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May 2013© national renal registry, Malaysiaissn 1675-8862

Published by:

The National Renal RegistryMalaysian society of nephrologysuite 1604, plaza permata6, Jalan Kampar50400 Kuala lumpurMalaysia

telephone. : (603) 4045 8636Direct fax : (603) 4042 7694e-mail : nrr@msn.org.myWeb site : http://www.msn.org.my

Important information:

1. this report is copyrighted. however it may be freely reproduced without the permission of the national renal registry. acknowledgment would be appreciated. suggested citation is: yn lim, Bl goh, lM ong, (eds) twentieth report of the Malaysian Dialysis and transplant 2012, Kuala lumpur 2013

2. this report is also published electronically on the website of the national renal registry at: http://www.msn.org.my

3. hard copies of the report can be made available with donation of rM60.00 per copy to defray the cost of printing.

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ACKNOWLEDGEMENTS

The Malaysian Dialysis and Transplant Registry of the National Renal Registry would like to thank each and everyone who have in one way or another contributed to

the success of the Malaysian Dialysis and Transplant Registry.

In particular we would like to thank the following:

The Nephrologists, physicians and staff of the Dialysis and Transplant follow-up centres: thank you for participating in the Registry.

The success of the Registry depends on you.

The Ministry of Health, Malaysia for financial support and other support seen and unseen;

The Clinical Research Centre, in particular Dr Goh Pik Pin and Dr Jamaiyah for their tireless effort in supporting the work of registries.

For their generous support:-

Roche

AIN Medicare

Baxter Healthcare

Fresenius Medical Care

Lucenxia

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NRR ADviSORy COMMiTTEE MEMbERS 2012 to 2014

MEMBERS: MSN APPOINTMENT: FACILITIES

Datuk Dr. Ghazali Ahmad chairman hospital Kuala lumpur

Dr. Abdul Halim Abd Gafor university representative university Kebangsaan Malaysia Medical centre

Dr. S. Prasad Menon private sector representative sime Darby Medical centre subang Jaya

Dr. Ong Loke Meng crc representative hospital penang

Mr. Tam Chong Chiang aDMan representative hospital tengku ampuan afzan, Kuantan

Dr. Lim Yam Ngo MDtr sub-committee chairperson hospital Kuala lumpur

Dr. wong Hin Seng eMoss sub-committee chairperson hospital selayang

Dato' Dr. wan Shaariah Md Yusuf MrrB sub-committee chairperson tuanku Ja’afar hospital, seremban

Dr. Goh Bak Leong MDtr editor hospital serdang

Dr. Rafidah Abdullah honorary Msn treasurer sultan haji ahmad shah hospital

statistician Jasmine Chew Sze Ming

nrr Manager Lee Day Guat

clinical research associate

Choo Cheh Loo

Suhazelini Ali

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AbOuT ThE MALAySiAN DiALySiS AND TRANSpLANT REGiSTRy (MDTR)……..

the Malaysia Dialysis and transplant registry (MDtr) collects information on patients with end stage renal disease (esrD) on renal

replacement therapy (rrt) in Malaysia.

Objectives:

the objectives of the registry are as follows:

1. Describe the natural history of ESRD. the registry shall describe the characteristics of patients with esrD, its management,

and patient survival and quality of life outcomes with treatment; and shall describe variation thereof across different groups,

healthcare sectors or geographic regions, and its secular trend over time in Malaysia.

2. Determine effectiveness of treatments for ESRD. the registry shall determine clinical effectiveness and cost effectiveness

of treatments of esrD in real-world clinical practices in Malaysia.

3. Monitor safety and harm of products and services used in the treatment of ESRD. the registry shall serve as an active

surveillance system for the occurrence of unexpected or harmful events for products and services.

4. Evaluating access to and quality of treatment services for ESRD. the registry shall assess differences between providers

or patient populations based on performance measures that compare treatments provided or outcomes achieved with “gold

standards” (e.g., evidence-based guidelines) or comparative benchmarks for specific health outcomes (e.g., risk-adjusted

survival rates). such programs may be used to identify disparities in access to care, demonstrate opportunities for improvement,

establish differentials for payment by third parties, or provide transparency through public reporting.

5. To maintain the national renal transplant waiting list electronically – the eMOSS or electronic Malaysian Organ Sharing

System. the dialysis registry shall maintain and update patients on dialysis who do not have contraindications to kidney

transplantation onto the national renal transplant waiting list according to published agreed criteria. this list is available on the

web for ready access by the transplant physicians any time a deceased kidney becomes available.

Registry design:

this is a multi-center, observational cohort study designed to evaluate the health outcomes of patients with esrD undergoing

treatment at participating clinical centres. patient inclusion criterion is deliberately broad and shall include any patient with a

confirmed diagnosis of esrD.

there is no prescribed study visits. patient shall attend the clinical site as and when required per the standard of care at the site.

required data shall be collected as they become available.

a clinical site shall notify all new patients to the registry, and shall continue to do so until the termination of the registry. patients

shall be follow-up for life.

participation. site shall notify the patients’ treatment to the registry in a calendar year of its participation. a site shall similarly

notify patients during each year of its participation in the registry.

Registry study population:the registry study population consists of male or female patients with esrD to be recruited from participating sites in Malaysia. participation in this study is voluntary. however, in accordance with the private health-care facilities act 1998 (aKta 586), all dialysis health facility are required to submit data to the Malaysian Dialysis and transplant registry (MDtr).

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all clinical centres or sites that satisfy the following selection criteria will be invited to participate:

1. this registry is opened to all clinical sites that provide rrt services for patients with esrD in Malaysia.

2. each site shall have a principal investigator who is also a licensed physician / surgeon and a qualified professional experienced

with esrD management.

3. each site shall appoint a site coordinator (sc). the sc is the person at the participating clinical site who is responsible for all

aspects of registry management and data collection at site, and who will liaise with the clinical registry Manager (crM) and

clinical registry assistant (cra) at the registry coordinating centre (rcc).

4. each site shall accept responsibility for data collection, as well as for ensuring proper record keeping and registry document

filing.

5. each site shall agree to comply with the registry procedures and shall be willing to be subjected to ongoing review of data by

crM or cra or other representative of MDtr. this may include one or more site visits by prior arrangement

Patient eligibility criteria:

all new patients with esrD undergoing treatment at a participating clinical site are eligible for entry into the registry.

in addition, a site may opt to enter existing patients on follow-up at the site into the registry.

Registry data:

the data elements to be collected by the registry shall be relevant and reliable with modest burden to sites, shall comply with

existing data standard where this exists, shall be compatible with established data set used by other existing registries, and shall

employ standard terminology (dictionary) where available.

Two datasets are defined:

core dataset: these are data elements that are needed to address the key questions for which the registry was created.

non-core dataset: these are speculative data elements included to provide an opportunity to generate hypotheses or to explore

other subsidiary questions not of primary interest to the registry.

the data domains and related specific data elements to be collected by this registry is tabulated below:

a Identifier name, nric number, other identifying document numbers, address, contact numbers

B Demographicsage, sex, ethnicity, educational attainment, occupation, household income group, Weight & height, use of tobacco, funding for treatment

c Medical history Medical history/ comorbidities, family history

D ESRD diagnosis Date of first diagnosis, Date re-entering each rrt.

e Laboratory investigations Date & time of tests, Blood chemistry, hematology, serology

f TreatmentModalities of rrt- haemodialysis, peritoneal dialysis; treatment of other uraemic complications; kidney transplantation

g Outcomespatient survival; death, date of death, cause of deathQuality of life/ Work rehabilitation status

h Economicssource of funding for dialysis treatment, and immunosuppressive drug treatment for transplantation

JHealthcare provider characteristics

sector providing dialysis treatment, (private, public or ngo),

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Johor Darul Takzim1. Batu Pahat Rotary2. BP Renal Care ( Rengit)3. BP Renal Care (Batu Pahat)4. BP Renal Care (Kluang)5. BP Renal Care (Segamat)6. BP Renal Care Simpang Renggam7. BP Renal Care (Yong Peng)8. Che Eng Khor Centre9. Hospital Enche’ Besar Hajjah Khalsom10. Hospital Pakar Sultanah Fatimah (Muar)11. Hospital Sultanah Nora Ismail12. JB Lions MAA-Medicare Charity Dialysis Centre (1)13. JB Lions MAA-Medicare Charity Dialysis Centre (2)14. JJ Lions Dialysis Centre15. Johor Quarries Association Dialysis Centre16. Johor Specialist Hospital17. Kota Tinggi Hospital18. KPJ Kluang Utama Specialist Hospital19. Mersing Hospital20. Mersing Rotary Centre21. Muar Dialysis22. Muar Lions Renal Centre23. Pelangi Haemodialysis Centre24. Persatuan Membaiki Akhlak-Che Luan Khor_NKF25. Pertubuhan Hemodialisis Muhibbah Segamat (Labis) 26. Pertubuhan Hemodialisis Muhibbah27. Pertubuhan Kebajikan Amitabha28. Pontian Hospital29. Pontian Rotary Haemodialysis Centre30. Premier Renal Care31. Prima Dialisis Lagenda Putra32. Prima Dialysis Kluang33. Prima Dialysis Masai34. Pusat Dialisis & Kesihatan Masjid Bandar Baru Uda35. Pusat Dialisis Nefro Utama (Johor Bahru)36. Pusat Dialisis Nefro Utama (Kota Tinggi)37. Pusat Dialisis Nefro Utama Pontian38. Pusat Dialisis Perbadanan Islam (Pontian)39. Pusat Dialisis Waqaf An-nur (Batu Pahat)40. Pusat Dialisis Waqaf An-nur (Pasir Gudang)41. Pusat Dialysis Ikhlas42. Pusat Dialysis Makmur (Senai)43. Pusat Haemodialisis Suria (Tangkak)44. Pusat Haemodialysis Amal Lexin45. Pusat Haemodialysis Majlis Agama Islam Negeri Johor46. Pusat Hemodialisis Ar-Raudhah47. Pusat Hemodialisis Bandar Mas48. Pusat Hemodialisis Darul Takzim (Batu Pahat)49. Pusat Hemodialisis Darul Takzim (Parit Raja)50. Pusat Hemodialisis Hidayah51. Pusat Hemodialisis Iman52. Pusat Hemodialisis Impian Kluang53. Pusat Hemodialisis MAIJ54. Pusat Hemodialisis Mawar (Yong Peng) HD Unit55. Pusat Hemodialisis Muar56. Pusat Hemodialisis Nour57. Pusat Hemodialisis Rotary Kota Tinggi58. Pusat Hemodialisis Rotary Kulai59. Pusat Hemodialisis Sejahtera (Batu Pahat)60. Pusat Hemodialisis Sejahtera Muar61. Pusat Hemodialisis Syifa (Bukit Gambir)62. Pusat Kesihatan Universiti (UTHO)63. Pusat Perubatan Perbadanan Islam (Segamat)64. Putera Bistari Dialysis Centre65. Puteri Specialist Hospital66. Segamat Hospital67. Sinar Haemodialysis (Batu Pahat)68. Sinar Haemodialysis (Parit Raja)69. Sultan Ismail Hospital (Paed)70. Sultan Ismail Hospital

71. Sultanah Aminah Hospital72. Tangkak Hospital73. Tangkak Lions Renal Centre74. Temenggong Seri Maharaja Tun Ibrahim Hospital75. The Rotary HD Centre (Johor Bahru)76. Total Kidney Care Haemodialysis77. Yayasan Pembangunan Keluarga Johor-NKF78. Yayasan Rotary Kluang79. Zhi En Dialysis Centre

Kedah Darul Aman80. Afiat Dialysis Centre81. Alor Setar Dialysis Centre82. Asia Renal Care (Penang) Kulim83. Baling Hospital84. Buddhist Tzu Chi Dialysis Centre (Kedah)85. Caring Dialysis (Gurun)86. Caring Dialysis (Sg. Petani-Selatan)87. Caring Dialysis (Sungai Petani-Utara)88. Caring Dialysis Centre (Pendang)89. Kuala Nerang Hospital90. Kulim Haemodialysis (CS Tan)91. Kulim Hospital92. Langkawi Hospital93. Metro Specialist Hospital94. Northern Dialysis Centre95. Pantai Hospital Sungai Petani96. Pertubuhan Bakti Fo En Bandar Kulim97. Pusat Dialisis Albukhary98. Pusat Dialisis Marjina99. Pusat Dialisis Mukmin Gurun100. Pusat Dialisis NKF-Kelab Lions Alor Star101. Pusat Dialyisis Ibnu Sina (Kuala Ketil)102. Pusat Dialysis K K Tan (Sg Petani)103. Pusat Haemodialisis Dr. Ismail104. Pusat Haemodialisis Zakat Kedah105. Pusat Hemodialisis Al Husna106. Pusat Hemodialisis Beng Siew107. Pusat Hemodialisis Dr Azhar Jitra108. Pusat Hemodialisis Mergong109. Pusat Hemodialisis S P110. Pusat Hemodialisis Seroja (Baling)111. Pusat Hemodialisis Seroja (Kulim 1)112. Pusat Hemodialisis Seroja (Kulim 2)113. Pusat Hemodialisis Syifa (Pendang)114. Pusat Kesihatan Jitra115. Pusat Pakar Dialisis Traktif (Jitra)116. Pusat Rawatan Dialisis Fazwinna117. Pusat Rawatan Hemodialisis Yayasan Emkay & Sultanah Bahiyah118. Putra Haemodialysis Centre119. Putra Medical Centre120. Renal Care (Kedah)121. Sik Hospital122. Sultan Abdul Halim Hospital123. Sultanah Bahiyah Hospital124. Superkids Trinity-NKF Dialysis Centre125. Yan Hospital

