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CHAPTER 5: PAEDIATRIC RENAL REPLACEMENT THERAPY Lee Ming Lee Lim Yam Ngo Lynster Liaw Susan Pee Yap Yok Chin Wan Jazilah Wan Ismail Source: 21 st MDTR.

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Presentation on theme: "CHAPTER 5: PAEDIATRIC RENAL REPLACEMENT THERAPY Lee Ming Lee Lim Yam Ngo Lynster Liaw Susan Pee Yap Yok Chin Wan Jazilah Wan Ismail Source: 21 st MDTR."— Presentation transcript:

1 CHAPTER 5: PAEDIATRIC RENAL REPLACEMENT THERAPY Lee Ming Lee Lim Yam Ngo Lynster Liaw Susan Pee Yap Yok Chin Wan Jazilah Wan Ismail Source: 21 st MDTR Report 2013, NRR

2 Table 5.1: Stock and flow of Paediatric Renal Replacement Therapy (RRT), 2004-2013 Year 2004200520062007200820092010201120122013 New HD patients 38355136443849435035 New PD patients 41484452496956605569 New Transplants 1118232021199201417 HD deaths 109711 14152017 PD deaths 6917811 15141126 Transplant deaths 0113422473 On HD at 31 st December 215241286314352371411430458471 On PD at 31 st December 176193189203208239250259275287 Functioning transplant at 31 st December 124138156165173180181193189205

3 Source: 21 st MDTR Report 2013, NRR Figure 5.1(a): Incidence cases of RRT by modality in children under 20 years old, 2004-2013

4 Source: 21 st MDTR Report 2013, NRR Figure 5.1(b): Prevalence cases of RRT by modality in children under 20 years old, 2004-2013

5 Source: 21 st MDTR Report 2013, NRR Table 5.2: Paediatric dialysis and transplant rates per million age related population, 2004-2013 Year 20042005200620072008200920102011 20122013 Incidence Rate New HD 4353445453 New PD 4545575657 New Transplant 1222221212 All RRT 8898910 Prevalence Rate at 31 st December On HD 21232730343640424345 On PD 17191820 2324252627 Functioning Graft 1213151617 191820 All RRT 49546065707681858790

6 Source: 21 st MDTR Report 2013, NRR Figure 5.2: Incidence and prevalence rate per million age related population, 2004-2013

7 Source: 21 st MDTR Report 2013, NRR Table 5.3(a): Dialysis treatment rate by state, per million state age related population, 2004-2013 State2004-20082009-2013 Pulau Pinang 149 Melaka 1413 Johor 912 Perak 911 Selangor & Putrajaya 710 Kuala Lumpur 1012 Negeri Sembilan 813 Kedah 611 Perlis 112 Terengganu 914 Pahang 911 Kelantan 77 Sarawak 89 Sabah & WP Labuan 710

8 Source: 21 st MDTR Report 2013, NRR Table 5.3(b): New dialysis patients by state, 2004-2013 State2004-20082009-2013 Pulau Pinang 3824 Melaka 2019 Johor 5373 Perak 4150 Selangor & Putrajaya 6286 Kuala Lumpur 2832 Negeri Sembilan 1524 Kedah 2242 Perlis 51 Terengganu 2131 Pahang 2732 Kelantan 2925 Sarawak 3738 Sabah & WP Labuan 3945

9 Source: 21 st MDTR Report 2013, NRR Table 5.4: Number of new dialysis and transplant patients by gender, 2004-2013 a) New Dialysis Year MaleFemale n%n% 2004-2008 2445619444 2009-2013 2815424346 b) New Transplant Year MaleFemale n%n% 2004-200859633437 2009-201345573443

10 Source: 21 st MDTR Report 2013, NRR Figure 5.4: Number of new dialysis and transplant patients by gender, 2004-2013

11 Source: 21 st MDTR Report 2013, NRR Table 5.5: New RRT rate, per million age related population by age group, 2004-2013 Year New RRT rate, pmp Age group (years) 0-45-910-1415-19 2004 12919 2005 251017 2006 14923 2007 141018 2008 06922 2009 151322 2010 451021 2011 46822 2012 131124 2013 151023

12 Source: 21 st MDTR Report 2013, NRR Figure 5.5: New RRT rate by age group, 2004-2013

13 Source: 21 st MDTR Report 2013, NRR Table 5.6: New dialysis by treatment modality, 2004-2013 Year HDCAPDCCPD n%n%n% 2004 3848415200 2005 354233401518 2006 5154353799 2007 3641475356 2008 4447454844 2009 3836646055 2010 4947494777 2011 4342555355 2012 5048474588 2013 3534676422

