1. CHAPTER 11 Haemodialysis Practices Tan Chwee Choon Shahnaz Shah Firdaus Khan Rafidah Abdullah Norleen Bt Zulkarnain Sim Source: 20 th MDTR Report 2012, NRR CHAPTER 11 Haemodialysis Practices Tan Chwee Choon Shahnaz Shah Firdaus Khan Rafidah Abdullah Norleen Bt Zulkarnain Sim

2. Table 11.1.1: Vascular access on haemodialysis, 1997-2012 Source: 20 th MDTR Report 2012, NRR Access types 199719981999200020012002 n%n%n%n%n%n% Wrist AVF 142785176384240681355982404979468078 BCF* 2131327313431156551589717106818 BBF 000000000000 Graft 171261421 1832922 HD Catheter 24145294396211521813 TOTAL 168110021071002973100435210051441006021100 Access types 20032004200520062007 n%n%n%n%n% Wrist AVF524973589175640569779867830964 BCF*135921169320216923285625342127 BBF0000000000 Graft13621902251330633413 HD Catheter24043323484564068437 TOTAL6984100810610093091001160010012914100 Access types 20082009201020112012 n%n%n%n%n% Wrist AVF9483621066560111305712569561357453 BCF*440029524329610531736033874134 BBF7011331191130613952 Graft47934653495348925052 HD Catheter984613638151381938923229 TOTAL1541610017869100194341002266210025537100

3. Table 11.1.2: Difficulties report with vascular access, 1997- 2012 Access difficulty 199719981999200020012002 n%n%n%n%n%n% Difficulty with needle placement5547.4824.21335.41463.92174.52153.9 Difficulty in obtaining desired blood flow rate 4841.4603.11124.61363.723952354.2 Other difficulties1210.3301.5552.2320.9390.8571 No difficulties10.9177891.2215587.8340291.6427689.6507390.9 TOTAL11610019501002455100371610047711005580100 Access difficulty 20032004200520062007 n%n%n%n%n% Difficulty with needle placement2173.42553.33193.53943.54783.8 Difficulty in obtaining desired blood flow rate 24343013.73543.93563.13682.9 Other difficulties600.9670.9580.6450.4570.5 No difficulties597091.8695792833991.910592931157792.8 TOTAL6490100758010090701001138710012480100 Access difficulty 20082009201020112012 n%n%n%n%n% Difficulty with needle placement4172.852235552.94792.16352.5 Difficulty in obtaining desired blood flow rate 4202.84732.74372.34952.25842.3 Other difficulties810.51010.6780.4720.31180.5 No difficulties1406593.91648293.81807194.42128495.32398394.7 TOTAL1498310017578100191411002233010025320100 Source: 20 th MDTR Report 2012, NRR

4. Table 11.1.3: Complications reported with vascular access, 1997-2012 Source: 20 th MDTR Report 2012, NRR

5. Table 11.2.1: Blood flow rates in HD centers, 1997-2012 Blood flow rates (ml/min) 199719981999200020012002 n%n%n%n%n%n% <150 20.140.26 9 70.190.2 150-199 342.1361.7652.3852691.4691.2 200-249 64940.273535.596233.3128230.4123324.597316.7 250-299 73445.596846.7136747.4193845.9222944.3269246.1 300-349 17610.929814.445515.881219.2127625.4159027.2 >=350 181.1301.4311.1942.22164.35058.7 Total 161310020711002886100422010050301005838100 Blood flow rates (ml/min) 20032004200520062007 n%n%n%n%n% <15040.1110.17 50100.1 150-199841.1861.29411030.9870.7 200-24988211.2879138149.19238.29297.4 250-299286539.8311242.3352339.2381833.8382130.5 300-349224134.7271133.1322635.9452940.1521441.7 >=35069013102010.2132814.8192017245119.6 Total6766100781910089921001129810012512100 Blood flow rates (ml/min) 20082009201020112012 n%n%n%n%n% <150100.1140.1160.1140.1150.1 150-1991200.81260.71130.61220.61220.5 200-2499286.211786.811926.31333612965.2 250-299463031.1505029502126.5552025595723.8 300-349612641.1709340.7772140.8893640.41037741.4 >=350309420.8397722.8485025.6617227.9729429.1 Total1490810017438100189131002209710025061100