Kelantan Darul Naim126. Gua Musang Hospital127. Hudaz Dialysis Centre128. Jeli Hospital129. Kuala Krai Hospital130. Lions Club Kota Budaya Dialysis Centre131. MAA Charity Dialysis (Kota Bharu)132. Machang Hospital133. Nephrolife Dialysis Centre134. Pakar Perdana Hospital135. Pasir Mas Hospital136. Pusat Dialisis Renal Pure

pARTiCpATiNG hAEMODiALySiS CENTRES 2012

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137. Pusat Dialisis Yayasan Buah Pinggang Kebangsaan (Kota Bharu)138. Pusat Hemodialisis Berkat Seroja (Machang)139. Pusat Kelestarian Dialysis140. Pusat Perubatan Tentera (Kota Bharu)141. Pusat Rawatan Dialisis Islah (Kota Bharu)142. Raja Perempuan Zainab II Hospital143. Renal-Link (Kelantan)144. Tanah Merah Hospital145. Tengku Anis Hospital146. Tumpat Hospital147. Universiti Sains Malaysia Hospital

Negeri Melaka148. 94 Hospital Angkatan Tentera (Terendak)149. Alor Gajah Dialysis Centre150. Alor Gajah Hospital151. Damai Medical & Heart Clinic152. Jasin Hospital153. Mahkota Medical Centre154. Melaka Hospital155. Pantai Air Keroh Hospital156. Pertubuhan Kebajikan Hemodialisis Hospital Pakar Putra Melaka157. Pusat Dialisis Giat Kurnia (Masjid Tanah)158. Pusat Dialisis Giat Kurnia (Merlimau)159. Pusat Dialisis Nephrocare (Bukit Piatu)160. Pusat Dialysis Comfort161. Pusat HD SJAM Bacang Melaka162. Pusat Hemodialisis Impian163. Pusat Hemodialisis Krisda164. Pusat Hemodialisis Perkis165. Pusat Hemodialisis SJAM Pulau Sebang166. Pusat Hemodialisis Yayasan Toh Puan Zurina167. Pusat Hemodialysis Suria (Melaka)168. Pusat Rawatan Dialisis Nefro Utama (Masjid Tanah)169. Sinar Hemodialisis170. Tenang Haemodialysis Centre171. Tenang Haemodialysis Jasin172. Yakin Jaya Haemodialysis

Negeri Sembilan Darul Khusus173. D’kasih Hemodialisis174. Giat Kurnia Dialysis Centre (Nilai)175. Haemodialysis Mawar Gemas176. Jelebu Hospital177. Jempol Hospital178. Persada Dialysis Centre179. Port Dickson Hospital180. Pusat Dialisis Mukmin Sikamat181. Pusat Dialisis Suria (Tampin)182. Pusat Dialisis Veteran ATM (Senawang)183. Pusat Dialysis Azalea184. Pusat Haemodialisis Bayu Caw. Taman Tasik185. Pusat Haemodialisis Bayu Rembau186. Pusat Haemodialisis Renalife187. Pusat Haemodialisis USIM188. Pusat Haemodialysis Suria (Senawang)189. Pusat Hemodialisis Bayu190. Pusat Hemodialisis Berkat Seroja (Kuala Pilah)191. Pusat Hemodialisis Gemencheh192. Pusat Hemodialisis Mawar (Kuala Pilah)193. Pusat Hemodialisis Mawar (Mantin)194. Pusat Hemodialisis Mawar N. Sembilan (Bahau)195. Pusat Hemodialisis Mawar N. Sembilan (Lukut)196. Pusat Hemodialisis Mawar N. Sembilan (Rantau)197. Pusat Hemodialisis Mawar N. Sembilan (Seremban)198. Pusat Hemodialsis Mutiara199. Pusat Pakar Dialisis Traktif (Kuala Pilah)

200. Pusat Waqaf An-nur (Senawang)201. Seremban Specialist Hospital202. Tampin Hospital203. Tuanku Ampuan Najihah Hospital204. Tuanku Ja’afar Hospital (Paed)205. Tuanku Ja’afar Hospital206. YKN Dialisis Kuala Pilah

Pahang Darul Makmur207. Bentong Hospital208. Caring Dialysis (Jerantut)209. Fitra Med210. Hospital Sultanah Hajjah Kalsom211. Jengka Hospital212. Jerantut Hospital213. Kuala Lipis Hospital214. Kuantan Clinical Diagnostic Centre215. Kuantan Medical Centres216. Kuantan Specialist Centre217. Lipis Dialysis Centre218. MAA-Medicare Charity (Mentakab)219. Mentakab Haemodialysis Unit220. Muadzam Shah Hospital221. Nur Iman Dialysis Pahang222. Pahang Buddhist Association223. Pekan Hospital224. Pusat Dialisis Mukmin Temerloh225. Pusat Hemodialisis Islam Makmur226. Pusat Hemodialisis Jerantut227. Pusat Hemodialysis Suria (Bentong)228. Pusat Hemodialysis Suria Kuantan229. Pusat Rawatan Dialisis Fitra (Kuantan)230. Pusat Rawatan Dialisis Tun Abdul Razak-NKF Kuantan231. Pusat Rawatan Fitra (Muadzam)232. Pusat Rawatan Hemodialisis Sang Riang Bera233. Raub Dialysis Centre234. Raub Hospital235. SJAM-KPS Haemodialysis Centre 9 (Raub)236. Sultan Haji Ahmad Shah Hospital237. Suria Dialysis Centre (Temerloh)238. Tengku Ampuan Afzan Hospital (Paed)239. Tengku Ampuan Afzan Hospital

Perak Darul Ridzuan240. 96 Hospital Angkatan Tentera (Lumut)241. Batu Gajah Hospital242. Bestari Haemodialysis Centre243. C.S. Loo Kidney & Medical Specialist Centre244. Caring Dialysis Centre (Sg Siput)245. Caring Dialysis Centre (Teluk Intan)246. Changkat Melintang Hospital247. Fatimah Hospital248. Gerik Hospital249. Harmony Sofia Dialysis Centre250. Hope Haemodialysis Society Ipoh251. Kampar Hospital252. Kuala Kangsar Hospital253. MAA-Medicare Charity (Teluk Intan)254. MB Star Rawatan Dialisis255. Nur Dialysis Centre256. Parit Buntar Hospital257. Persatuan Amal Chin Malaysia Barat258. Pertubuhan Perkhidmatan Haemodialisis Ar-Ridzuan259. Pertubuhan Perkhidmatan Hemodialisis AIXIN Kerian260. PMA Chan Meng Khor-MAA Medicare Charity Dialysis Centre261. Pulau Pangkor Hospital262. Pusat Dialisis Darul Iltizam (Slim River)

pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)

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263. Pusat Dialisis Darul Iltizam (Taiping)264. Pusat Dialisis Ehsan Perak (Bagan Serai)265. Pusat Dialisis Ehsan Perak (Parit Buntar)266. Pusat Dialisis Intan267. Pusat Dialisis Kuala Kangsar268. Pusat Dialisis Makmur (Batu Gajah)269. Pusat Dialisis Mukmin Ipoh270. Pusat Dialisis Mutiara (Ayer Tawar)271. Pusat Dialisis Mutiara272. Pusat Dialisis NKF-Yayasan Dialisis Pertubuhan

Pendidikan Akhlak Taiping273. Pusat Dialisis Penawar Permai274. Pusat Dialisis Setia (Ipoh)275. Pusat Dialisis Taiping (Kamunting)276. Pusat Dialisis Taiping (Kuala Kangsar)277. Pusat Dialisis Taiping (Parit Buntar)278. Pusat Dialisis Taiping279. Pusat Dialisis Tg Malim280. Pusat Dialysis Ibnu Sina (Bagan Serai)281. Pusat Dialysis Setia282. Pusat Hemodialisis Darul Iltizam (Ipoh)283. Pusat Hemodialisis Darul Iltizam (Tapah)284. Pusat Hemodialisis Felda285. Pusat Hemodialisis Kampar Yayasan Nanyang-SJAM286. Pusat Hemodialisis Manjung287. Pusat Hemodialisis Qaseh288. Pusat Hemodialysis Nyata Segar289. Pusat Rawatan Dialisis Ahmad Khalif290. Pusat Rawatan Dialisis Wan Nong291. Putri Haemodialysis Centre (Ipoh)292. Raja Permaisuri Bainun Hospital (Home)293. Raja Permaisuri Bainun Hospital294. Renal Care (Ipoh Specialist)295. Selama Hospital296. Seri Manjung Hospital297. Sg Siput Hospital298. SJ Dialysis Centre (Bidor)299. SJ Dialysis Centre (Ipoh)300. SJAM_KPS Pusat Hemodialisis Centre 15 (Ipoh)301. Slim River Hospital (Tanjong Malim)302. Taiping Hospital303. Taiping Medical Centre304. Tapah Hospital305. Teluk Intan Hospital306. Woh Peng Cheang Seah307. Yayasan Dialysis Pendidikan Akhlak Perak-NKF Ipoh

Perlis Indera Kayangan308. Caring Dialysis (Kangar)309. Pusat Dialysis Remedic310. Pusat Dialysis Tuanku Syed Putra_NKF311. Tuanku Fauziah Hospital

Penang312. Alkom Bakti Dialysis313. AMD Rotary (Penang)314. Anggun Dialysis Centre315. Asia Renal Care (Penang) BM316. Balik Pulau Hospital317. BBA (Butterworth) Dialysis Centre318. Bertam Dialysis Centre319. Buddhist Tzu Chi Dialysis Centre (Butterworth)320. Buddhist Tzu Chi HD Centre (Penang)321. Bukit Mertajam Hospital322. Carlatan Dialysis Centre323. Fo Yi NKF Dialysis Centre (1)324. Fo Yi NKF Dialysis Centre (2)

325. Gleneagles Medical Centre326. Happy Kid Nees Dialysis Centre327. Imercy Dialysis Centre328. Island Hospital329. K K Tan Specialist (BM)330. Kepala Batas Hospital331. KPJ Penang Specialist Hospital332. Lam Wah Ee Hospital333. Lim Boon Sho Dialysis Centre334. Loh Guan Lye Specialist Centre335. MAA-Medicare Charity (Butterworth)336. Muhibah Renal Care337. Neph Sdn Bhd (Sg Ara)338. NEPH Sdn Bhd339. Nucare Dialysis Centre340. Pantai Hospital Penang341. Penang Adventist Hospital342. Penang Caring Dialysis Society343. Persatuan Kebajikan Haemodialysis St Anne BM344. Pertubuhan Dialisis Rotary-Satu Hati345. Pertubuhan Hemodialisis SPS346. Province Wellesley Renal Medifund347. Pulau Pinang Hospital (Home)348. Pulau Pinang Hospital (Paed)349. Pulau Pinang Hospital350. Pusat Dialisis BMC351. Pusat Dialisis Ehsan Perak (Pedar)352. Pusat Dialisis Mukmin Simpang Amapat353. Pusat Dialisis Nefro Utama (Seberang Perai)354. Pusat Dialisis Prima 355. Pusat Dialisis SJ (Sg Bakap)356. Pusat Haemodialisis Zakat (Bayan Lepas)357. Pusat Haemodialisis Zakat (Jawi)358. Pusat Haemodialisis Zakat Tasek Gelugor359. Pusat Hemodialisis Bayan Baru360. Pusat Hemodialisis Sinona361. Pusat Hemodialisis Zakat (Balik Pulau)362. Pusat Hemodialisis Zakat (Bukit Mertajam)363. Pusat Hemodialisis Zakat (Butterworth)364. Pusat Hemodialisis Zakat (Kepala Batas)365. Pusat Hemodialisis Zakat (P. Pinang)366. Pusat Hemodialysis Bestari367. Pusat Rawatan Dialisis Lions-NKF (Penang)368. PWRM (BM) Dialysis Centre369. Renal Link (Penang)370. Seberang Jaya Hospital371. Seberang Perai (Bagan)372. SJ Dialysis Centre (Seberang Jaya)373. Sungai Bakap Hospital374. The Penang Community HD Society375. TSC Renal Care

Sabah376. BBA (Kota Kinabalu) Dialysis Centre377. BBA (Tawau) Dialysis Centre378. Beaufort Hospital379. Beluran Hospital380. Caring Dialysis Centre (Sandakan)381. Caring Dialysis Centre Kota Kinabalu382. Duchess of Kent Hospital383. Keningau Hospital384. Kota Belud Hospital385. Kota Kinabatangan Hospital386. Kota Marudu Hospital387. Kudat Hospital388. Labuan Hospital389. Lahad Datu Hospital390. Likas Hospital (Paed)

pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)

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391. Likas Hospital392. Nobel Dialysis Centre393. Papar Hospital394. Persatuan Buah Pinggang Sabah395. Persatuan Hemodialysis Kinabalu Sabah396. Peter Mole MAA-Medicare Charity Dialysis Centre397. Pusat Dialisis NKF-Sandakan Kidney Society398. Pusat Rawatan Dialisis NKF-MUIS399. Queen Elizabeth Hospital400. Ranau Hospital401. Sabah Medical Centre402. Semporna Hospital403. Sipitang Hospital404. Tambunan Hospital405. Tawau Hospital406. Tenom Hospital407. Tuaran Hospital

Sarawak408. 801 Rumah Sakit Angkatan Tentera (Kuching)409. Bau Hospital410. Betong Hospital411. Bintulu Hospital412. CHKMUS-MAA Medicare Charity413. Dalat Hospital414. Golden Age Dialysis Centre415. Hospital Daerah Daro416. Kanowit Hospital417. Kapit Hospital418. KAS-Rotary-NKF419. Kuching Specialist Hospital420. Lawas Hospital421. Limbang Hospital422. Lundu Hospital423. Marudi Hospital424. Miri Hospital425. Miri Red Crescent Dialysis Centre426. Mukah Hospital427. Normah Medical Specialist Centre428. Persatuan Dialisis Cahaya Kuching429. Pusat Dialisis Cahaya430. Pusat Dialisis Waqaf An-Nur (Sarawak)431. Pusat Hemodialisis KOPPES432. Rejang Medical Centre433. Renal Life Dialysis Centre434. Renal Therapy Services435. Saratok Hospital436. Sarawak General Hospital437. Sarikei Hospital438. Serian Hospital439. Sibu Hospital440. Sibu Kidney Foundation441. Simunjan Hospital442. SJAM_KPS Pusat Hemodialisis Centre 10 (Bintulu)443. SJAM-KPS Haemodialysis Centre 8 (Sibu)444. Sri Aman Hospital445. Timberland Medical Centre

