Chapter 3 Section 2 HAEMODIALYSIS NON-GOVERNMENTAL ORGANISATION (NGO) CENTRES

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1 Chapter 3 Section 2 HAEMODIALYSIS IN NON-GOVERNMENTAL ORGANISATION (NGO) CENTRES Stock and Flow Death on Haemodialysis and Transfer to PD NGO Haemodialysis Centres Haemodialysis Patient Characteristics Survival Analysis Work related rehabilitation and quality of life Haemodialysis practices Dyslipidaemia in HD patients Treatment of Renal Bone Disease Management of Blood Pressure Management of Anaemia Nutritional status Prevalence of anti-hcv antibodies and HBsAg

2 3.2: HAEMODIALYSIS IN NON-GOVERNMENTAL ORGANISATION (NGO) CENTRES 3.2. STOCK AND FLOW Table 3.2.0: Stock and Flow: NGO Centres Year New patients Died Transferred to PD Transplanted Lost to follow up Dialysing at 3st December Figure 3.2.0: Stock and Flow, HD patients, NGO Centres New patients on HD at 3st December No. of patients Year

3 3.2 2 DEATH ON HAEMODIALYSIS, NGO CENTRES Table : Death Rate on HD: NGO Centres Year No. at risk Deaths Death rate % Transfer to PD Transfer to PD rate % All Losses All Losses rate % Figure : Death Rate on HD, NGO Centres to Death rate % Year

4 Table : Causes of Death: NGO Centres Causes of death No. % No. % No. % No. % Cardiovascular Died at home Sepsis GIT bleed Cancer Liver disease Others Unknown Total _

5 3.2.3 NGO HAEMODIALYSIS CENTRES Table : Centre Distribution of HD patients, NGO Centres n Centre No percent 0 No.on RRT at 3st December Amitabha Centre Association Klang Buddhist Pahang 20 4 Buddhist Tzu Chi CHKMUS-MAA Che Eng Khor 3 7 Fo En Haemodialysis Islam PJ KAS-Rotary/NKF Sarawak 5 0 Kidney Sibu 26 2 Kiwanis Dialysis 8 2 Lions Muar MAA Cheras 6 4 MAA Butterworth MAA KL MAA Lions JB MAA Teluk Intan MMA Kajang 5 9 Mawar N. Sembilan (Bahau) 20 Mawar N. Sembilan (Lukut) 2 2 Mawar N. Sembilan (Seremban) NKF Charis (Cheras) NKF Alor Setar NKF Bakti (Kelang) NKF Berjaya (PJ) NKF Hang Lekiu NKF Ipoh NKF Manjong (Setiawan) NKF Rotary Damansara (Kepong) NKF Trengganu 9 3 Penang Community Persatuan Buah Pinggang Sabah Persatuan Bulan Sabit Merah (Miri) Persatuan Membaiki Akhlak Che Luan 0 Khor 35 Pertubuhan Hemodialisis SPS Pusat Darul Iltizam 6 37 Pusat Hemodialisis (MCA Cawagan Pasar Meru) 0

6 n Centre No percent 38 Pusat Muhibah Pusat Yayasan Felda 0 40 Rotary AMD 9 4 Rotary Batu Pahat Rotary JB Rotary Kluang Rotary Kota Tinggi Rotary Kulai Rotary MAA (KB), HD Rotary Pontian SJAM Bacang SJAM-KPS ( Kelang) 9 50 Woh Peng Cheang Seah Yayasan Kebajikan SSL Heamodialisis 59 4

7 3.2.4 HAEMODIALYSIS PATIENTS CHARACTERISTICS, NGO CENTRES Table : Age Distribution of Dialysis Patients, NGO Centres Year New Dialysis patients years years years years years years >65 years Dialysing at 3 st December years years years years years years >65 years

8 Table : Patients Characteristics, NGO Centres Year New Dialysis patients Mean age+sd % male % Diabetic % HBsAg % Anti-HCV "

9 3.2 SURVIVAL ANALYSIS, NGO CENTRES Table 3.2.0: HD Patient Survival, NGO Centres Year Interval (months) % survival SE No % survival SE No % survival SE No Year Interval (months) % survival SE No % survival SE No % survival SE No No. = number at risk SE = standard error Figure 3.2.0: HD Patient Survival, NGO Centres Kaplan-Meier survival estimates, by Year.00 Yr 999 Yr 998 Yr 995 Cumulative survival Yr 997 Yr duration in months

10 Table 3.2.: HD Technique Survival, NGO Centres Year Interval (months) % survival SE No % survival SE No % survival SE No Year Interval (months) % survival SE No % survival SE No % survival SE No No. = number at risk SE = standard error Figure 3.2. HD Technique Survival by year of entry, NGO centres Kaplan-Meier survival estimates, by Year.00 Yr 999 Yr 998 Yr 995 Cumulative survival Yr 997 Yr duration in months