6. Figure 11.2.1: Blood flow rates in HD centers, 1997-2012 Source: 20 th MDTR Report 2012, NRR

7. Table 11.2.2: Number of HD sessions per week, 1997-2012 HD sessions per week 199719981999200020012002 n%n%nnn%n%n% 1 10.1104 80.28 100.2 2 60.450.21535.13417.93376.53696.2 3 166499211099.6281194.6398091.7476192.3560393.4 4 90.520.13 100.2501180.3 Total 168010021181002971100433910051561006000100 HD sessions per week 20032004200520062007 n%n%n%n%n% 1150.1110.270.1250.2140.1 23433.52814.92652.82732.32562 3658596774294.7901096.71132697.21260297.7 490.4300.1310.3340.3310.2 Total6952100806410093131001165810012903100 HD sessions per week 20082009201020112012 n%n%n%n%n% 150609060320.1 22591.72691.53091.62421.13511.4 31504397.917574981908998.12247498.82524798.1 4610.4880.5470.2310.11090.4 Total1536810017937100194541002275310025739100 Source: 20 th MDTR Report 2012, NRR

8. Table 11.2.3: Duration of HD, 1997-2012 Duration of HD per session (hours) 199719981999200020012002 n%n%n%n% n% n% <=3 70.4190.940.1100.28 180.3 3.5 10.12 90.3120.3120.2150.3 4 159895199794.4273892.2408693.9498896.7585497.7 4.5 674874.11575.31543.5931.8601 5 80.580.4612.1751.7591.1470.8 5 10.13 00130.30000 TOTAL 168210021161002969100435010051601005994100 Duration of HD per session (hours) 20032004200520062007 n%n%n%n%n% <=3140.3250.2310.3280.2370.3 3.530.111090.16 110.1 4679897.6787697.9917498.51150798.81279299.2 4.5661.31061460.5660.6230.2 5630.6450.9520.6420.4310.2 >50030001010 TOTAL6944100806610093121001165010012895100 Duration of HD per session (hours) 20082009201020112012 n%n%n%n%n% <=3540.4660.4770.4710.31200.5 3.5100.1250.1360.2100750.3 41518998.81773298.81923198.82258899.32542998.8 4.5740.5780.4720.4400.2720.3 5420.3420.2500.3390.2430.2 >50010005030 TOTAL1536910017944100194661002275310025742100

9. Table 11.2.4: Dialyser membrane types in HD centres, 1997-2012 Dialyser membrane 1997199819992000 2001 2002 n%n%n%n%n%n% Modified Cellulose 36121.341319.3122440.9161136.7166637137724.2 Regenerated Cellulose 114967.8120156.1101733.9118827.189019.8147426 Hydrophobic/Hypdrophilic 18410.952424.575425.2158936.2194443.2282849.8 Hydrophilized copolymers 10.12 10000010 TOTAL 169510021401002996100438810045001005680100 Dialyser membrane 20032004200520062007 n%n%n%n%n% Modified Cellulose115022.1171917.4197421.8248921.6289022.7 Regenerated Cellulose159914.8115024.193010.29978.76995.5 Hydrophobic/Hypdrophilic384162.2484658602066.3786068.3898470.7 Hydrophilized copolymers351740.51501.71611.41371.1 TOTAL6625100778910090741001150710012710100 Dialyser membrane 20082009201020112012 n%n%n%n%n% Modified Cellulose343122.7324119330618.9392824.1397826.1 Regenerated Cellulose4863.24182.52021.2600.4100.1 Hydrophobic/Hypdrophilic1088672.11305276.61360977.71200573.61097072 Hydrophilized copolymers2861.933524092.332322741.8 TOTAL1508910017046100175261001631610015232100 Source: 20 th MDTR Report 2012, NRR

