43 11369 439 25 373 483 154 2415 771 1246 455 1.69 25 1218 46 13264 51 26 418 455 17 2275 848 1371 511 1.66 29 1362 51 1572 562 27 456 599 188 25495 938 15828 582 1.61 35 1544 57 17372 639 28 492 549 196 2745 982 17567 638 1.54 35 1744 63 19311 71 29 539 562 21 281 4 1962 73 1.43 37 1936 69 21538 772 21 585 656 23 3253 1151 21657 767 1.5 37 1781 63 23438 83 211 643 7131 25 35655 1249 2415 844 1.48 39 254 72 26159 916 212 67 7599 259 37995 1295 2644 9 1.44 4 2321 79 28725 979 Figure 2.2.1(a): Number of dialysis centres, 1993-212 Figure 2.2.1(b): Numberof, 1993-212 Dialysis 4, 8 35, Dialysis centres 7 6 5 4 3 3, 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

2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Figure 2.2.1(c): Number of dialysis, 1993-212 3, Dialysis Patients Figure 2.2.1(d): to patient ratio, 1993-212 2 1.9 Dialysis Patients 25, 2, 15, 1, : patient ratio 1.8 1.7 1.6 1.5 1.4 5, ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 1.3 ' '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 2.2.2 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 2.2.2 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 2.2.2 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 36 42 272 2 136 1211 784 1.73 4 375 243 1586 127 Melaka 1 169 243 845 1215 53 762 1.59 2 12 17 542 78 Pulau Pinang 24 326 227 163 1133 77 535 2.12 2 118 82 888 617 Johor 35 441 148 225 738 1336 447 1.65 1 165 55 151 52 Perak 28 381 171 195 856 752 338 2.53 2 46 21 798 359 Selangor 42 548 121 274 65 1261 279 2.17 3 98 22 1359 3 Sarawak 15 158 71 79 354 582 261 1.36 1 26 12 68 273 Kedah 24 27 116 135 582 479 269 2.16 479 269 Terengganu 6 61 64 35 32 17 178 1.79 1 57 6 227 238 Negeri Sembilan 8 97 15 485 525 115 125 4.22 1 72 78 187 23 Pahang 1 95 68 475 342 241 173 1.97 1 3 22 271 195 Kelantan 1 97 66 485 331 196 134 2.47 2 31 21 227 155 Sabah 12 112 38 56 19 356 121 1.57 2 51 17 47 138 Perlis 1 27 123 135 615 Malaysia 261 3139 124 15695 62 7999 316 1.96 22 181 43 98 359 9

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 45 553 333 2765 1663 173 141 1.6 4 39 186 239 1226 Pulau Pinang 42 485 314 2425 1572 142 99 1.73 3 158 12 156 111 Melaka 2 219 295 195 1475 644 868 1.7 2 32 43 676 911 Johor 63 744 233 372 1165 2557 8 1.45 6 26 64 2763 865 Negeri Sembilan 18 216 221 18 114 713 729 1.51 2 12 123 833 852 Perak 49 56 237 28 1185 178 753 1.57 3 71 3 1851 783 Selangor 88 129 21 5145 152 2964 66 1.74 5 252 52 3216 658 Perlis 2 39 169 195 843 13 562 1.5 13 562 Kedah 3 35 161 1525 85 863 456 1.77 1 3 16 893 472 Terengganu 1 115 114 575 57 384 38 1.5 1 88 87 472 468 Sarawak 29 37 128 1535 64 128 429 1.49 2 7 29 198 458 Pahang 17 182 123 91 614 513 346 1.77 2 83 56 596 42 Kelantan 17 143 9 715 452 466 295 1.53 2 54 34 52 329 Sabah 26 22 63 11 314 654 23 1.54 2 71 22 725 225 Malaysia 456 599 188 25495 938 15828 582 1.61 35 1544 57 17372 639 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 55 659 385 3295 1923 2169 1266 1.52 6 38 222 2549 1488 Pulau Pinang 64 686 426 343 2129 219 139 1.63 3 21 13 2319 1439 Johor 83 112 326 56 1628 4431 1288 1.26 6 177 51 468 134 Negeri Sembilan 35 36 341 18 174 1253 1186 1.44 2 134 127 1387 1313 Melaka 26 31 368 155 184 979 1162 1.58 2 69 82 148 1244 Perak 68 814 337 47 1684 2837 1174 1.43 3 11 42 2938 1216 Selangor 143 1539 272 7695 1362 4896 866 1.57 5 61 16 5497 973 Kedah 49 468 234 234 1172 1716 859 1.36 1 86 43 182 92 Terengganu 14 188 172 94 86 677 619 1.39 2 235 215 912 834 Pahang 34 352 227 176 1137 1191 769 1.48 2 67 43 1258 812 Sarawak 4 46 181 23 93 1765 693 1.3 2 9 35 1855 729 Perlis 4 54 226 27 1128 171 714 1.58 171 714 Kelantan 23 242 148 121 738 894 545 1.35 2 7 43 964 588 Sabah 32 347 13 1735 515 1316 39 1.32 4 11 3 1417 42 Malaysia 67 7599 259 37995 1295 2644 9 1.44 4 2321 79 28725 979 1