Selangor Darul Ehsan446. 819 Rumah Sakit Angkatan Tentera447. Ampang Hospital448. Apex Club of Klang-NKF Charity Dialysis Centre449. Assunta Hospital450. Bakti-NKF Dialysis Centre451. Bangi Dialysis Centre452. Banting Hospital

453. BBA (Puchong) Dialysis Centre454. Caring Dialysis (Bangi)455. Caring Dialysis Centre (Batang Berjuntai)456. Caring Dialysis Centre (Cheras)457. Caring Dialysis Centre (Sabak Bernam)458. Caring Dialysis Centre (Sg. Besar)459. Caring Dialysis Centre (Tanjong Karang)460. Caring Dialysis Centre Andalas (Klang)461. Damansara Specialist Hospital462. DEMC Dialysis Centre463. DSS Dialysis Centre (Rawang)464. EAM Dialysis Centre465. Haemodialysis Association Klang466. Harmoni Dialysis (Damansara)467. Harmoni Dialysis (Sg Long)468. Healthcare Dialysis Centre469. Hemodialisis Yayasan Veteran ATM (S Kembangan)470. Ibnu Al-Nafis Dialysis Centre471. Jerteh Dialysis Centre472. Kajang Hospital473. Kelana Jaya Medical Centre474. KPJ Ampang Puteri Specialist Hospital475. KPJ Kajang Specialist Hospital476. KPJ Selangor Specialist Hospital477. Kuala Kubu Bharu Hospital478. MAA-Medicare Kidney (Kajang)479. MB Star Rawatan Dialisis (Kelana Jaya)480. Mynephro Dialysis Sdn Bhd481. Nefrol I-Care482. Persatuan Dialisis Kurnia PJ483. Ping Rong-NKF484. PJCC Dialysis Centre485. PNSB Dialisis Centre486. Pusat Dialisis Aiman (Shah Alam)487. Pusat Dialisis Airah488. Pusat Dialisis An’nur Seksyen 13489. Pusat Dialisis An’nur490. Pusat Dialisis LZS (Kapar)491. Pusat Dialisis LZS (Sg. Besar)492. Pusat Dialisis MAIS (Shah Alam)493. Pusat Dialisis MAIS Taman Melawati494. Pusat Dialisis MAIS495. Pusat Dialisis Mesra (Kuala Selangor)496. Pusat Dialisis MS497. Pusat Dialisis Mukmin Telok Panglima Garang498. Pusat Dialisis Nephrocare (Klang)499. Pusat Dialisis NKF - Dato’ Dr GA Sreenevasan500. Pusat Dialisis NKF-Rotary Damansara501. Pusat Dialisis Pakar Medi-Nefron (Lestari)502. Pusat Dialisis Pakar Medi-Nefron (Putra Permai)503. Pusat Dialisis Putra Jaya (Banting)504. Pusat Dialisis Putra Jaya (Kajang)505. Pusat Dialisis Rakyat Ampang506. Pusat Dialisis Rakyat Sementa507. Pusat Dialisis Rakyat Taman Medan508. Pusat Dialisis Sijangkang509. Pusat Dialisis Subang510. Pusat Dialisis Touch511. Pusat Dialisis Zara512. Pusat Dialysis Ibnu Sina (Cawangan Rawang)513. Pusat Dialysis Mesra (Kapar)514. Pusat Dialysis Mesra (Rahman Putra)515. Pusat Dialysis Putra Jaya (Semenyih)516. Pusat Haemodialysis Nilam (Seri Kembangan)517. Pusat Hemodialisis Fasa (Kg Medan)518. Pusat Hemodialisis Fasa (Sri Manja)519. Pusat Hemodialisis Kau Ong Yah Ampang520. Pusat Hemodialisis MAIWP-PICOMS

pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)

xi

521. Pusat Hemodialisis Mawar N. Sembilan (Sepang)522. Pusat Hemodialisis Mawar N. Sembilan (Seri Kembangan)523. Pusat Hemodialisis Nilam (Semenyih)524. Pusat Hemodialisis Permata525. Pusat Hemodialisis Shah Alam526. Pusat Hemodialisis Syifa (Batangkali)527. Pusat Hemodialysis Yayasan Veteran ATM (Batu Caves)528. Pusat Perubatan Dialisis Dengkil529. Pusat Perubatan Dialisis530. Pusat Perubatan Primier HUKM531. Pusat Rawatan Dialisis Farah Mahami532. Pusat Rawatan Dialisis Hidayah (Sepang)533. Pusat Rawatan Dialisis Hidayah534. Pusat Rawatan Dialisis Islah (Batu Caves)535. Pusat Rawatan Dialisis Islah (Prima Sri Gombak)536. Pusat Rawatan Dialisis Islah (Selayang)537. Pusat Rawatan Dialisis Mukmin538. Pusat Rawatan Dialisis Nefro Utama (Puchong)539. Pusat Rawatan Dialysis Nefro Utama (Kajang Prima)540. Pusat Rawatan Hemodialisis Felina541. Putrajaya Hospital542. Rawatan Dialysis Bukit Tinggi543. Renal Associates544. Renal Care Dialysis Services545. S.P. Menon Dialysis Centre (Klang)546. S.P. Menon Dialysis Centre (Petaling Jaya)547. Sayang Dialysis Selayang548. Selayang Hospital (Paed)549. Selayang Hospital550. Serdang Hospital551. Sime Darby Medical Centre Subang Jaya552. SJAM-KPS Haemodialysis Centre 1 (Raja Muda Musa)553. SJAM-KPS Haemodialysis Centre 11 (Shah Alam)554. SJAM-KPS Haemodialysis Centre 12 (Balakong)555. SJAM-KPS Haemodialysis Centre 2 (Klang)556. SJAM-KPS Haemodialysis Centre 3 (Banting)557. SJAM-KPS Haemodialysis Centre 5 (Rawang)558. SJAM-KPS Haemodialysis Centre 6 (Kuala Selangor)559. SJAM-KPS Pusat Hemodialisis Tasik Puteri560. Smartcare Dialysis Centre (Subang Jaya)561. Sri Kota Medical Centre562. Sungai Buloh Hospital563. Sunway Medical Centre (2)564. Sunway Medical Centre565. Suriya Dialysis Centre566. Syukur Dialisis (Petaling Jaya)567. Syukur Dialisis (Puchong)568. Syukur Dialisis (Shah Alam)569. Tanjung Karang Hospital570. Tengku Ampuan Jemaah Hospital571. Tengku Ampuan Rahimah Hospital572. Tulips Dialysis Centre573. Universiti Kebangsaan Malaysia Bangi574. Yayasan Kebajikan SSL (Puchong)575. Yayasan Kebajikan SSL (Petaling Jaya)

Terengganu Darul Iman576. Besut Hospital577. Dungun Hospital578. Hulu Terengganu Hospital579. Kemaman Hospital580. Pusat Dialisis MAIDAM581. Pusat Dialisis NKF-Yayasan Buah Pinggang Kemaman582. Pusat Dialisis Nuraeen583. Pusat Dialisis Terengganu/NKF584. Pusat Hemodialisis Nabilah

585. Pusat Pakar Dialisis Traktif (Besut)586. Pusat Rawatan Dialisis Islah (Kuala Terengganu)587. Setiu Hospital588. Sultanah Nur Zahirah Hospital589. YKN Dialisis (Terengganu)

wilayah Persekutuan Kuala Lumpur590. Aiman Dialysis Centre591. Al-Islam Specialist Hospital592. Caring Dialysis (Wangsa Maju)593. Charis-NKF Dialysis Centre594. Cheras Dialysis Centre595. Davita Seri Setia Dialysis Centre596. Hospital Angkatan Tentera Tuanku Mizan597. Kuala Lumpur Hospital (Home)598. Kuala Lumpur Hospital (Paed.)599. Kuala Lumpur Hospital (Unit 1)600. Kuala Lumpur Hospital (Unit 3)601. Kuala Lumpur Hospital (Unit 4)602. Kuala Lumpur Lions Renal Centre603. MAA-Medicare Charity (Kuala Lumpur)604. Pantai ARC Dialysis Services605. Pantai Hospital Ampang606. Poliklinik Komuniti Tanglin607. Prince Court Medical Centre608. Pusat Dialisis Amal MAA-Medicare (Sg Besi)609. Pusat Dialisis Bandar Sri Permaisuri610. Pusat Dialisis Nefro Utama (Bangsar)611. Pusat Hemodialisis Dato’ Lee Kok Chee612. Pusat Hemodialisis Desa Aman Puri613. Pusat Hemodialisis Felda614. Pusat Hemodialisis Harmoni (Cheras)615. Pusat Hemodialisis Harmoni (Shamelin)616. Pusat Hemodialisis Mawar N. Sembilan (Seputih)617. Pusat Hemodialisis PMKL618. Pusat Hemodialisis PUSRAWI619. Pusat Hemodialisis Waz Lian620. Pusat Hemodialysis Medipro Alliance621. Pusat Pakar Dialysis Traktif622. Pusat Pakar Tawakal623. Pusat Perubatan Universiti Kebangsaan Malaysia624. Pusat Rawatan Dialisis Fungates Superflow-NKF625. Pusat Rawatan Dialisis Good Health-NKF (Kg Pandan)626. Pusat Rawatan Dialisis Islah (KL)627. Pusat Rawatan Dialisis Nefro Utama (Setapak)628. Renal Dialysis Centre629. S.P. Menon Dialysis Centre (Kuala Lumpur)630. Sentosa Medical Centre631. Smartcare Dialysis Clinic (Cheras)632. The Kidney Dialysis Centre (1)633. The Kidney Dialysis Centre (2)634. The Nayang-NKF Dialysis Centre635. Tung Shin Hospital & Yayasan Nanyang Press636. Tung Shin Hospital637. University Malaya Medical Centre638. University Malaya Specialist Centre639. YKN Dialisis (Kuala Lumpur)

pARTiCpATiNG hAEMODiALySiS CENTRES 2012 (con’t)

xii

pARTiCipATiNG pD CENTRES 2012

Johor Darul Takzim1. BP Renal Care (Batu Pahat)2. BP Renal Care (Segamat)3. Hospital Pakar Sultanah Fatimah (Muar)4. Sultan Ismail Hospital (Paed)5. Sultanah Aminah Hospital

Kedah Darul Aman6. Sultanah Bahiyah Hospital

Kelantan Darul Naim7. Raja Perempuan Zainab II Hospital8. Universiti Sains Malaysia Hospital

Negeri Melaka9. Melaka Hospital

Negeri Sembilan Darul Khusus10. Tuanku Ja’afar Hospital (Paed)11. Tuanku Ja’afar Hospital

Pahang Darul Makmur12. Tengku Ampuan Afzan Hospital (Paed)13. Tengku Ampuan Afzan Hospital

Perak Darul Ridzuan14. Raja Permaisuri Bainun Hospital15. Renal Care (Ipoh Specialist)

Penang16. Pulau Pinang Hospital (Paed)17. Pulau Pinang Hospital

Sabah18. Duchess of Kent Hospital19. Queen Elizabeth Hospital20. Sabah Medical Centre

Sarawak21. Sarawak General Hospital

Selangor Darul Ehsan22. Selayang Hospital (Paed)23. Selayang Hospital24. Serdang Hospital25. Tengku Ampuan Rahimah Hospital

Terengganu Darul Iman26. Kemaman Hospital27. Sultanah Nur Zahirah Hospital

wilayah Persekutuan Kuala Lumpur28. Kuala Lumpur Hospital (Paed.)29. Kuala Lumpur Hospital30. Prince Court Medical Centre31. Pusat Perubatan Universiti Kebangsaan Malaysia32. Renal Dialysis Centre33. University Malaya Medical Centre

xiii

pARTiCipATiNG TRANSpLANT fOLLOW-up CENTRES 2012

Johor Darul Takzim1. Batu Pahat Hospital2. Hospital Enche’ Besar Hajjah Khalsom3. Mersing Hospital4. Pakar Sultanah Fatimah Muar Hospital5. Pontian Hospital6. Segamat Hospital7. Sultan Ismail Hospital (Paed)8. Sultan Ismail Pandan Hospital9. Sultanah Aminah Hospital

Kedah Darul Aman10. Sultanah Bahiyah Hospital

Kelantan Darul Naim11. Raja Perempuan Zainab II Hospital12. Universiti Sains Malaysia Hospital

Negeri Melaka13. Mahkota Medical Centre14. Melaka Hospital

Negeri Sembilan Darul Khusus15. Tuanku Ja’afar Hospital

Pahang Darul Makmur16. Tg. Ampuan Afzan Hospital

Perak Darul Ridzuan17. Raja Permaisuri Bainun Hospital18. Renal Care (Ipoh Specialist)19. Taiping Hospital

Penang20. Pulau Pinang Hospital

Sabah21. Duchess of Kent Hospital22. Klinik Dr Choo & Liew23. Labuan Hospital24. Queen Elizabeth Hospital25. Sabah Medical Centre26. Tawau Hospital

Sarawak27. Bintulu Hospital28. Miri Hospital29. Sarawak General Hospital30. Sibu Hospital31. Timberland Medical Centre