11 3.2.6 WORK RELATED REHABILITATION AND QUALITY OF LIFE ON HAEMODIALYSIS, NGO CENTRES Table 3.2.2: Work Related Rehabilitation on HD, NGO centres REHABILITATION STATUS No. % No. % No. % Full time work for pay Part time work for pay Able to work but unable to get a job Able to work but not yet due to dialysis schedule Able but disinclined to work Home maker Full time student Age<5 years Retired Age>65 years Unable to work due to poor health Total

12 Table 3.2.3: Quality of Life on Haemodialysis, NGO Centres, QOL Index Summated Score No. % No. % No. % 0 (Worst QOL) (Best QOL) Total

13 3.2.7 HAEMODIALYSIS PRACTICES IN NGO CENTRES Table 3.2.4: Vascular Access on Haemodialysis, NGO Centres, Access types No. % No. % No. % Wrist AVF BCF* venous graft artificial graft PERMCATH temporary CVC Total BCF = Brachiocephalic fistula CVC = Central venous catheter Table 3.2.5: Difficulties reported with Vascular Access, NGO Centres Access difficulty No. % No. % No. % Difficulty with needle placement Difficulty in obtaining desired blood flow rate Other difficulty No difficulty Total

14 Table 3.2.6: Complications reported with Vascular Access, NGO Centres Complication No. % No. % No. % thrombosis bleed aneurysmal dilatation swollen limb access related infection, local/systemic distal limb ischaemia venous outflow obstruction carpal tunnel other no complication Total Table 3.2.7: Blood Flow Rates in NGO HD Units, Blood flow rates No. % No. % No. % <50 ml/min ml/min ml/min ml/min ml/min >350 ml/min Total

15 Table 3.2.8: Number of HD Sessions per week, NGO HD Units, HD sessions per week No. % No. % No. % Total Table Duration of HD in NGO Units, Duration of HD per session No. % No. % No. % <3 hours hours hours hours hours >5 hours Total Table : Dialyser membrane types in NGO HD Units, Dialyser membrane No. % No. % No. % Cellulosic Cellulose acetate Synthetic Total

16 Table 3.2.2: Dialyser Reuse Frequency in NGO HD Units, Dialyser reuse frequency No. % No. % No. % * > Total is single use ie no reuse Table Dialysate Buffer used in NGO HD Units, Dialysate buffer No. % No. % No. % Acetate Bicarbonate Total

17 Table : year Distribution of Prescribed KT/V, NGO Centres observations median LQ UQ % > Figure : Cumulative Distribution of Prescribed KT/V by Year ktv

18 3.2.8 DYSLIPIDAEMIA IN HD PATIENTS, NGO CENTRES Table : Distribution of Serum Cholesterol Concentrations (mmol/l), HD patients, NGO Centres year observation s median LQ UQ % patients < 5.3 mmol/l Figure : of serum cholesterol concentration by year Serum cholesterol concentration (mmol/l)

19 Table 3.2: year Distribution of Serum Triglyceride (mmol/l), HD patients, NGO Centres observation s median LQ UQ % patients < 3 mmol/l Figure 3.2: of serum triglyceride concentration by year Serum triglyceride concentration (mmol/l)

20 Table : year Distribution of serum LDL (mmol/l), HD patients, NGO Centres observations median LQ UQ % patients <5 mmol/l Figure : of serum LDL by year LDL (mmol/l)

21 Table : year Distribution of serum HDL (mmol/l), HD patients, NGO Centres observations median LQ UQ % patients < 2mmol/l Figure : of serum HDL by year Serum HDL concentration (mmol/l)

22 3.2.9 MANAGEMENT OF RENAL BONE DISEASE, NGO CENTRES Table : Treatment for Renal Bone Disease, HD patients, NGO Centres year % on CaCO3 % on Al(OH)3 % on Vitamin D Table : year Distribution of serum Phosphate (mmol/l), HD patients, NGO Centres observations median LQ UQ % patients <.6 mmol/l Figure Cumulative Distribution of serum Phosphate by year Serum phosphate concentration (mmol/l)

23 Table : year Distribution of serum Calcium (mmol/l), HD patients, NGO Centres observations median LQ UQ % patients > 2.2 & <2.6 mmol/l Figure : of Serum Calcium by year Serum calcium concentration (mmol/l)

24 Table 3.2.3: year Distribution of serum ipth (ng/l), HD patients, NGO Centres observations median LQ UQ % patients > 00 & < 250 ng/l Figure 3.2.3: Cumulative Distribution of serum ipth by year, IPTH concentration (ng/l)