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, 23-212 Figure 2.2.2(b): Distribution of dialysis by State, 23-212 Figure 2.2.2(c): Distribution of per million State population, 23-212 Figure 2.2.2(d): to patient ratio by State, 23-212 11

Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 2.2.3: 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, 2-212 Private NGO Public Sector Cumulative Cumulative Cumulative Cumulative Cumulative Cumulative 2 42 312 492 3427 4235 2883 21 4465 3276 532 369 4725 3244 22 515 3766 62 418 535 3716 23 5715 4168 672 4485 583 433 24 775 525 7275 481 698 4882 25 89 6647 792 521 8115 5724 26 9955 7439 867 5687 836 5884 27 1165 8215 945 686 846 5962 28 1267 9426 978 633 854 612 29 14465 1761 1165 6547 854 612 21 159 1173 1675 6856 864 668 211 1745 12837 111 73 869 611 212 1835 13159 1125 788 8755 6157 Figure 2.2.3(a): Growth in and in Private, NGO and Public sectors, 2-212 12

2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table 2.2.3 (b): Number of dialysis centres, machines and treatment by sector, 2-212 2 21 22 23 24 25 26 27 28 29 21 211 212 Public centre 49 58 7 75 98 122 132 133 136 136 138 14 143 machines 45 553 723 763 95 172 1181 133 1354 1437 1557 1556 1633 225 2765 3615 3815 4525 536 595 6515 677 7185 7785 778 8165 1673 1884 2277 2323 284 3428 3858 436 4617 4994 5153 5689 5924 : ratio 1.34 1.47 1.59 1.64 1.61 1.56 1.53 1.51 1.47 1.44 1.51 1.37 1.38 centre 13 14 14 14 16 15 21 22 23 23 24 24 25 497 651 776 923 966 174 124 1445 1654 1742 157 1853 2151 All Dialysis 217 2535 353 3246 377 452 562 5751 6271 6736 6723 7542 875 NGO centre 53 6 7 79 91 99 111 122 125 131 139 144 145 machines 647 789 985 118 1376 1463 1638 1816 1887 1847 2126 22 2241 3235 3945 4925 59 688 7315 819 98 9435 9235 163 1 1125 2 2431 2916 2797 366 428 4587 5136 5659 617 6474 6821 788 : ratio 1.62 1.62 1.69 2.11 1.88 1.74 1.79 1.77 1.67 1.51 1.64 1.61 1.58 centre 1 1 1 1 3 All Dialysis 2 2431 2919 2797 366 428 4587 5136 5659 617 6474 6821 788 Private (PRV) centre 67 74 81 93 118 14 162 187 217 258 293 344 367 machines 674 838 917 18 1215 1448 1611 186 269 2212 2697 322 367 337 419 4585 54 675 724 855 93 1345 116 13485 16 1835 2116 2343 2693 274 3658 417 518 699 772 8291 988 11171 13159 : ratio 1.59 1.79 1.7 1.97 1.66 1.74 1.61 1.52 1.46 1.33 1.37 1.44 1.37 centre 2 5 5 4 4 5 4 9 8 1 9 11 11 6 5 6 6 6 14 26 12 29 53 41 53 37 All Dialysis 2122 2348 2699 2746 3664 4184 544 6111 711 8344 9849 11224 13196 University (UNI) centre 3 3 3 5 5 5 6 7 7 7 8 8 8 machines 36 39 36 78 45 54 76 77 57 66 87 87 82 18 195 18 39 225 27 38 385 285 33 435 435 41 93 5 15 69 42 138 151 188 131 126 142 198 168 : ratio 1.94 3.9 1.71 5.65 5.36 1.96 2.52 2.5 2.18 2.62 3.6 2.2 2.44 centre 2 2 3 3 3 3 3 3 3 3 3 3 3 123 122 147 152 136 128 129 82 57 134 126 145 128 All Dialysis 216 172 252 221 178 266 28 27 188 26 268 343 296 Armed Force (AF) centre 9 9 9 9 9 7 7 7 7 7 7 7 7 machines 44 46 44 38 62 46 44 43 42 4 39 68 36 22 23 22 19 31 23 22 215 21 2 195 34 18 115 116 111 7 94 12 96 99 88 84 8 226 65 : ratio 1.91 1.98 1.98 2.71 3.3 2.25 2.29 2.17 2.39 2.38 2.44 1.5 2.77 centre 1 1 1 1 1 1 1 1 1 3 2 3 5 4 7 44 3 5 All Dialysis 115 116 111 7 97 14 99 14 92 91 124 229 7 13