14 Source: 21 st MDTR Report 2013, NRR Figure 5.6: New dialysis by treatment modality, 2004-2013

15 Source: 21 st MDTR Report 2013, NRR Table 5.7: New dialysis by sector, 2004-2013 Year GovernmentNGOPrivate n%n%n% 2004 70894556 2005 77935611 2006 79837799 2007 79906733 2008 849000910 2009 97911198 2010 8581881211 2011 817911 2012 8682881110 2013 88854412

16 Source: 21 st MDTR Report 2013, NRR Figure 5.7: New dialysis by sector, 2004-2013

17 Source: 21 st MDTR Report 2013, NRR Table 5.8: Primary renal disease by sex among new dialysis patients, 2004-2013 Primary Renal Disease MaleFemaleAll n%n%n% Glomerulonephritis 156231242328023 FSGS 65104381089 Refux nephropathy 507234736 SLE 915811676 Obstructive uropathy 507387887 Renal dysplasia 315194504 Hereditary nephritis 15220171 Cystic kidney disease 51102151 Metabolic 512071 Others 142234373 Unknown 274411963647039

18 Source: 21 st MDTR Report 2013, NRR Table 5.9: Types of renal transplantation, 2004-2013 Year 2004-20082009-2013 n%n% Commercial cadaver 202234 Commercial living donor 2223 Living related donor 33352735 Cadaver 37404558 Living emotionally related 1111 TOTAL 9310078101

19 Source: 21 st MDTR Report 2013, NRR Table 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality), 2004-2013 Modality Interval (months) TransplantPDHD n% survivalSEn% survivalSEn% survivalSE 0 71100859100698100 6 66972794971636961 12 63962725941584921 24 54962597871485861 36 51962495831425832 48 943415792364802 60 46943336752316782 72 44943281712272752 84 43914234682232732 96 43914196652196712 108 40914173642167692 120 40914139612141672

20 Source: 21 st MDTR Report 2013, NRR Figure 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality), 2004-2013

21 Source: 21 st MDTR Report 2013, NRR Table 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality), 2004-2013 Modality Interval (months) TransplantPDHD n% survivalSEn% survivalSEn% survivalSE 0 71100859100698100 6 62972778971607961 12 54972678941544941 24 50972502881443891 36 49972368841377861 48 46953282802322842 60 44953197762280832 72 41953144722243802 84 4095393663208772 96 4095360613174752 108 3695344584145732 120 3695327515119722

22 Source: 21 st MDTR Report 2013, NRR Figure 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality), 2004-2013

23 Table 5.11: Causes of death in dialysis patients, 2004-2013 Year Causes of Death 2004-20082009-2013 n%n% Cardiovascular 10192733 Died at home 611 13 Sepsis 17312733 PD peritonitis 0000 GIT bleed 1211 Cancer 0000 Liver disease 0000 Withdrawal 1222 Others 142678 Unknown 59810 TOTAL 5410083100 Source: 21 st MDTR Report 2013, NRR

24 Table 5.12: Dialysis technique survival by modality, 2004-2013 Modality Interval (months) PDHD n% survivalSEn% survivalSE 0 580100577100 6 517951517941 12 436891458901 24 306762357842 36 202642285802 48 140533218782 60 82433169752 72 48363127722 84 2932392693 96 1625453663 108 1025431634 120 11

25 Source: 21 st MDTR Report 2013, NRR Figure 5.12: Dialysis technique survival by modality, 2004-2013

26 Table 5.13: Reasons for drop-out from PD program, 2004-2013 Year 2004-20082009-2013 n%n% Death 56303841 Transplant 54291213 Peritonitis 38211516 Catheter related infection 0055 Membrane failure 1581112 Technical problem 7478 Patient preference 11611 Others2144 Unknown2100 Source: 21 st MDTR Report 2013, NRR

27 Table 5.14: Transplant graft survival, 2004-2013 Interval (month)n% survivalSE 0 335100 6 303921 12 292902 24 269862 36 245842 48 226802 60 202782 72 180753 84 153703 96 132673 108 114643 120 99593