Selangor Darul Ehsan32. Assunta Hospital33. Selayang Hospital34. Serdang Hospital35. Smartcare Dialysis Centre (Subang Jaya)36. Tan Medical Renal Clinic37. Tg. Ampuan Rahimah Hospital

Terengganu Darul Iman38. Dungun Hospital39. Kemaman Hospital40. Sultanah Nur Zahirah Hospital

wilayah Persekutuan Kuala Lumpur41. Fan Medical Renal Clinic42. Kuala Lumpur Hospital (Paed)43. Kuala Lumpur Hospital44. Prince Court Medical Centre45. Prince Court Medical Centre46. Pusat Perubatan Universiti Kebangsaan Malaysia47. University Malaya Medical Centre

xiv

CONTRibuTiNG AuThORSCHAPTER TITLE AuTHORS INSTITuTIONS

1ALL RENAL REPLACEMENT THERAPY IN MALAYSIA

Lim Yam Ngo Kuala Lumpur Hospital Ghazali B Ahmad Kuala Lumpur Hospital Goh Bak Leong Serdang HospitalLee Day Guat National Renal Registry

2 DIALYSIS IN MALAYSIA

Goh Bak Leong Serdang HospitalLim Yam Ngo Kuala Lumpur HospitalOng Loke Meng Penang HospitalGhazali B Ahmad Kuala Lumpur Hospital Lee Day Guat National Renal Registry

3 DEATH AND SuRvIvAL ON DIALYSISWong Hin Seng Selayang HospitalOng Loke Meng Penang Hospital

4QOL AND REHABILITATION OuTCOMES ON DIALYSIS PATIENT IN MALAYSIA

Liu Wen Jiun Sultanah Aminah HospitalChew Thian Fook Seremban Specialist HospitalChristopher Lim Thiam Seong University Putra MalaysiaTan Wee Ming Sunway Medical CentreYia @ Yeow Hua Jern Hospital Pakar Sultanah Fatimah

5PAEDIATRIC RENAL REPLACEMENT THERAPY

Lee Ming Lee Tuanku Ja’afar HospitalLim Yam Ngo Kuala Lumpur Hospital Lynster Liaw Chiew Tung Penang HospitalSusan Pee Sultan Ismail HospitalWan Jazilah Wan Ismail Selayang Hospital

6MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS

Philip N. Jeremiah KPJ Ampang Puteri Specialist HospitalBee Boon Cheak Selayang HospitalGhazali B Ahmad Kuala Lumpur Hospital Lim Soo Kun University Malaya Specialist CentreZawawi B Nordin Sultanah Nur Zahirah Hospital

7 NuTRITIONAL STATuS ON DIALYSIS

Winnie Chee Siew Swee International Medical UniversityAbdul Halim B Abd Gafor Pusat Perubatan Universiti Kebangsaan MalaysiaAhmad Fauzi B Abd Rahman Puteri Specialist HospitalKoh Keng Hee Sarawak General Hospital

Tilakavati Karupaiah Faculty of Allied Health Sciences University Kebangsaan Malaysia

8BLOOD PRESSuRE CONTROL AND DYSLIPIDAEMIA

S. Prasad Menon Sime Darby Medical Centre Subang JayaHooi Lai Seong Sultanah Aminah HospitalLee Wan Tin Sime Darby Medical Centre Subang JayaSunita Bavanandan Kuala Lumpur Hospital

9CHRONIC KIDNEY DISEASE - MINERAL AND BONE DISORDERS

Rozina Bt Ghazalli Pulau Pinang HospitalChing Chen Hua Sultanah Bahiyah HospitalFan Kin Sing Gleneagles Intan Medical CentreLiew Yew Fong Pulau Pinang Hospital

10 HEPATITIS ON DIALYSIS

Teo Sue Mei Putri Haemodialysis Centre (Ipoh)Chow Yok Wai Pantai Air Keroh HospitalClare Tan Hui Hong Sarawak General HospitalT. Thiruventhiran Sunway Medical CentreNg Eng Khim Kuala Lumpur Hospital

11 HEAEMODIALYSIS PRACTICES

Tan Chwee Choon Tengku Ampuan Rahimah HospitalNorleen Bt Zulkarnain Sim Tengku Ampuan Rahimah HospitalRafidah Abdullah Sultan Haji Ahmad Shah HospitalShahnaz Shah Firdaus Khan Tengku Ampuan Rahimah Hospital

12CHRONIC PERITONEAL DIALYSIS PRACTICES

Sunita Bavanandan Kuala Lumpur HospitalAnita Bhajan Manocha Hospital Seberang JayaLily Mushahar Tuanku Ja’afar Hospital

13 RENAL TRANSPLANTATION

Goh Bak Leong Serdang HospitalFan Kin Sing Gleneagles Intan Medical CentreRohan Malek Bin Dato’ Dr. Johan Selayang HospitalRosnawati Yahya Kuala Lumpur HospitalS. Prasad Menon Sime Darby Medical Centre Subang JayaTan Si Yen Prince Court Medical CentreWong Hin Seng Selayang Hospital

xv

20 years had lapsed since the first publication of the Malaysian Dialysis and Transplant Registry. Far from being a mere reporting of

dialysis and transplant activities in the Ministry of Health facilities as in its initial years , currently , nearly ALL the centres which provide

haemodialysis and peritoneal dialysis services nationwide transecting private, public and NGO sectors , contribute their datasets on

regular basis to the NRR office to enable timely publication and dissemination of the annual registry report which by now has become a

regular feature in the Annual Congress of the Malaysian Society of Nephrology. This year’ s return is provided by a total of 710 dialysis

centres out of which 670 are HD centres and the rest made up of PD centres .

With continuing rise in the number of dialysis units operating across the country, the administrative tasks of the NRR secretariat do

increase substantially. Additionally, the uncertainty of continuous funding of the registry financial needs becomes increasingly more

obvious lately. Recent developments in the Division of Health Informatics , which partly oversee the operation of the Clinical Research

Centres in Ministry of Health hospitals, has led to the possibility of further curtailment in the partial registry funding for the Information

System component in addition to the possible changes in the way the national clinical registry operates. A good piece of welcome news

is the decision by the Malaysian Society of Nephrology recently to procure a strategically placed property in Jalan Pahang Kuala Lumpur

to house the NRR office which until now operates from rented premises .

As a part of the transition strategy, to ensure not just continuity but also further enhancements of the registry reports , a new editorial

team has taken over this year led by Dr Goh Bak Leong from Hospital Serdang , working closely with the co editor Dr Ong Loke Meng

from Hospital Pulau Pinang. With immense experience behind her sterling long years of service, the outgoing Chief Editor Dr Lim Yam Ngo

will continue to provide a helping hand to ensure orderliness and quality reporting which many of us are so used to by now.

On behalf of the registry Advisory Committee, I wish to express my utmost appreciation to all the sponsors especially Roche Malaysia

Sdn Bhd which had shown their continued generosity and commitment to support NRR, all the Source Data Providers which had diligently

and consistently submit useful and quality data without fail , members of the Expert Committee who persevered in their volunteerism ,

provide important and relevant commentaries and last but not least the experienced and committed NRR administrators under the able

leadership of Staff Nurse Lee Day Guat who work tirelessly and enthusiastically to ensure a high return to the requested data from all

the service providers as well as timely completion of all the necessary tasks to see yet again the publication of this year’s report ready

for dissemination by the time we meet in this year’s Annual Congress of Malaysian Society of Nephrology.

Datuk Dr. Ghazali AhmadChairmanAdvisory Committee 2012-2014National Renal Registry

fOREWORD

xvi

Acknowledgement iii NRR Advisory Board Members iv About The Malaysian Dialysis and Transplant Registry (MDTR v Participating Haemodialsyis Centres vii Participating Chronic Peritoneal Dialsysis Centres xiiParticipating Transplant Follow-up Centres xiiiContributing Editors xiv Foreword xv Contents xvi List of Tables xix List of Figures xxv Executive Summary xxx Abbreviations xxxi

CHAPTER 1: ALL RENAL REPLACEMENT THERAPY IN MALAYSIA 1

Section 1.1: Stock and flow 2

Section 1.2: Treatment provision rate 3

CHAPTER 2: DIALYSIS IN MALAYSIA 5

section 2.1: provision of dialysis in Malaysia (registry report) 6

Section 2.2: Dialysis provision in Malaysia (Centre survey report) 8

2.2.1: Growth in dialysis in Malaysia by state and sector 8

2.2.2: Geographic distribution 9

2.2.3: Growth in dialysis provision by sector 12

Section 2.3: Distribution of dialysis Treatment 14

2.3.1: Gender distribution 14

2.3.2: Age distribution 15

2.3.3: Method and location of dialysis 17

2.3.4: Funding for dialysis treatment 18

2.3.5: Distribution of dialysis patients by sector 19

Section 2.4: Primary renal disease 20

CHAPTER 3: DEATH AND SuRvIvAL ON DIALYSIS 21

Section 3.1: Death on dialysis 22

Section 3.2: Patient survival on dialysis 24

3.2.1: patient survival by type of dialysis modality 24

3.2.2: Patient survival by year of starting dialysis 25

3.2.3: Patient survival by age at starting dialysis 26

3.2.4: Patient survival by diabetic status 28

Section 3.3: Survival of incident dialysis patients by centre 29

3.3.1: Survival of incident haemodialysis patients 1993-2011 by centre 29

3.3.2: Survival of incident PD patients by centre 30

Section 3.4: Adusted mortality of dialysis patient 31

3.4.1: Adjusted hazard ratio for mortality of dialysis patients 31

3.4.2: Adjusted hazard ratio for mortality of haemodialysis patients 34

3.4.3: Adjusted hazard ratio for mortality of peritoneal dialysis patients 36

3.4.4: Risk adjusted mortality rate for haemodialysis patients by haemodialysis centres 38

3.4.5: Risk Adjusted Mortality Rate by PD centres 38

CONTENTS

xvii

CHAPTER 4: QuALITY OF LIFE AND REHABILITATION OuTCOMES OF DIALYSIS PATIENTS IN MALAYSIA 39

Section A: QoL Index score 40

Section B: Work related rehabilitation 43

Summary

CHAPTER 5: PAEDIATRIC RENAL REPLACEMENT THERAPY 45

Section A: RRT provision for paediatric patients 46

Section B: Distribution of paediatric dialysis patients 48

Section C: Primary renal disease 51

Section D: Types of renal transplantation 51

Section E: Survival analysis 52

Section F: Haemodialysis practice 55

Section G: Anaemia treatment 56

Report Summary 57

CHAPTER 6: MANAGEMENT OF ANAEMIA IN DIALYSIS PATIENTS 59

Section 6.1: Treatment for anaemia in patient on Dialysis 60

Section 6.2: Iron status on dialysis 65

Section 6.3: Haemoglobin outcomes on dialysis 74

CHAPTER 7: NuTRITIONAL STATuS ON DIALYSIS 83

Section 7.1: Serum albumin levels on dialysis 84

Section 7.2: Body Mass Index (BMI) on dialysis 88

Section 7.3: Nutritional parameters 92

CHAPTER 8: BLOOD PRESSuRE CONTROL AND DYSLIPIDAEMIA 93

Section 8.1: Blood Pressure Control on dialysis 94

Section 8.2: Dyslipidaemia in dialysis patients 103

CHAPTER 9: CHRONIC KIDNEY DISEASE - MINERAL BONE DIORDERS 111

Section 9.1: Treatment of hyperphosphateamia 112

Section 9.2: Serum calcium and phosphate control 114

Section 9.3: Serum parathyroid hormone control 124

Section 9.4: Renal bone disease among dialysis patients 130

Conclusion 132

CHAPTER 10: HEPATITIS ON DIALYSIS 133

Section A: Prevalence 134

Section B: Centre variation 134

Section C: Seroconversion risks 137

Conclusion 138

CONTENTS (CONT.)

xviii

CHAPTER 11: HAEMODIALYSIS PRACTICES 139

Section 11.1: Vascular access and its complications 140

Section 11.2: HD prescription 142

Section 11.3: Technique survival on dialysis 153

CHAPTER 12: PERITONEAL DIALYSIS PRACTICES 159

Section 12.1: Modalities and prescription of PD 160

Section 12. 2: Achievement of solute clearance and peritoneal transport 161

Section 12.3: Technique survival on PD 163

Section 12.4: PD Peritonitis 170

CHAPTER 13: RENAL TRANSPLANTATION 175

Section 13.1: Stock and flow 176

Section 13.2: Recipients' charateristics 178

Section 13.3: Transplant practices 180

13.3.1: Type of transplant 180

13.3.2: Place of transplant 181

Section 13.4: Transplant outcomes 182

13.4.1: Post ransplant complications 182

13.4.2: Biochemical outcome 183

13.4.3: Death and graft loss 184

13.4.4: Causes of death and graft loss 185

Section 13.5: Patient and graft survival 187

13.5.1: Patient and graft survival 187

13.5.2: Survival according to type of transplant 189

13.5.3: Outcome of living related renal transplantation 190

13.5.4: Outcome of commercial cadaveric transplantation 191

Section 13.6: Used of immunosuppressions and non immunosuppressive medication 193

13.6.1: Immunosuppresion medications 193

13.6.2: Non immunosuppression medications 194

Section 13.7: Cardiovascular risk in renal transplant recipients 195

13.7.1: Risk factors for ischaemic heart disease 195

13.7.2: Blood pressure classification according to JNC VIII criteria, 2004-2012 197

13.7.3: Level of allograft function 198

13.7.4: Body mass Index 198

13.7.5: Lipid profile 199

13.7.6: Blood pressure control 200

Section 13.8: Influence of immunosuppression on outcome and cardiovascular risk factors 202

Section 13.9: QoL index score in renal transplant recipients 207

APPENDIX I: DATA MANAGEMENT I-iv

APPENDIX II: ANALYSIS SETS, STATISTICAL METHODS AND DEFINITIONS v-IX

CONTENTS (CONT.)