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, 1993-212 Figure 2.2.3(b)(ii): Distribution of by Sector, 1993-212 MOH NGO Private University Armed Force MOH NGO Private University Armed Force % of Dialysis 9 8 7 6 5 4 3 2 1 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 % of 9 8 7 6 5 4 3 2 1 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 Figure 2.2.3(b)(iii): Distribution of dialysis by Sector, 1993-212 Figure 2.2.3(b)(iv): to patient ratio by Sector, 1993-212 % of Dialysis Patients 9 8 7 6 5 4 3 2 1 MOH NGO Private University Armed Force ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 : patient ratio 6 5 4 3 2 1 ' '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 1993-212 Gender 1993 1994 1995 1996 1997 1998 1999 2 21 22 23 24 25 26 27 28 29 21 211 212 Male 22 33 39 51 63 63 81 92 97 11 122 128 139 155 171 193 24 215 239 231 Female 17 23 32 45 49 56 6 73 88 94 96 11 111 134 144 159 169 18 24 192 Figure 2.3.1(a): Dialysis Treatment Rate by Gender 1993-212 14

2 th Report of the Malaysian Dialysis and Transplant Registry 212 Dialysis IN Malaysia Table 2.3.1(b): Gender Distribution of Dialysis Patients 1993-212 New Dialysis 358 534 699 971 1154 128 1562 1853 2114 2375 % Male 58 6 56 54 57 53 59 57 54 55 % Female 42 4 44 46 43 47 41 43 46 45 Dialysing at 31 st December 1396 1742 2233 2921 374 4548 555 672 7838 917 % Male 6 6 58 56 57 56 56 56 55 55 % Female 4 4 42 44 43 44 44 44 45 45 New Dialysis 2629 291 3145 3674 467 4599 497 5243 593 583 % Male 58 55 57 55 55 56 56 55 55 56 % Female 42 45 43 45 45 44 44 45 45 44 Dialysing at 31 st December 145 11832 13339 1557 1753 19336 215 23598 2691 2859 % Male 55 55 55 55 55 55 55 55 55 55 % Female 45 45 45 45 45 45 45 45 45 45 Figure 2.3.1(b): Gender Distribution of Dialysis Patients 1993-212 (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 2.3.2 (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 1993-212 Age groups (years) 1993 1994 1995 1996 1997 1998 1999 2 21 22 14 1 2 1 3 2 3 3 4 4 5 15-24 5 1 1 14 16 16 17 18 22 28 25-34 23 18 32 39 4 42 44 47 45 52 35-44 38 52 59 67 8 81 84 98 12 97 45-54 59 87 12 154 167 171 222 249 248 27 55-64 68 142 162 226 292 313 367 433 53 527 65 55 78 16 166 25 219 289 347 443 56 Age groups (years) 23 24 25 26 27 28 29 21 211 212 14 4 5 6 5 6 6 8 7 7 6 15-24 25 27 3 32 32 3 35 31 33 28 25-34 49 47 51 6 6 71 71 81 84 75 35-44 98 19 14 132 119 145 134 14 154 164 45-54 272 3 291 451 352 393 4 417 456 466 55-64 578 579 64 662 758 757 88 86 926 934 65 588 66 671 815 853 973 132 125 1172 145 15