25 3.2.0 MANAGEMENT OF BLOOD PRESSURE, NGO CENTRES Table : year No. % on antihypertensives Treatment for hypertension, HD patients, NGO Centres % on antihypertensives % on 2 antihypertensives % on 3 antihypertensives Table : year Distribution of Systolic BP without anti-hypertensives, HD patients, NGO Centres observations median LQ UQ % patients < 60 mmhg Figure : Cumulative Distribution of Systolic BP without anti-hypertensives by year Systolic BP (mmhg)

26 Table : Year Distribution of Diastolic BP without anti-hypertensives, HD patients, NGO Centres observations median LQ UQ % patients < 90 mmhg Figure : Cumulative Distribution of Diastolic BP without anti-hypertensives by year Diastolic BP (mmhg)

27 Table : Year Distribution of systolic BP on anti-hypertensives, HD patients, NGO Centres observations median LQ UQ % patients < 60 mmhg Table : Cumulative Distribution of systolic BP on anti-hypertensives, by year Systolic BP (mmhg)

28 Table : year Distribution of diastolic BP on anti-hypertensives, HD patients, NGO Centres observations median LQ UQ % patients < 90 mmhg Figure : Cumulative Distribution of diastolic BP on anti-hypertensives by year Diastolic BP (mmhg)

29 3.2. TREATMENT OF ANAEMIA, NGO HD CENTRES Table : Treatment for Anaemia, HD patients, NGO Centres year No % on rhuepo % received blood transfusion % received parenteral iron % received oral iron Table : Distribution of rhuepo dose per week, HD patients, NGO Centres Year No. of patients % on 2000 u/week % on u/week % on u/week % on u/week 5 % on u/week % on >2000 u/week "

30 Table : year Distribution of serum Iron without rhuepo, HD patients, NGO Centres observations median LQ UQ % patients > 0 umol/l Figure : Cumulative Distribution of serum Iron without rhuepo by year serum iron concentration,(umol/l)

31 Table : Year Distribution of serum Iron on rhuepo,hd patients, NGO Centres observations median LQ UQ % patients > 0 umol/l Figure :Cumulative Distribution of serum Iron on rhuepo,by year serum iron concentration (umol/l)

32 Table 3.2.4: Year Distribution of serum Transferrin Saturation without rhuepo, HD patients, NGO Centres observations median LQ UQ % patients > 20% Figure 3.2.4: Cumulative Distribution of serum Transferrin Saturation without rhuepo by year Transferrin saturation, %

33 Table : Year Distribution of serum Transferrin Saturation on rhuepo, HD patients, NGO Centres observations median LQ UQ % patients > 20% Figure : Cumulative Distribution of serum Transferrin Saturation on rhuepo by year Transferrin saturation, %

34 Table : year Distribution of serum Ferritin without rhuepo, HD patients, NGO Centres observations median LQ UQ % patients > 00 ug/l Figure :Cumulative Distribution of serum Ferritin without rhuepo by year serum ferritin concentration (ug/l)

35 Table : year Distribution of serum Ferritin on rhuepo, HD patients, NGO Centres observations median LQ UQ % patients > 00 ug/l Figure : Cumulative Distribution of serum Ferritin on rhuepo, by year serum ferritin concentration (ug/l)

36 Table : Distribution of Haemoglobin without rhuepo, HD patients, NGO Centres year observations median LQ UQ % patients <0 g/dl % patients >0 & <2 g/dl % patients >2 g/dl Table :Cumulative Distribution of Haemoglobin without rhuepo by year Haemoglobin concentration (g/dl)

37 Table : Distribution of Haemoglobin on rhuepo, HD patients, NGO Centres year observations median LQ UQ % patients <0 g/dl % patients >0 & <2 g/dl % patients >2 g/dl Figure : Cumulative Distribution of Haemoglobin on rhuepo, by year Haemoglobin concentration (g/dl)

38 3.2.2 NUTRITIONAL STATUS OF HD PATIENTS, NGO CENTRES Table : year Distribution of serum Albumin (g/l), HD patients, NGO Centres observations median LQ UQ % patients >40g/l Figure : Cumulative Distribution of serum Albumin by year serum albumin concentration (g/l)

39 Table : Distribution of Body Mass Index HD patients, NGO Centres year observations median LQ UQ % patients <8 % patients >8 & <25 % patients > Figure : Cumulative Distribution of BMI by year BMI, Kg/M^2

40 3.2.3 SEROLOGICAL STATUS, HD PATIENTS, NGO CENTRES Table : Prevalence of positive anti-hcv and HBsAg HD patients, NGO Centres year No % HBsAg positive % anti-hcv positive Figure : Prevalence of positive anti-hcv and HBsAg HD patients, NGO Centres HBsAg anti-hcv Prevalence % Year

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