xix

Table 1.1: Stock and flow of RRT, Malaysia 1993-2012 2

Table 1.2: New dialysis acceptance rate and new transplant rate per million population 1993-2012 3

Table 1.3: RRT prevalence rate per million population 1993-2012 3

Table 2.1.1(a): Stock and flow- HD Patients 1993-2012 6

Table 2.1.1(b): Stock and flow- PD Patients 1993-2012 6

Table 2.1.2(a): HD Treatment Rate per million population 1993-2012 6

Table 2.1.2(b): PD Treatment Rate per million population 1993-2012 7

Table 2.1.3: Dialysis Treatment Rate by state, per million population 1993-2012 7

Table 2.2.1: Number of dialysis centres, HD machines and treatment capacity, 2000-2012 8

Table 2.2.2(a): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2003

9

Table 2.2.2(b): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2007

10

Table 2.2.2(c): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2012

10

Table 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 12

Table 2.2.3(b): Number of dialysis centres, HD machines and treatment capacity by sector, 2000-2012 13

Table 2.3.1(a): Dialysis Treatment Rate by Gender, per million male or female population 1993-2012 14

Table 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 15

Table 2.3.2(a): Dialysis Treatment Rate by Age Group, per million age group population 1993-2012 15

Table 2.3.2: Percentage Age Distribution of Dialysis Patients 1993-2012 16

Table 2.3.3: Method and Location of Dialysis Patients 1993-2012 17

Table 2.3.4: Funding for Dialysis Treatment 1993-2012 18

Table 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 19

Table 2.4.1: Primary Renal Diseases 1993-2012 20

Table 3.1.1: Deaths on dialysis 1993-2012 22

Table 3.1.2(a): Causes of death on HD dialysis 1994-2012 23

Table 3.1.2(b): Causes of death on PD dialysis 1993-2012 23

Table 3.2.1(a): HD Patient survival (censored for change of modality) 24

Table 3.2.1(b): PD Patient survival (censored for change of modality) 24

Table 3.2.1(c): HD Patient survival (not censored for change of modality) 24

Table 3.2.1(d): PD Patient survival (not censored for change of modality) 24

Table 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012 25

Table 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012 25

Table 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012 26

Table 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012 27

Table 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012 28

Table 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012 28

Table 3.4.1: Adjusted hazard ratio for mortality of dialysis patients (not censored for change of modality (1993-2012) ) 31

Table 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality (1993-2012 cohort) 34

Table 3.4.3: Adjusted hazard ratio for mortality of PD patients uncensored for change of modality (1993-2012 cohort) 36

Table 4.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, all dialysis patients 1993-2012 40

Table 4.2: Cumulative distribution of QoL-Index score in relation to DM, all dialysis patients 1993-2012 40

Table 4.3: Cumulative distribution of QoL-index score in relation to gender, all dialysis patients 1993-2012 40

Table 4.4: Cumulative distribution of QoL-index score in relation to age, all dialysis patients 1993-2012 41

Table 4.5: Cumulative distribution of QoL-Index score in relation to year of entry, HD patients 1993-2012 41

Table 4.6: Cumulative distribution of QoL-Index score in relation to year of entry, PD patients 1993-2012 42

Table 4.7: Work related rehabilitation in relation to modality, dialysis patients, 1993-2012 43

Table 4.8: Work related rehabilitation in relation to year of entry, HD patients 1993-2012 43

Table 4.9: Work related rehabilitation in relation to year of entry, PD patients 1993-2012 43

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Table 5.1: Stock and flow of Paediatric Renal Replacement Therapy (RRT) 1993-2012 46

Table 5.2: Paediatric dialysis and transplant rates per million age-group population 1993-2012 47

Table 5.3(a): Dialysis treatment rate by state, per million state age group populations, 1993-2012 48

Table 5.3(b): New dialysis patients by state, 1993-2012 48

Table 5.4: Number of new dialysis and transplant patients by gender 1993-2012 48

Table 5.5: New RRT rate, per million age related population by age group 1993-2012 49

Table 5.6: New dialysis by treatment modality 1993-2012 50

Table 5.7: New dialysis by sector 1993-2012 50

Table 5.8: Primary renal disease by sex, 1993-2012 51

Table 5.9: Types of renal transplantation, 1993-2012 51

Table 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality) 52

Table 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality) 52

Table 5.11: Causes of death in dialysis patients, 1993-2012 53

Table 5.12: Dialysis technique survival by modality, 1993-2012 53

Table 5.13: Reasons for drop-out from PD program, 1993-2012 54

Table 5.14: Transplant graft survival, 1993-2012 54

Table 5.15: Causes of graft loss 54

Table 5.16: Vascular access on haemodialysis, 1997-2012 55

Table 5.17(a): Distribution of prescribed Kt/V, HD patients 2006-2012 55

Table 5.17(b): Distribution of delivered Kt/V, HD patients 2006-2012 55

Table 5.17(c): Distribution of URR, HD patients 2006-2012 55

Table 5.18: Treatment for anaemia, HD patients 1997-2012 56

Table 5.20: Distribution of transferrin saturation on Erythropoietin, PD patients, 1997-2012 56

Table 5.21: Distribution of ESA dose (u/wk) 1997-2012 57

Table 6.1.1: Treatment for anaemia, HD patients 1997-2012 60

Table 6.1.2: Treatment for anaemia, PD patients 1997-2012 60

Table 6.1.3: Variation in Erythropoiesis-Stimulating Agents (ESAs) utilization (% patients) among HD centres, 1997-2012 61

Table 6.1.4: Variation in ESAs utilization (% patients) among PD centres, 1997-2012 61

Table 6.1.5: Variation in mean weekly ESAs dose (u/week) among HD centres, 1997-2012 62

Table 6.1.6: Variation in mean weekly ESAs dose (u/week) among PD centres, 1997-2012 63

Table 6.1.7: Variation in use of blood transfusion (% patients) among HD centres, 1997-2012 63

Table 6.1.8: Variation in use of blood transfusion (% patients) among PD centres, 1997-2012 64

Table 6.2.1: Distribution of serum ferritin without ESAs, HD patients 1997-2012 65

Table 6.2.2: Distribution of serum ferritin without ESAs, PD patients 1997-2012 66

Table 6.2.3: Distribution of serum ferritin on ESAs, HD patients 1997-2012 66

Table 6.2.4: Distribution of serum ferritin on ESAs, PD patients 1997-2012 67

Table 6.2.5: Distribution of transferrin saturation without ESAs, HD patients, 1997-2012 67

Table 6.2.6: Distribution of transferrin saturation without ESAs, PD patients, 1997-2012 68

Table 6.2.7: Distribution of transferrin saturation on ESAs, HD patients, 1997-2012 68

Table 6.2.8: Distribution of transferrin saturation on ESAs, PD patients, 1997-2012 69

Table 6.2.9(a): Variation in Medium serum ferritin among patients on ESAs, HD centres 1997-2012 69

Table 6.2.9(b): Proportion of patients on ESAs with serum ferritin ≥100 ng/ml, HD centres 70

Table 6.2.9(c): Median transferrin saturation among patients on ESAs, HD centres 70

Table 6.2.9(d): Proportion of patients on ESAs with transferrin saturation ≥ 20%, HD centres 71

Table 6.2.10(a): Variation in medium serum ferritin among patients on ESAs, PD centres 1997-2012 71

Table 6.2.10(b): Proportion of patients on ESAs with serum ferritin ≥100 ng/ml, PD centres 72

Table 6.2.10(c): Median transferrin saturation among patients on ESAs, PD centres 72

Table 6.2.10(d): Proportion of patients on ESAs with transferring saturation ≥ 20%, PD centres 73

Table 6.3.1: Distribution of haemoglobin concentration without ESAs, HD patients 1997-2012 74

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Table 6.3.2: Distribution of haemoglobin concentration without ESAs, PD patients 1997-2012 74

Table 6.3.3(a): Distribution of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75

Table 6.3.3(b): Distribution of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76

Table 6.3.4(a): Distribution of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 76

Table 6.3.4(b): Distribution of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77

Table 6.3.5(a): Proportion in median haemoglobin level among patients on ESAs, HD centres 1997-2012 78

Table 6.3.5(b): Proportion of patients on ESAs with haemoglobin level > 10g/dL, HD centres 78

Table 6.3.6(a): Proportion in Median haemoglobin level among patients on ESAs, PD centres 1997-2012 79

Table 6.3.6(b): Proportion of patients on ESAs with haemoglobin level > 10g/dL, PD centres 79

Table 6.3.7: Distribution of haemoglobin concentration on ESAs, HD patients 1997-2012 80

Table 6.3.8: Distribution of haemoglobin concentration on ESAs, PD patients 1997-2012 81

Table 7.1.1: Distribution of serum albumin, HD patients, 1997-2012 84

Table 7.1.2: Distribution of serum albumin, PD patients, 1997-2012 85

Table 7.1.3: Variation in proportion of patients with serum albumin ≥ 40g/L among HD centres 1997-2012 86

Table 7.1.4: Variation in proportion of patients with serum albumin ≥40g/L among PD centres 1997-2012 87

Table 7.2.1: Distribution of BMI, HD patients, 1997-2012 88

Table 7.2.2: Distribution of BMI, PD patients 1997-2012 89

Table 7.2.3: Variation in proportion of patients with BMI ≥ 18.5 among HD centres 1997-2012 90

Table 7.2.4: Variation in proportion of patients with BMI ≥ 18.5 among PD centres1997-2012 90

Table 7.2.5: Variation in proportion of patients with BMI ≥ 18.5 and serum albumin ≥ 40 g/dL among HD centres 1997-2012 91

Table 7.2.6: Variation in proportion of patients with BMI ≥ 18.5 and serum albumin ≥ 40 g/dL among PD centres 1997-2012 91

Table 7.3.1(a): Nutritional parameters between HD patients, 2012 92

Table 7.3.1(b): Nutritional parameters between PD patients, 2012 92

Table 7.3.2(a): Nutritional parameters between diabetic and non- diabetic HD patients, 2012 92

Table 7.3.2(b): Nutritional parameters between diabetic and non-diabetic PD patients, 2012 92

Table 7.3.3(a): Distribution of serum albumin and BMI by duration of dialysis among HD patients, 1997-2012 92

Table 7.3.3(b): Distribution of serum albumin and BMI by duration of dialysis among PD patients, 1997-2012 92

Table 8.1.1: Distribution of pre dialysis systolic blood pressure, HD patients 1997-2012 94

Table 8.1.2: Distribution of pre dialysis systolic blood pressure, PD patients 1997-2012 95

Table 8.1.3: Distribution of pre dialysis diastolic blood pressure, HD patients 1997-2012 96

Table 8.1.4: Distribution of pre dialysis diastolic blood pressure, PD patients 1997-2012 97

Table 8.1.5(a): Median systolic blood pressure among HD patients, HD centres 98

Table 8.1.5(b): Median diastolic blood pressure among HD patients, HD centres 99

Table 8.1.5(c): Proportion of HD patients with pre dialysis blood pressure < 140/90 mmHg, HD centres 100

Table 8.1.6(a): Median systolic blood pressure among PD patients, PD centres 101

Table 8.1.6(b): Median diastolic blood pressure among PD patients, PD centres 102

Table 8.1.6(c): Proportion of PD patients with pre dialysis blood pressure < 140/90 mmHg, PD centres 102

Table 8.2.1: Distribution of serum cholesterol, HD patients 1997-2012 103

Table 8.2.2: Distribution of serum cholesterol, PD patients 1997-2012 104

Table 8.2.3: Distribution of serum triglyceride, HD patients 1997-2012 105

Table 8.2.4: Distribution of serum triglyceride, PD patients 1997-2012 105

Table 8.2.5(a): Median serum cholesterol level among HD patients, HD centres 106

Table 8.2.5(b): Proportion of HD patients with serum cholesterol < 5.3mmol/L, HD centres 107

Table 8.2.5(c): Median serum triglyceride level among HD patients, HD centres 107

Table 8.2.5(d): Proportion of HD patients with serum triglyceride < 2.1mmol/L, HD centres 108

Table 8.2.6(a): Median serum cholesterol level among PD patients, PD centres 109

Table 8.2.6(b): Proportion of PD patients with serum cholesterol < 5.3mmol/L, PD centres 109

Table 8.2.6(c): Median serum triglyceride level among PD patients, PD centres 110

Table 8.2.6(d): Proportion of PD patients with serum triglyceride < 2.1mmol/L, PD centres 110

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Table 9.1.1: Phosphate Binder in HD patients, 1997-2012 112

Table 9.1.2: Phosphate Binder in PD patients, 1997-2012 112

Table 9.1.3: Phosphate Binders by Sector in HD patients 113

Table 9.2.1: Distribution of corrected serum calcium, HD patients, 1997-2012 114

Table 9.2.2: Distribution of corrected serum calcium, PD patients, 1997-2012 114

Table 9.2.3: Distribution of serum phosphate, HD patients, 1997-2012 115

Table 9.2.4: Distribution of serum phosphate, PD patients, 1997-2012 115

Table 9.2.5: Distribution of corrected calcium x phosphate product, HD patients 1997-2012 116

Table 9.2.6: Distribution of corrected calcium x phosphate product, PD patients 1997-2012 116

Table 9.2.7(a): Variation in corrected median serum calcium level among HD centres 1997-2012 117

Table 9.2.8(a): Variation in corrected median serum calcium level among PD centres 1997-2012 117

Table 9.2.7(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 1997-2012 118

Table 9.2.8(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres 118

Table 9.2.9(a): Variation in median serum phosphate level among HD centres, 2002- 2012 119

Table 9.2.10(a): Variation in median serum phosphate levels among PD centres 1997-2012 119

Table 9.2.9(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres, 1997-2012 120