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 1993-212 Treatment rateper million population 12 8 6 4 2 '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 25-34 years Age group 45-54 years Age group >=65 years Age group 15-24 years Age group 35-44 years Age group 55-64 years Table 2.3.2 (b): Percentage Age Distribution of Dialysis Patients 1993-212 New Dialysis 358 534 699 971 1154 128 1562 1853 2114 2375 % 1-14 years 2 2 1 2 2 2 2 1 1 2 % 15-24 years 5 6 5 5 5 5 4 4 4 5 % 25-34 years 21 11 14 13 11 11 1 9 8 8 % 35-44 years 24 23 2 18 18 17 16 16 14 13 % 45-54 years 22 23 26 25 24 24 27 27 25 25 % 55-64 years 16 24 22 23 26 26 26 26 28 27 % >=65 years 1 11 12 14 14 15 15 17 2 2 Dialysing at 31 st December 1396 1742 2233 2921 374 4548 555 672 7838 917 % 1-14 years 1 1 1 2 2 2 2 1 1 1 % 15-24 years 6 6 6 5 5 5 5 5 5 5 % 25-34 years 23 2 19 18 17 16 15 14 13 12 % 35-44 years 28 28 26 24 23 22 21 2 2 19 % 45-54 years 23 23 24 24 24 24 25 25 25 25 % 55-64 years 14 16 18 19 2 21 22 23 23 24 % >=65 years 5 6 6 8 9 1 1 12 13 14 New Dialysis 2629 291 3145 3674 467 4599 497 5243 593 583 % 1-14 years 1 1 1 1 1 1 1 1 1 1 % 15-24 years 4 4 4 4 3 3 3 3 2 2 % 25-34 years 7 7 6 6 6 6 6 6 6 6 % 35-44 years 12 13 12 11 11 12 1 1 1 1 % 45-54 years 24 25 24 26 25 25 24 24 24 24 % 55-64 years 29 27 3 27 3 28 29 31 31 31 % >=65 years 23 23 23 25 24 25 27 25 26 26 Dialysing at 31 st December 145 11832 13339 1557 1753 19336 215 23598 2691 2859 % 1-14 years 1 1 1 1 1 1 1 1 1 1 % 15-24 years 5 5 5 5 5 5 5 5 4 4 % 25-34 years 12 11 11 1 1 1 9 1 9 9 % 35-44 years 18 18 17 16 16 16 15 15 14 14 % 45-54 years 26 26 26 26 26 26 26 26 26 26 % 55-64 years 24 24 24 24 25 25 26 26 27 27 % >=65 years 14 15 16 18 17 17 18 17 19 19 16

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 1993-212 (i) New Dialysis Patients (ii) Dialysing at 31st December Age group 1-24 years Age group 35-44 years Age group 55-64 years Age group 25-34 years Age group 45-54 years Age group >=65 years Age group 1-24 years Age group 35-44 years Age group 55-64 years Age group 25-34 years Age group 45-54 years Age group >=65 years 9 9 8 8 Proportion of 7 6 5 4 Proportion of 7 6 5 4 3 3 2 2 1 1 '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 2.3.3: 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 1993-212 New Dialysis 358 534 699 971 1154 128 1562 1853 2114 2375 % 72 69 73 75 82 87 86 88 85 86 % Home and office 11 1 5 3 2 2 2 1 1 1 % 17 21 22 22 16 11 12 11 14 13 Dialysing at 31 st December 1311 1639 2116 2781 3523 4353 5321 6421 7489 8689 % 65 69 72 76 79 83 85 87 88 89 % Home and office 22 18 13 9 7 5 4 3 3 2 % 13 13 15 15 14 12 11 1 9 9 New Dialysis 2629 291 3145 3674 467 4599 497 5243 593 583 % 85 9 9 89 87 87 88 89 89 87 % Home and office 1 1 1 1 1 1 1 % 14 1 1 11 12 12 11 1 1 12 Dialysing at 31 st December 9955 11293 12728 14361 1627 18432 256 22457 24791 27142 % 89 9 91 91 91 91 91 91 92 91 % Home and office 2 1 1 1 1 1 1 1 1 1 % 9 9 8 8 8 8 8 8 7 8 Figure 2.3.3: Method and Location of Dialysis Patients 1993-212 (i) New Dialysis Patients (ii) Dialysing at 31 st December 17