28 Source: 21 st MDTR Report 2013, NRR Figure 5.14: Transplant graft survival, 2004-2013

29 Table 5.15: Causes of graft loss, 2004-2013 Causes of graft loss 2004-20082009-2013 n%n% Rejection 17652362 Calcineurin toxicity 1413 Other drug toxicity 0000 Ureteric obstruction 0013 Infection 1400 Vascular causes 62313 Recurrent/ de novo renal disease 0000 Others 0025 Unknown 14924 TOTAL 2610037100 Source: 21 st MDTR Report 2013, NRR

30 Table 5.16: Vascular access on haemodialysis, 2004-2013 Access types 2004-20082009-2013 n%n% Wrist AVF 79761.3110754.2 BCF* 37628.968233.4 Venous graft 20.230.1 Artificial graft 20.280.4 cuffed catheter 6551627.9 non-cuffed catheter 594.5803.9 TOTAL 13011002042100

31 Source: 21 st MDTR Report 2013, NRR Table 5.17(a): Distribution of prescribed Kt/V, HD patients 2009-2012 Year Number of patients MeanSDMedianLQUQ % patients ≥ 1.3 % patients ≥ 1.8 % patients ≥ 2 2009 3602.20.62.21.82.6957763 2010 3672.20.62.21.82.6947464 2011 4042.20.62.21.82.7957665 2012 4422.30.62.21.92.7957765 2013 4602.10.62.11.72.4937157

32 Source: 21 st MDTR Report 2013, NRR Table 5.17(b): Distribution of delivered Kt/V, HD patients 2009-2013 Year Number of patients MeanSDMedianLQUQ % patients ≥ 1.3 % patients ≥ 1.8 % patients ≥ 2 2009 2862.20.62.21.82.5823620 2010 3052.20.62.21.92.6863221 2011 3222.30.62.21.92.7873524 2012 3632.30.62.31.92.7883925 2013 3862.10.621.72.4883722

33 Source: 21 st MDTR Report 2013, NRR Table 5.17(c): Distribution of URR, HD patients 2009-2013 Year Number of patients MeanSDMedianLQUQ % patients ≥ 65% 2009 32575.38.27670.880.490 2010 32675.47.57670.18192 2011 36976.1776.772.181.392 2012 39475.97.977.171.281.591 2013 41776.47.477.171.681.894

34 Source: 21 st MDTR Report 2013, NRR Table 5.18: Treatment for anaemia, HD patients 2004-2013 Year Number of patients % on Erythropoietin % received blood transfusion % on oral iron % received parenteral iron 2004 1928498818 2005 21888147618 2006 27189187127 2007 29392147325 2008 33992175936 2009 37292165739 2010 37892135737 2011 42093145636 2012 45892145738 2013 48194125542

35 Table 5.19: Distribution of transferrin saturation on Erythropoietin, HD patients 2004-2013 Year Number of patients MeanSDMedianLQUQ % Patients ≥20 % 2004 12536.514.532.626.441.994 2005 16536.616.432.624.444.488 2006 20935.915.732.6254488 2007 24433.714.931.123.44086 2008 28534.915.531.824.141.986 2009 31735.11631.924.942.286 2010 31935.116.131.624.342.885 2011 36433.114.430.823.537.985 2012 3833313.430.224.44088 2013 40032.713.330.523.938.487 Source: 21 st MDTR Report 2013, NRR

36 Table 5.20: Distribution of transferrin saturation on Erythropoietin, PD patients 2004-2013 Year Number of patients MeanSDMedianLQUQ % Patients ≥20 % 2004 14841.516.6393048.797 2005 16940.515.438.931.246.994 2006 17641.216.138.830.449.395 2007 18236.71633.226.344.391 2008 19338.516.635.128.246.790 2009 2213817.234.625.548.888 2010 23639.117.635.626.149.192 2011 24536.315.43424.647.287 2012 2533615.334.725.544.487 2013 22937.215.233.826.844.691

37 Source: 21 st MDTR Report 2013, NRR Table 5.21: Distribution of ESA dose (u/kg/wk), 2004-2013 Year Number of patients MeanSDMedianLQUQ 2004 2583790.52915.32000 4000 2005 3153758.72934.32000 4000 2006 3634987.62866.44000 6000 2007 4025614.44524.64000 6000 2008 43652113996.9400030006000 2009 4804953.82766.1400020006000 2010 51152903062.14000 6000 2011 5355480.43373.34000 6000 2012 5635252.93073.94000 6000 2013 5995640.23923.2400030006000

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