Table 9.2.10(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 1997-2012 120

Table 9.2.9(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres, 2012 121

Table 9.2.10(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres, 2012 121

Table 9.2.11(a): Variation in corrected median calcium x phosphate product HD centres 1997-2012 122

Table 9.2.12(a): Variation in corrected median calcium x phosphate product PD centres 1997-2012 122

Table 9.2.11(b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, HD centres 123

Table 9.2.12(b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, PD 123

Table 9.3.1(a): Treatment of hyperparathyroidism in HD patients, 1997-2012 124

Table 9.3.1(b): Treatment of hyperparathyroidism in PD patients, 1997-2012 124

Table 9.3.2(a): Distribution of iPTH, HD patients, 1997-2012 125

Table 9.3.2(b): Distribution of iPTH, diabetic HD patients, 1997-2012 125

Table 9.3.2(c): Distribution of iPTH, non-diabetic HD patients, 1997-2012 126

Table 9.3.3(a): Distribution of iPTH, PD patients, 1997-2012 126

Table 9.3.3(b): Distribution of iPTH, diabetic PD patients, 1997-2012 127

Table 9.3.3(c): Distribution of iPTH, non diabetic PD patients, 1997-2012 127

Table 9.3.4(a): Variation in iPTH among HD centres 1997-2012 128

Table 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 1997-2012 128

Table 9.3.5(a): Variation in median iPTH among PD patients 1997-2012 129

Table 9.3.5(b): Proportion of patients with iPTH 150-300pg/ml 129

Table 9.4.1: Low turnover bone disease vs high turnover bone disease in dialysis patient, 1997-2012 130

Table 9.4.2: Low turnover bone disease vs high turnover bone disease by gender, 1997-2012 130

Table 9.4.3: Low turnover bone disease vs high turnover bone disease by age group, 1997-2012 131

Table 9.4.4: Low turnover bone disease vs high turnover bone disease by diabetes status, 1997-2012 131

Table 10.1: Prevalence of positive HBsAg and positive Anti-HCV at annual survey, HD patients 1993-2012 134

Table 10.2: Prevalence of positive HBsAg and positive Anti-HCV at annual survey, PD patients 1993-2012 134

Table 10.3: Variation in Proportion of patients with positive HBsAg at annual survey among HD centres, 1993-2012 135

Table 10.4: Variation in proportion of patients with positive HBsAg at annual survey among PD centres, 1993-2012 135

Table 10.5: Variation in proportion of patients with positive anti-HCV at annual survey among HD centres, 1993-2012 136

Table 10.6: Variation in proportion of patients with positive anti-HCV at annual survey among PD centres, 1993-2012 136

Table 10.7(a): Risk factors in relation to HD practices for seroconversion to anti-HCV positive among sero-negative patients 1993-2012 137

Table 10.7(b): Risk factors for seroconversion to anti-HCV positive among sero-negative patients in PD 1993-2012 138

Table 11.1.1: Vascular access on haemodialysis, 1997-2012 140

Table 11.1.2: Difficulties report with vascular access, 1997-2012 140

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Table 11.1.3: Complications reported with vascular access, 1997-2012 141

Table 11.2.1: Blood flow rates in HD centers, 1997-2012 142

Table 11.2.2: Number of HD sessions per week, 1997-2012 143

Table 11.2.3: Duration of HD, 1997-2012 143

Table 11.2.4: Dialyser membrane types in HD centres, 1997-2012 144

Table 11.2.5: Frequency of Dialyser use in HD centres, 1997-2012 145

Table 11.2.6(a): Distribution of prescribed Kt/V, HD patients 1997-2012 146

Table 11.2.6(b): Distribution of delivered Kt/V, HD patients 2006-2012 146

Table 11.2.6(c): Distribution of URR, HD patients 2006-2012 147

Table 11.2.7(a): Variation in median blood flow rates in HD patients, HD centres, 1997-2012 148

Table 11.2.7(b): Proportion of patients with blood flow rates > 300 ml/min, HD centres 1997-2012 148

Table 11.2.7(c): Proportion of patients with 3 HD sessions per week, HD centres 1997-2012 149

Table 11.2.7(d): Median prescribed Kt/V in HD patients, HD centres 1997-2012 149

Table 11.2.7(e): Proportion of patients with prescribed Kt/V ≥ 1.3, 1997-2012 150

Table 11.2.7(f): Median delivered Kt/V in HD patients, HD centres 2006-2012 150

Table 11.2.7(g): Proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2006-2012 151

Table 11.2.7(h): Median URR among HD patients, HD centres 2006-2012 151

Table 11.2.7(i): Proportion of HD patients with URR ≥ 65%, HD centres 2006-2012 152

Table 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 153

Table 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1993-2012 154

Table 11.3.2(a): Unadjusted technique survival by age, 1993-2012 156

Table 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1993-2012 157

Table 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 158

Table 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 158

Table 12.1.1: Peritoneal dialysis regimes, 1997-2012 160

Table 12.1.2: PD System, 1997-2012 160

Table 12.1.3(a): CAPD Number of Exchanges per day, 1997-2012 160

Table 12.1.3(b): APD dwell volumes per day, 1997-2012 161

Table 12.2.1: Distribution of delivered Kt/V, PD patients 2003-2012 161

Table 12.2.2: Variation in proportion of patients with Kt/V >1.7 per week among PD centres, 1997-2012 162

Table 12.2.3: Peritoneal transport status by PET D/P creatinine at 4 hours, new PD patients 2004-2012 162

Table 12.2.4: Peritoneal Transport Status (PET) with dialysis vintage 162

Table 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012 163

Table 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012 164

Table 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012 165

Table 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012 165

Table 12.3.3(a): Unadjusted technique survival by diabetes status (uncensored for death and transplant), 1997-2012 166

Table 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012 166

Table 12.3.4: Unadjusted technique survival by Kt/V, 1997-2012 167

Table 12.3.5: Adjusted hazard ratio for change of modality, 1997-2012 167

Table 12.3.6: Reasons for drop-out from PD program, 2003-2012 168

Table 12.3.7: Drop-out rate from PD program with time on treatment, 2003-2012 168

Table 12.3.8: Time on PD (1997-2012) 168

Table 12.4.1: Variation in peritonitis rate (patient-month/episode) among PD centres, 1997-2012 170

Table 12.4.2: Causative organism in PD peritonitis, 2003-2012 171

Table 12.4.3(a): Outcome of peritonitis by causative organism, 1993-2002 172

Table 12.4.3(b): Outcome of peritonitis by causative organism, 2003-2012 173

Table 12.4.4: Risk factors influencing peritonitis rate, 1993-2012 174

Table 13.1.1: Stock and flow of renal transplantation, 1993-2012 176

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Table 13.1.2: New transplant rate per million population (pmp), 1993-2012 176

Table 13.1.3: Transplant prevalence rate per million population (pmp), 1993-2012 177

Table 13.2.1: Renal transplant recipients’ characteristics, 1993-2012 178

Table 13.2.2: Primary causes of end stage renal failure, 1993-2012 179

Table 13.3.1: Type of renal transplantation, 1993-2012 180

Table 13.3.2: Place of transplantation, 1993-2012 181

Table 13.4.1: Post-transplant complications, 1993-2012 182

Table 13.4.2: Biochemical data, 2004-2012 183

Table 13.4.3: Transplant patients’ death rate and graft loss, 1993-2012 184

Table 13.4.4(a): Causes of death in transplant recipients, 1993-2012 185

Table 13.4.4(b): Causes of graft failure, 1993-2012 186

Table 13.5.1.1: Patient survival, 1993-2012 187

Table 13.5.1.2: Risk factors for transplant patient survival 1993-2012 187

Table 13.5.1.3: Graft survival, 1993-2012 188

Table 13.5.1.4: Risk factors for transplant graft survival 1993-2012 188

Table 13.5.2.1: Unadjusted patient survival by type of transplant, 1993-2012 189

Table 13.5.2.2: Graft survival by type of transplant, 1993-2012 190

Table 13.5.3.1: Patient survival by year of transplant (Living related transplant, 1993-2012) 190

Table13.5.3.2: Graft survival by year of transplant (Living related transplant, 1993-2012) 191

Table 13.5.4.1: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2012) 191

Table 13.5.4.2: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192

Table 13.6.1: Medication data, 2004-2012 193

Table 13.6.2: Use of antihypertensives 194

Table 13.7.1: Risk factors for IHD in renal transplant recipients at year 2004-2012 195

Table 13.7.2(a): Systolic BP, 2004-2012 197

Table 13.7.2(b): Diastolic BP, 2004-2012 197

Table 13.7.3: CKD stages, 2004-2012 198

Table 13.7.4: BMI, 2004-2012 198

Table 13.7.5(a): LDL, 2004-2012 199

Table 13.7.5(b): Total cholesterol, 2004-2012 199

Table 13.7.5(c): HDL, 2004-2012 200

Table 13.7.6(a): Treatment for hypertension, 2004-2012 200

Table 13.7.6(b): Distribution of systolic BP without anti-hypertensive, 2004-2012 201

Table 13.7.6(c): Distribution of diastolic BP without anti-hypertensive, 2004-2012 201

Table 13.7.6(d): Distribution of systolic BP on anti-hypertensives, 2004-2012 201

Table 13.7.6(e): Distribution of diastolic BP on anti-hypertensives, 2004-2012 201

Table 13.8.3.1: Allograftraft and patient survival, Azathioprine vs Mycophenolic Acid 1993-2012 202

Table 13.8.3.2: Graft and patient survival, CsA vs Tacrolimus 203

Table 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012 203

Table 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012 203

Table 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 2004-2012 204

Table 13.8.3.6: Incidence of post transplant diabetes mellitus, CsA vs Tacrolimus, 2004-2012 204

Table 13.9.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, transplant recipient patients 1993-2012 204

Table 13.9.2: Cumulative distribution of QoL-Index score in relation to diabetes mellitus, transplant recipient patients 1993-2012 205

Table 13.9.3: Cumulative distribution of QoL-Index score in relation to gender, transplant recipient patients 1993-2012 205

Table 13.9.4: Cumulative distribution of QoL-Index score in relation to age, transplant recipient patients 1993-2012 205

Table 13.9.5: Cumulative distribution of QoL-Index score in relation to year of entry, transplant recipient patients 1993-2012 206

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Figure 1.1: Stock and flow of RRT, Malaysia 1993-2012 2

Figure 1(a): New dialysis and transplant patients 2

Figure 1(b): Patients dialysing and with functioning transplant at 31st December 1993-2012 2

Figure 1.2: New dialysis acceptance and new transplant rate 1993-2012 3

Figure 1.3: Dialysis and transplant prevalence rate per million population 1993-2012 3

Figure 2.2.1(a): Distribution of dialysis centres, 1993-2012 8

Figure 2.2.1(b): Distribution of HD capacity, 1993-2012 8

Figure 2.2.1(c): Distribution of dialysis patients, 1993-2012 9

Figure 2.2.1(d): HD capacity to patient ratio, 1993-2012 9

Figure 2.2.2(a): Distribution of hemodialysis centres by State, 2003-2012 11

Figure 2.2.2(c): Distribution of patients/million population by State, 2003-2012 11

Figure 2.2.2(b): Distribution of dialysis patients by State, 2003-2012 11

Figure 2.2.2(d): HD capacity to patient ratio by State, 2003-2012 11

Figure 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 12

Figure 2.2.3(b)(i): Distribution of dialysis centres by Sector, 1993-2012 14

Figure 2.2.3(b)(ii): Distribution of HD capacity by Sector, 1993-2012 14

Figure 2.2.3(b)(iii): Distribution of dialysis patients by Sector, 1993-2012 14

Figure 2.2.3(b)(iv): HD capacity to patient ratio by Sector, 1993-2012 14

Figure 2.3.1(a): Dialysis Treatment Rate by Gender 1993-2012 14

Figure 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 15

Figure 2.3.2(a): Dialysis Treatment Rate by Age Group 1993-2012 16

Figure 2.3.2(b): Age Distribution of New Dialysis Patients 1993-2012 17

Figure 2.3.3: Method and Location of Dialysis Patients 1993-2012 17

Figure 2.3.4: Funding for Dialysis Treatment 1993-2012 18

Figure 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 19

Figure 2.4.1: Primary Renal Diseases for New Dialysis Patients 1993-2012 20

Figure 3.1.1: Death rates on dialysis 1993-2012 22

Figure 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012 25

Figure 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012 25

Figure 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012 26

Figure 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012 27

Figure 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012 28

Figure 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012 28

Figure 3.3.1(a): Variation in patient survival at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011 29

Figure 3.3.1(b): Funnel plot for adjusted age at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011cohor 29

Figure 3.3.1(c): Variation in patient survival at 5-years among HD centres adjusted for age and diabetes mellitus status, 1993-2007 29

Figure 3.3.1(d): Funnel plot for patient survival at 5-years among HD centres adjusted age and diabetes mellitus, 1993-2007cohort 29

Figure 3.3.2(a): Variation in patient survival at 1-year among PD centres adjusted for age and diabetes mellitus, 1993-2011 30

Figure 3.3.2(b): Funnel plot of 1-year patient survival from the 90th day of dialysis adjusted for age and diabetes mellitus among PD centres, 1993-2011 cohort 30

Figure 3.3.2(c): Variation in patient survival at 5-years among PD centres adjusted for age and diabetes mellitus, 1993-2007 30

Figure 3.3.2(d): Funnel plot of 5-years patient survival from 90 day of dialysis adjusted for age and diabetes mellitus among PD centres, 1993-2007 cohort 30

Figure 3.4.1(a): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by diastolic blood pressure (1993-2012 cohort) 33

Figure 3.4.1(b): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by serum phosphate (1993-2012 cohort) 33

Figure 3.4.1(c): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by hemoglobin (1993-2012 cohort) 33