10. Figure 11.2.4: Dialyser membrane types in HD centres, 1997-2012 Source: 20 th MDTR Report 2012, NRR

11. Table 11.2.5: Frequency of Dialyser use in HD centres, 1997-2012 Source: 20 th MDTR Report 2012, NRR

12. Table 11.2.6(a): Distribution of prescribed Kt/V, HD patients 1997-2012 Year Number of patients MeanSDMedianLQUQ% patients ≥ 1.3 1997 15581.40.31.41.21.657 1998 20221.40.31.41.21.665 1999 28311.50.41.51.31.773 2000 40851.50.41.51.31.773 2001 49081.50.41.51.31.874 2002 54961.50.41.51.31.773 2003 65251.60.41.61.31.879 2004 74571.60.41.61.41.882 2005 87491.60.41.61.41.981 2006 110921.60.41.61.31.878 2007 123541.60.41.61.31.978 2008 147521.60.41.61.31.880 2009 172521.70.41.61.41.983 2010 187261.60.41.61.41.981 2011 219281.70.41.61.41.983 2012 249301.70.41.71.41.984 Source: 20 th MDTR Report 2012, NRR

13. Figure 11.2.6(a): Cumulative distribution of prescribed Kt/V, HD patients 1997-2012 Source: 20 th MDTR Report 2012, NRR

14. Table 11.2.6(b): Distribution of delivered Kt/V, HD patients 2006-2012 Year Number of patients MeanSDMedianLQUQ% patients ≥1.2% patients ≥1.3Variance* 200655551.41.31.41.21.676600.1 200763601.50.61.41.21.678620.1 200885291.40.31.41.21.678610.1 2009104671.50.71.41.21.781650.1 2010116971.40.51.41.21.679630.1 2011136221.51.21.41.21.680640.1 2012158001.50.51.51.31.782670.1 Source: 20 th MDTR Report 2012, NRR

15. Figure 11.2.6 (b): Cumulative distribution of delivered Kt/V, HD patients 2006-2012 Source: 20 th MDTR Report 2012, NRR

16. Table 11.2.6(c): Distribution of URR, HD patients 2006-2012 Year Number of patients MeanSDMedianLQUQ% patients ≥ 65% 2006826771.49.271.866.377.179 2007994571.39.271.966.377.279 20081260171.2971.766.27779 20091494771971.766.176.979 20101672771.18.671.666.376.880 20111966871.18.871.866.176.979 20122283771971.7667779 Source: 20 th MDTR Report 2012, NRR

17. Figure 11.2.6 (c): Cumulative distribution of URR, HD patients 2006-2012 Source: 20 th MDTR Report 2012, NRR

18. Table 11.2.7(a): Variation in median blood flow rates in HD patients, HD centres, 1997-2012 Year Number of centers Min5 th CentileLQMedianUQ 95 th Centile Max 1997 45200 220250 280300 1998 46200 230250 300 1999 67200 230250 300 2000 100200 240250275300 2001 116200220250252.5300 350 2002 137200230250280300 350 2003 155200240250280300325350 2004 184220250257.5287.5300350400 2005 228200250260300 350400 2006 283200250270300 350400 2007 302200250280300 350400 2008 355200250280300 350400 2009 404180250280300320350400 2010 435150250280300320350400 2011 500200250300 330350400 2012 556165250300 350 400 Source: 20 th MDTR Report 2012, NRR

19. Figure 11.2.7 (a): Variation in median blood flow rates in HD patients among centres 2012 Source: 20 th MDTR Report 2012, NRR

20. Table 11.2.7 (b) Proportion of patients with blood flow rates > 300 ml/min, HD centres 1997-2012 Year Number of centers Min5 th CentileLQMedianUQ95 th CentileMax 1997 450018194352 1998 4600211.5236180 1999 67002133054100 2000 1000031438.56981 2001 11600825.551.581100 2002 1370013336190100 2003 1550021456991100 2004 1840423.548.57393100 2005 2280028537794100 2006 2830530638394100 2007 3020737688496100 2008 3550940708699100 2009 40401142.5728899100 2010 43509467590100 2011 500012.5557790100 2012 556019578091100 Source: 20 th MDTR Report 2012, NRR