Dialysis IN Malaysia 2 th Report of the Malaysian Dialysis and Transplant Registry 212 2.3.4: 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 1993-212 New Dialysis 348 521 691 957 1152 1279 156 1847 211 2369 % by Government 58 59 51 53 55 46 46 48 52 52 % by Charity 6 5 8 7 8 9 9 8 1 11 % self funded 28 32 36 36 32 4 37 37 33 3 % subsidized by Employer 1 1 1 1 % Others 8 4 5 4 5 5 7 6 4 6 Dialysing at 31 st December 1311 1639 2116 2781 3523 4353 5321 6421 7489 8689 % by Government 62 62 59 57 56 53 5 49 5 51 % by Charity 4 5 6 7 8 9 9 1 11 12 % self funded 25 26 29 31 31 34 36 36 35 33 % subsidized by Employer 1 1 1 1 % Others 9 7 6 5 5 4 4 4 3 3 New Dialysis 262 2879 313 3662 446 4578 4871 5178 593 5754 % by Government 5 53 56 56 56 57 6 59 59 57 % by Charity 12 13 12 11 1 11 12 11 12 11 % self funded 32 29 28 29 31 3 26 28 26 29 % subsidized by Employer 1 2 1 1 1 1 1 % Others 5 3 3 3 3 1 1 2 3 2 Dialysing at 31 st December 9955 11293 12728 14361 1627 18432 256 22457 24791 27142 % by Government 51 52 53 55 56 56 57 58 58 58 % by Charity 13 14 13 12 12 12 12 12 13 13 % self funded 32 31 29 28 29 29 28 28 27 28 % subsidized by Employer 1 1 1 2 2 2 2 1 2 2 % Others 3 2 4 3 1 1 1 1 Figure 2.3.4: Funding for Dialysis Treatment 1993-212 (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 9 9 8 8 Proportion of 7 6 5 4 Proportion of 7 6 5 4 3 3 2 2 1 1 '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

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 1993-212 New Dialysis 358 534 699 971 1154 128 1562 1853 2114 2375 % Public centre 65 64 54 54 53 41 39 35 4 38 % NGO centre 18 19 26 25 27 34 32 33 31 29 % Private centre 17 17 2 21 2 25 29 32 29 33 Dialysing at 31 st December 1396 1742 2233 2921 374 4548 555 672 7838 917 % Public centre 76 72 65 6 56 51 46 43 43 42 % NGO centre 11 14 18 22 25 28 3 31 31 31 % Private centre 13 14 17 18 19 21 24 26 26 27 New Dialysis 2629 291 3145 3674 467 4599 497 5243 593 583 % Public centre 35 33 35 33 33 32 29 28 28 27 % NGO centre 3 3 27 29 27 25 25 23 22 2 % Private centre 35 37 38 38 4 43 46 49 5 53 Dialysing at 31 st December 145 11832 13339 1557 1753 19336 215 23598 2691 2859 % Public centre 4 39 38 38 37 35 34 32 31 3 % NGO centre 31 31 3 29 29 28 28 27 26 25 % Private centre 29 3 32 33 34 37 38 41 43 45 Figure 2.3.5: Distribution of Dialysis Patients by Sector 1993-212 (i) New Dialysis Patients (ii) Dialysing at 31 st December 19

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 1993-212 New Dialysis 358 534 699 971 1154 128 1562 1853 2114 2375 % Unknown cause 36 36 39 36 31 3 27 26 28 27 % Diabetes Mellitus 2 28 25 29 35 4 4 44 45 49 % GN/SLE 24 16 16 16 15 13 12 11 9 8 % Polycystic kidney 3 2 3 2 2 1 1 1 2 1 % Obstructive Nephropathy 4 5 6 6 4 4 4 3 3 3 % Toxic Nephropathy 1 1 1 1 1 % Hypertension 1 1 9 9 1 1 13 13 11 9 % Others 1 2 3 2 2 2 2 1 2 2 New Dialysis 2629 291 3145 3674 467 4599 497 5243 593 5829 % Unknown cause 26 25 24 24 25 26 27 28 29 25 % Diabetes Mellitus 52 53 55 57 57 57 58 57 57 58 % GN/SLE 7 6 6 5 5 4 4 4 3 4 % Polycystic kidney 1 1 1 1 1 1 1 1 1 1 % Obstructive Nephropathy 3 2 2 2 2 2 2 1 1 1 % Toxic Nephropathy % Hypertension 1 1 9 9 9 9 8 8 7 11 % Others 2 2 2 1 1 1 1 1 1 1 Figure 2.4: Primary Renal Diseases for New Dialysis Patients 1993-212 Diabetes Mellitus Toxic Nephropathy, Hypertension and Others Polycystic kidney Unknown cause GN and SLE Obstructive Nephropathy 9 Proportion of 8 7 6 5 4 3 2 1 '93 '94 '95 '96 '97 '98 '99 ' '1 '2 '3 '4 '5 '6 '7 '8 '9 '1 '11 '12 2