Figure 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality by Delivered Kt/V (1993-2012 cohort) 35

Figure 3.4.4(a): Variations in RAMR by HD centre, 2011 38

Figure 3.4.4(b): Funnel plot of RAMR by HD centre, 2011 38

Figure 3.4.5(a): Variations in RAMR by PD centres, 2011 38

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Figure 3.4.5(b): Funnel plot for RAMR by PD centres, 2011 38

Figure 4.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, all dialysis patients 1993-2012 40

Figure 4.2: Cumulative distribution of QoL-Index score in relation to DM, All Dialysis patients, 1993-2012 40

Figure 4.3: Cumulative distribution of QoL-Index score in relation to gender, all dialysis patients, 1993-2012 40

Figure 4.4: Cumulative distribution of QoL-Index score in relation to age, all dialysis patients, 1993-2012 41

Figure 4.5: Cumulative distribution of QoL-Index score in relation to year of entry, HD patients 1993-2012 42

Figure 4.6: Cumulative distribution of QoL-Index score in relation to year of entry, PD patients 1993-2012 42

Figure 5.1(a): Incidence cases of RRT by modality in children under 20 years old, 1993-2012 46

Figure 5.1(b): Prevalence cases of RRT by modality in children under 20 years old, 1993-2012 46

Figure 5.2: Incidence and prevalence rate per million age related population years old on RRT, 1993-2012 47

Figure 5.4: Number of new dialysis and transplant patients by gender 1993-2012 49

Figure 5.5: New RRT rate by age group 1993-2012 49

Figure 5.6: New dialysis by treatment modality 1993-2012 50

Figure 5.7: New dialysis by sector 1993-2012 50

Figure 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality) 52

Figure 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality) 52

Figure 5.12: Dialysis technique survival by modality, 1993-2012 53

Figure 5.14: Transplant graft survival, 1993-2012 54

Figure 6.1.3(a): Variation in ESAs utilization (% patients) among HD centres, 2012 61

Figure 6.1.3(b): Median of ESA utilisation (% patients) among HD centres, 1997-2012 61

Figure 6.1.4(a): Variation in ESAs utilization (% patients) among PD centres, 2012 62

Figure 6.1.4(b): Median of ESA utilisation (% patients) among PD centres, 1997-2012 62

Figure 6.1.5(a): Variation in mean weekly ESAs dose (u/week) among HD centres 2012 62

Figure 6.1.5(b): Median of mean weekly ESAs dose (u/week) among HD centres, 1997-2012 62

Figure 6.1.6(a): Variation in mean weekly ESAs dose (u/week) among PD centres 2012 63

Figure 6.1.6(b): Median of mean weekly ESAs dose (u/week) among PD centres, 1997-2012 63

Figure 6.1.7(a): Variation in use of blood transfusion (% patients) among HD centres, 2012 64

Figure 6.1.7(b): Median of use of blood transfusion (% patients) among HD centres, 1997-2012 64

Figure 6.1.8(a): Variation in use of blood transfusion (% patients) among PD centres, 2012 64

Figure 6.1.8(b): Median of use of blood transfusion (% patients) among PD centres, 1997-2012 64

Figure 6.2.1: Cumulative Distribution of serum ferritin without ESAs, HD patients 1997-2012 65

Figure 6.2.2: Distribution of serum ferritin without ESAs, PD patients 1997-2012 66

Figure 6.2.3: Cumulative distribution of serum ferritin on ESAs, HD patients 1997-2012 66

Figure 6.2.4: Cumulative distribution of serum ferritin on ESAs, PD patients 1997-2012 67

Figure 6.2.5: Cumulative distribution of transferrin saturation without ESAs, HD patients 1997-2012 67

Figure 6.2.6: Cumulative distribution of transferrin saturation without ESAs, PD patients 1997-2012 68

Figure 6.2.7: Cumulative distribution of transferrin saturation on ESAs, HD patients 1997-2012 68

Figure 6.2.8: Cumulative distribution of transferrin saturation on ESAs, PD patients 1997-2012 69

Figure 6.2.9(a): Variation in medium serum ferritin among patients on ESAs, HD centres 2012 69

Figure 6.2.9(b): Variation in proportion of patients on ESAs with serum ferritin ≥ 100 ng/ml, HD centres 2012 70

Figure 6.2.9(c): Variation in median transferring saturation among patients on ESAs HD centres, 2012 70

Figure 6.2.9(d): Variation in proportion of patients on ESAs with transferring saturation ≥ 20%, HD centres, 2012 71

Figure 6.2.10(a): Variation in medium serum ferritin among patients on ESAs, PD centres 2012 71

Figure 6.2.10(b): Variation in proportion of patients on ESAs with serum ferritin ≥ 100ng/ml, PD centres 2012 72

Figure 6.2.10(c): Variation in median transferrin saturation among patients on ESAs, PD centres 2012 72

Figure 6.2.10(d): Variation in proportion of patients on ESAs with transferrin saturation ≥ 20 %, PD centres 2012 73

Figure 6.3.1(a): Cumulative distribution of haemoglobin concentration without ESAs, HD patients 1997-2012 74

Figure 6.3.1(b): Mean of haemoglobin concentration without ESAs, HD patients 1997-2012 74

Figure 6.3.2(a): Cumulative distribution of haemoglobin concentration without ESAs, PD patients 1997-2012 75

Figure 6.3.2(b): Mean of haemoglobin concentration without ESAs, PD patients 1997-2012 75

Figure 6.3.3(a)(i): Cumulative distribution of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75

Figure 6.3.3(a)(ii): Mean of haemoglobin concentration on ESAs, diabetes HD patients 1997-2012 75

Figure 6.3.3(b)(i): Cumulative distribution of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76

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Figure 6.3.3(b)(ii): Mean of haemoglobin concentration on ESAs, non-diabetes HD patients 1997-2012 76

Figure 6.3.4(a)(i): Cumulative distribution of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 77

Figure 6.3.4(a)(ii): Mean of haemoglobin concentration on ESAs, diabetes PD patients 1997-2012 77

Figure 6.3.4(b)(i): Cumulative distribution of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77

Figure 6.3.4(b)(ii): Mean of haemoglobin concentration on ESAs, non-diabetes PD patients 1997-2012 77

Figure 6.3.5(a): Variation in median haemoglobin level among patients on ESAs, HD centres 2012 78

Figure 6.3.5(b): Variation in proportion of patients on ESAs with haemoglobin level > 10g/dL, HD centres 2012 78

Figure 6.3.6(a): Variation in median haemoglobin level among patients on ESAs, PD centres 2012 79

Figure 6.3.6(b): Variation in proportion of patients on ESAs with haemoglobin level > 10g/dL, PD centres, 2012 79

Figure 6.3.7(a): Cumulative distribution of haemoglobin concentration on ESAs, HD patients 1997-2012 80

Figure 6.3.7(b): Mean of haemoglobin concentration on ESAs, HD patients 1997-2012 80

Figure 6.3.8(a): Cumulative distribution of haemoglobin concentration on ESAs, PD patients 1997-2012 81

Figure 6.3.8(b): Mean of haemoglobin concentration on ESAs, PD patients 1997-2012 81

Figure 7.1.1: Cumulative distribution of serum albumin, HD patients 1997-2012 84

Figure 7.1.2: Cumulative distribution of serum albumin, PD patients 1997-2012 85

Figure 7.1.3: Variation in proportion of patients with serum albumin >40g/L, HD centres 2012 86

Figure 7.1.4: Variation in proportion of patients with serum albumin >40g/L, PD centres 2012 87

Figure 7.2.1(a): Cumulative distribution of BMI, HD patients 1997-2012 88

Figure 7.2.1(b): mean BMI, HD patients 1997-2012 88

Figure 7.2.2(a): Cumulative distribution of BMI, PD patients 1997-2012 89

Figure 7.2.2(b): mean BMI, PD patients 1997-2012 89

Figure 7.2.3: Variation in proportion of patients with BMI >18.5 among HD centres 2012 90

Figure7.2.4: Variation in proportion of patients with BMI> 18.5 among PD centres 2012 90

Figure 7.2.5: Variation in proportion of patients with BMI >18.5 and serum albumin > 40 g/dL among HD centres 2012 91

Figure 7.2.6: Variation in proportion of patients with BMI >18.5 and serum albumin >40 g/dL among PD centres 2012 91

Figure 8.1.1(a): Cumulative distribution of pre dialysis systolic blood pressure, HD patients 1997-2012 94

Figure 8.1.1(b): Mean of pre dialysis systolic blood pressure, HD patients 1997-2012 94

Figure 8.1.2(a): Distribution of pre dialysis systolic blood pressure, PD patients 1997-2012 95

Figure 8.1.2(b): Mean of pre dialysis systolic blood pressure, PD patients 1997-2012 95

Figure 8.1.3(a): Cumulative Distribution of pre dialysis diastolic blood pressure, HD patients 1997-2012 96

Figure 8.1.3(b): Mean of pre dialysis diastolic blood pressure, HD patients 1997-2012 96

Figure 8.1.4(a): Cumulative Distribution of pre dialysis diastolic blood pressure, PD patients 1997-2012 97

Figure 8.1.4(b): Mean of pre dialysis diastolic blood pressure, PD patients 1997-2012 97

Figure 8.1.5(a): Variation in median systolic blood pressure among HD patients, HD centres 2012 98

Figure 8.1.5(b): Variation in median diastolic blood pressure among HD patients, HD centres 2012 99

Figure 8.1.5(c): Variation in proportion of HD patients with pre dialysis blood pressure < 140/90 mmHg, HD centres 2012 100

Figure 8.1.6(a): Variation in median systolic blood pressure among PD patients, PD centres 2012 101

Figure 8.1.6(b): Variation in median diastolic blood pressure among PD patients, PD centres 2012 102

Figure 8.1.6(c): Variation in proportion of PD patients with pre dialysis blood pressure ≤140/90 mmHg, PD centres 2012 102

Figure 8.2.1: Cumulative distribution of cholesterol, HD patients 1997-2012 103

Figure 8.2.2: Cumulative distribution of cholesterol (mmol/L), PD patients 1997-2012 104

Figure 8.2.3: Cumulative distribution of serum triglyceride, HD patients 1997-2012 105

Figure 8.2.4: Cumulative distribution of serum triglyceride, PD patients 1997-2012 105

Figure 8.2.5(a): Variation in median serum cholesterol level among HD patients, HD centres 2012 106

Figure 8.2.5(b): Variation in proportion of patients with serum cholesterol < 5.3mmol/L, HD centres 2012 107

Figure 8.2.5(c): Variation in median serum triglyceride level among HD patients, HD centers 2012 107

Figure 8.2.5(d): Variation in proportion of patients with serum triglyceride < 2.1mmol/L, HD centers 2012 108

Figure 8.2.6(a): Variation in median serum cholesterol level among PD patients, PD centres 2012 109

Figure 8.2.6(b): Variation in proportion of patients with serum cholesterol < 5.3mmol/L, PD centres 2012 109

Figure 8.2.6(c): Variation in median serum triglyceride level among PD patients, PD centres 2012 110

Figure 8.2.6(d): Variation in proportion of patients with serum triglyceride < 2.1mmol/L, PD centres 2012 110

Figure 9.2.1: Cumulative distribution of corrected serum calcium, HD patients, 1997-2012 114

Figure 9.2.2: Cumulative distribution of corrected serum calcium, PD patients, 1997-2012 114

Figure 9.2.3: Cumulative distribution of serum phosphate, HD patients, 1997-2012 115

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Figure 9.2.4: Cumulative distribution of serum phosphate, PD patients, 1997-2012 115

Figure 9.2.5: Cumulative distribution of corrected calcium x phosphate product, HD patients 1997-2012 116

Figure 9.2.6: Cumulative distribution of corrected calcium x phosphate product, PD patients 1997-2012 116

Figure 9.2.7(a): Variation in median serum calcium among HD patients, HD centres, 2012 117

Figure 9.2.8(a): Variation in median serum calcium level among PD patients, PD centres, 2012 117

Figure 9.2.7(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 2012 118

Figure 9.2.8(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres, 2012 118

Figure 9.2.9(a): Variation in median serum phosphate level among HD patients, HD centres, 2012 119

Figure 9.2.10(a): Variation in median serum phosphate level among PD patients, PD centres 2012 119

Figure 9.2.9(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres, 2012 120

Figure 9.2.10(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 2012 120

Figure 9.2.9(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres, 2012 121

Figure 9.2.10(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres 2012 121

Figure 9.2.11(a): Variation in median corrected calcium x phosphate product among HD patients, HD centres, 2012 122

Figure 9.2.12(a): Variation in median corrected calcium x phosphate product among PD centres, to 2012 122

Figure 9.2.11(b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, HD centres 2012 123

Figure 9.2.12(b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, PD centres, 2012 123

Figure 9.3.2(a): Cumulative distribution of iPTH, HD, 1997-2012 125

Figure 9.3.2(b): Cumulative distribution of iPTH, diabetic HD patients, 1997-2012 125

Figure 9.3.2(c): Cumulative distribution of iPTH, non-diabetic HD patients, 1997-2012 126

Figure 9.3.3(a): Cumulative distribution of iPTH, PD patients, 1997-2012 126

Figure 9.3.3(b): Cumulative distribution of iPTH, diabetic PD patients, 1997-2012 127

Figure 9.3.3(c): Cumulative distribution of iPTH, non diabetic PD patients, 1997-2012 127

Figure 9.3.4(a): Variation in median iPTH among HD patients, HD centres 2012 128

Figure 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 2012 128

Figure 9.3.5(a): Variation in median iPTH among PD patients, PD centres, 2012 129

Figure 9.3.5(b): Variation in proportion of patients with iPTH 150-300pg/ml, PD centres 2012 129

Figure 10.3: Variation in proportion of patients with positive HBsAg among HD centres, 2012 135

Figure 10.4: Variation in proportion of patients with positive HBsAg among PD centres, 2012 135

Figure 10.5: Variation in proportion of patients with positive anti-HCV among HD centres, 2012 136

Figure 10.6: Variation in proportion of patients with positive anti-HCV among PD centres, 2012 136

Figure 11.2.1: Blood flow rates in HD centers, 1997-2012 142

Figure 11.2.4: Dialyser membrane types in HD centres, 1997-2012 144

Figure 11.2.6(a): Cumulative distribution of prescribed Kt/V, HD patients 1997-2012 146

Figure 11.2.6(b): Cumulative distribution of delivered Kt/V, HD patients 2006-2012 146

Figure 11.2.6(c): Cumulative distribution of URR, HD patients 2006-2012 147

Figure 11.2.7(a): Variation in median blood flow rates in HD patients among centres 2012 148

Figure 11.2.7(b): Variation in Proportion of patients with blood flow rates >= 300 ml/min among HD centres 2012 148

Figure 11.2.7(c): Variation in proportion of patients with 3 HD sessions per week among HD centres 2012 149

Figure 11.2.7(d): Variation in median prescribed Kt/V in HD patients among HD centres 2012 149

Figure 11.2.7(e): Variation in proportion of patients with prescribed Kt/V ≥ 1.3 among HD centres 2012 150

Figure 11.2.7(f): Variation in median delivered Kt/V in HD patients among HD centres 2012 150

Figure 11.2.7(g): Variation in proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2012 151

Figure 11.2.7(h): Variation in median URR among HD patients, HD centres 2012 151

Figure 11.2.7(i): Variation in proportion of patients with URR ≥ 65% among HD centres 2012 152

Figure 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 154

Figure 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1997-2012 155

Figure 11.3.2(a): Unadjusted technique survival by age, 1997-2012 156

Figure 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1997-2012 157

Figure 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 158

Figure 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 158

Figure 12.2.1: Cumulative distribution of delivered Kt/V, PD patients 1997-2012 161

Figure 12.2.2: Variation in proportion of patients with Kt/V > 1.7 per week among PD centres 162

Figure 12.3.1(a): Unadjusted technique survival by age (uncensored for death and transplant), 1997-2012 164

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Figure 12.3.1(b): Unadjusted technique survival by age (censored for death and transplant), 1997-2012 164

Figure 12.3.2(a): Unadjusted technique survival by gender (uncensored for death and transplant), 1997-2012 165

Figure 12.3.2(b): Unadjusted technique survival by gender (censored for death and transplant), 1997-2012 165

Figure 12.3.3(a): Unadjusted technique survival by Diabetes status (uncensored for death and transplant), 1997-2012 166

Figure 12.3.3(b): Unadjusted technique survival by diabetes status (censored for death and transplant), 1997-2012 166

Figure 12.3.4: Unadjusted technique survival by Kt/V, 1997-2012 167

Figure 12.4.1: Variation in peritonitis rate among PD centres, 2012 170

Figure12.4.2: Causative organism in PD peritonitis, 2001-2012 171

Figure 12.4.3(a): Outcome of peritonitis by causative organism, 2012 172

Figure 12.4.3(b): Outcome of peritonitis by causative organism, 1993-2002 172

Figure 12.4.3(c): Outcome of peritonitis by causative organism, 2003-2012 173

Figure 12.4.3(d): Comparing outcome of peritonitis by causative organism in 1993-2002 vs 2003-2012 174

Figure 13.1.1: Stock and flow of renal transplantation, 1993-2012 176

Figure 13.1.2: New transplant rate, 1993-2012 176

Figure 13.1.3: Transplant prevalence rate, 1993-2012 177

Figure 13.4.3(a): Transplant recipient death rate, 1993-2012 184

Figure 13.4.3(b): Transplant recipient graft loss rate, 1993-2012 184

Figure 13.5.1.1: Patient survival, 1993-2012 187

Figure 13.5.1.3: Graft survival, 1993-2012 188

Figure 13.5.2.1: Patient survival by type of transplant, 1993-2012 189

Figure 13.5.2.2: Graft survival by type of transplants, 1993-2012 190

Figure 13.5.3.1: Patient survival by year of transplant (Living related transplant, 1993-2012) 191

Figure 13.5.3.2: Graft survival by year of transplant (Living related transplant, 1993-2012) 191

Figure 13.5.4.1: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192

Figure 13.5.4.2: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2012) 192

Figure 13.6.1(a)(i): Calcineurin inhibitors - Cyclosporin vs Tacrolimus 194

Figure 13.6.1(a)(ii): Antimetabolites - Azathioprine vs Mycophenolic Acid 194

Figure 13.7.1(a): Venn diagram for pre and post transplant complications (%) at year 2004 195

Figure 13.7.1(b): Venn diagram for pre and post transplant complications (%) at year 2006 195

Figure 13.7.1(c): Venn diagram for pre and post transplant complications (in %) at year 2008 196

Figure 13.7.1(d): Venn diagram for pre and post transplant complications (%) at year 2010 196

Figure 13.7.1(e): Venn diagram for pre and post transplant complications (%) at year 2012 196

Figure 13.7.2(a): Systolic BP, 2004-2012 197

Figure 13.7.2(b): Diastolic BP, 2004-2012 197

Figure 13.7.3: CKD stages by year 198

Figure 13.7.4: BMI, 2004-2012 198

Figure 13.7.5(a): LDL, 1993-2012 199

Figure 13.7.5(b): Total cholesterol, 2004-2012 199

Figure 13.7.5(c): HDL, 2004-2012 200

Figure 13.8.3.1(a): Graft survival, Azathioprine vs Mycophenolic Acid 1993-2012 202

Figure 13.8.3.1(b): Patient survival, Azathioprine vs Mycophenolic Acid, 1993-2012 202

Figure 13.8.3.2(a): Graft survival, CsA vs Tacrolimus, 1993-2012 203

Figure 13.8.3.2(b): Patient survival, CsA vs Tacrolimus, 1993-2012 203

Figure 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012 203

Figure 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012 203

Figure 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 1993-2012 204

Figure 13.8.3.6: Cumulative incidence of post transplant diabetes, CsA vs Tacrolimus, 2004-2012 204

Figure 13.9.1: Cumulative distribution of QoL-Index score in relation to dialysis modality, transplant recipient patients 1993-2012 204

Figure 13.9.2: Cumulative distribution of QoL-Index score in relation to diabetes mellitus, transplant recipient patients 1993-2012 205

Figure 13.9.3: Cumulative distribution of QoL-Index score in relation to gender, transplant recipient patients 1993-2012 205

Figure 13.9.4: Cumulative distribution of QoL-Index score in relation to age, transplant recipient patients 1993-2012 205

Figure 13.9.5: Cumulative distribution of QoL-Index score in relation to year of entry, transplant recipient patients 1993-2012 206

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In 2012, there were 28,590 patients receiving dialysis in Malaysia, and this reflects an exponential increase from a mere 1,396 in 1993. While the new intake of dialysis patients was only 358 in 1993, this has shown a steep increase to 5,830 in 2012. The equivalent incidence and prevalence rate of patients on dialysis were 199 and 975 per million populations in 2012. Vast majority (92%) of these patients were on haemodialysis (HD), only 8% were on peritoneal dialysis (PD). The increase in the dialysis population was mainly contributed by the rapid growth in private haemodialysis in the last 20 years. There is also significant demographic changes in dialysis population in Malaysia as patients more than 65 years old made up 26% of all new dialysis patients in 2012 versus a mere 10% in 1993. A staggering 58% of end stage kidney disease was reported to be caused by diabetes mellitus in 2012, versus 20% in 1993.

The increase in HD capacity was mainly contributed by the private dialysis centres which had quadrupled over the last 12 years. NGO centres and Public had only doubled the HD capacity over the same period of time. In fact, the growth in MOH had plateaued since 2006. Most of the increases in the private occurred in the more economically developed west coast states of Malaysian Peninsula. Although the public, NGO and private sector provided 30%, 25% and 45% of overall dialysis treatment in 2012 respectively, the government provided 58% of total funding for dialysis. However, 83% of new dialysis patients younger than 20 years of age were on government-funded dialysis programmes.

The annual death rate on dialysis in 2012 was 11.2%. In 2012, the death rate was 10.9% among haemodialysis patients while peritoneal dialysis patients had an annual death rate of 15.2%. The trend for death rate among haemodialysis patients had gradually increased over the past 2 decades. Annual death rate on PD in the past two decades has maintained around 15-18%, and the gap between HD and PD has narrowed in recent years. HD patients who commenced dialysis recently seemed to fare less well than those started in the early years, while this is reversed in PD patients as PD patients started in the last 4 years has better survival in comparison to those who commenced in the 1990’s. Majority of dialysis patients died due to cardiovascular disease and this is probably due to the increasing number of elderly and diabetic patients undergoing dialysis. Death from infection remained as the second commonest cause of death (excluding unknown). Despite attempts at adjusting for multiple variables contributing to death, there were wide variations in adjusted mortality rates between dialysis centres.

91% of HD patients and 80% of PD patients received Erythropoeisis Stimulating Agents (ESAs) in 2012. However, the concern is substantial percentage of these patients still received blood transfusions (14 to 18%). More than 70% of dialysis patients achieved calcium-phosphate-product < 4.5 mmol2/L2. However, about 43-48% of dialysis patients were at risk of low bone turn over disease with iPTH <150pg/ml. Majority (90%) of patients were on calcium based phosphate binders. The use of non-calcium based phosphate binders remained low at less than 3%.

We have achieved improvement over the years in terms of achieving target haemoglobin, control of calcium-phosphate-product <4.5mmol2/L2, and dyslipidaemia, however, malnutrition and blood pressure control still need further improvement. There were also suggestions that nutritional markers such as low serum albumin, extremely low phosphate levels, low BMI and very low cholesterol levels seems to predict worse outcome. Interestingly these parameters can also reflect chronic inflammation. There were also demonstrable variations in the achievement of these various targets between dialysis centres. The contributing factors may be case mix, adequacy of funding for the different medications required, and adequacy of dialysis and medical care.

HD patients run the risk of Hepatitis infection due to nosocomial transmission. However, over the years, we have seen an encouraging decline in its prevalence with lower seroconversion rates. This is largely due to constant surveillance and strict implementation of infection control protocols within HD facilities around the country. PD patients consistently have lower HCV prevalence compare to HD.

Despite the rapid increase in dialysis population, the number of kidney transplantation performed in patients has remained very low. There was only 49 live related and 22 deceased donor kidney transplantation done in 2012. The transplantation rate has dropped to the lowest rate of 3 per million population compared to 6-7 per million in the previous 20 years. The patient survival rates were 95% and 88% at 1- year and 5-years respectively. Graft survival rate at 1-year was 92%, and at 5-years 80%. Those patients underwent transplantation in the recent years seem to do better than those in the previous decades (excluding cadaver transplant), and this may be attributed to the use of newer immunosuppression (newer anti-metabolite) in the recent years. Different CNIs do not seem to affect patient and graft survival, but they do differ in cardiovascular risk profile such as blood pressure, eGFR and cholesterol.

EXECuTivE SuMMARy

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AIIRB Angiotensin II Receptor Blockers

ACE Angiotensin-Converting Enzyme

ADPKD Adult polycystic kidney disease

ALT Alanine transaminase

APD Automated Peritoneal Dialysis

BMI Body Mass Index

BP Blood pressure

CAPD Continuous Ambulatory Peritoneal Dialysis

CCPD/APD Continuous cycling peritoneal dialysis/automated peritoneal dialysis

CI Concentration Index

CKD Chronic kidney disease

CNI calcineurin inhibitors

CRA Clinical Registry Assistant

CRC Clinical Research Centre

CRF Case report form

CRM Clinical Registry Manager

CsA Cyclosporine

CvD Cardiovascular Disease

DAPD Daytime Ambulatory Peritoneal Dialsysis

DM Diabetes Mellitus

DOQI Dialysis Outcome Quality Initiative

DRI Direct Renin Inhibitors

eMOSS Malaysian Organ Sharing System (Renal)

ESRD End Stage Renal Disease

FMC Fresenius Medical Care

GDP Gross domestic product

GN Glomerulonephritis

GNI Gross National Income

Hb Haemoglobin

HbsAg Hepatitis B antigen

HCv Hepatitis C virus

HD Haemodialysis

HDL High-density lipoprotein cholesterol

HKL Kuala Lumpur Hospital

HPT Hypertension

AbbREviATiONS

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HR Hazard Ratio

ITT Intention to treat

iPTH Intact parathyroid hormone

JNC Joint National Committee on management of hypertension

KDIGO Kidney Disease Improving Global Outcomes

Kt/v Number used to quantify hemodialysis and peritoneal dialysis treatment adequacy

LDL Low-density lipoprotein cholesterol

LQ Lower quartile

MDTR Malaysian Dialysis and Transplant Registry

MOH Ministry of Health, Malaysia

MRRB Malaysian Registry of Renal Biopsy

MSN Malaysian Society of Nephrology

NGO Non-governmental organization

NODAT New onset of diabetes after transplantation

NRIC National Registration Identity Card

NRR National Renal Registry, Malaysia

PD Peritoneal dialysis

PET D/P peritoneal transport status dialysate and plasma (D/P ratio)

pmp per million population

PPuKM Pusat Perubatan Universiti Kebangsaan Malaysia

pmarp per million age related population

QoL Quality of Life

ref Reference

RCC Registry coordinating centre

RRT Renal replacement therapy

SC Site coordinator

SDP Source data producer

SE standard error

SLE Systemic Lpus Eythematosus

SMR Standardised Mortality Ratio

Tx transplant

uMMC University Malaya Medical Centre,

uQ Upper quartile

uRR Urea reduction rate

AbbREviATiONS (CONT.)