21. Figure 11.2.7 (b): Variation in Proportion of patients with blood flow rates >= 300 ml/min among HD centres 2012. Source: 20 th MDTR Report 2012, NRR

22. Table 11.2.7 (c): Proportion of patients with 3 HD sessions per week, HD centres 1997-2012 Year Number of centers Min 5 th Centile LQMedianUQ95 th CentileMax 1997 47809299100 1998 468098100 1999 69174597100 2000 1002544.590.5100 2001 118235092100 2002 13728489499100 2003 160365597100 2004 188377098100 2005 231407599100 2006 287528398100 2007 309518798100 2008 358518998100 2009 4041888100 2010 4372090100 2011 5025093100 2012 562179098100 Source: 20 th MDTR Report 2012, NRR

23. Figure 11.2.7 (c): Variation in proportion of patients with 3 HD sessions per week among HD centres 2012 Source: 20 th MDTR Report 2012, NRR

24. Table 11.2.7 (d): Median prescribed Kt/V in HD patients, HD centres 1997-2012 Year Number of centers Min5 th CentileLQMedianUQ 95 th Centile Max 1997 441.2 1.31.4 1.51.7 1998 4511.3 1.41.5 1.6 1999 671.11.31.41.51.61.8 2000 9911.31.41.51.61.82.8 2001 1141.21.31.41.51.61.71.9 2002 1321.21.31.41.51.61.71.8 2003 1501.11.31.41.61.71.92 2004 1811.21.41.51.61.71.92.2 2005 2241.21.31.51.61.71.82 2006 28111.31.41.61.71.82.1 2007 3021.11.31.41.61.71.82.2 2008 3531.11.31.51.61.71.92.1 2009 4001.11.31.51.61.71.92.2 2010 4340.81.31.51.61.71.92.9 2011 5001.11.31.51.61.822.5 2012 5551.11.41.51.61.822.8 Source: 20 th MDTR Report 2012, NRR

25. Figure 11.2.7 (d): Variation in median prescribed Kt/V in HD patients among HD centres 2012 Source: 20 th MDTR Report 2012, NRR

26. Table 11.2.7 (e): Proportion of patients with prescribed Kt/V ≥ 1.3, 1997-2012 Year Number of centers Min 5 th Centile LQMedianUQ 95 th Centile Max 1997 4432425060698091 1998 450425767738388 1999 67294565738494100 2000 99264364798494100 2001 114334267758493100 2002 13226436574.5839298 2003 150304871818996100 2004 181285874839198100 2005 2243258738290.598100 2006 28104668808896100 2007 302215067808996100 2008 353144869839098100 2009 4002653.575859297.5100 2010 434650748591100 2011 5001557768693100 2012 5552958778693100 Source: 20 th MDTR Report 2012, NRR

27. Figure 11.2.7 (e): Variation in proportion of patients with prescribed Kt/V ≥ 1.3 among HD centres 2012 Source: 20 th MDTR Report 2012, NRR

28. Table 11.2.7 (f): Median delivered Kt/V in HD patients, HD centres 2006-2012 Year Number of centers Min5 th CentileLQMedianUQ95 th CentileMax 2006 14211.21.31.41.51.61.7 2007 1571.11.21.31.41.51.71.8 2008 19911.21.31.41.51.71.8 2009 23911.21.31.41.51.62 2010 2530.81.11.31.41.51.62 2011 3020.91.21.31.41.51.72 2012 35511.21.31.5 1.72.2 Source: 20 th MDTR Report 2012, NRR

29. Figure 11.2.7 (f): Variation in median delivered Kt/V in HD patients among HD centres 2012 Source: 20 th MDTR Report 2012, NRR

30. Table 11.2.7 (g): Proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2006-2012 Year Number of centers Min5 th CentileLQMedianUQ95 th CentileMax 20061420436576.58694100 2007157344670798998100 20081992149688189100 2009239185174849097100 201025304771838998100 2011302651738491100 2012355264974859298100 Source: 20 th MDTR Report 2012, NRR

31. Figure 11.2.7 (g): Variation in proportion of patients with delivered Kt/V ≥ 1.2, HD centres 2012 Source: 20 th MDTR Report 2012, NRR

32. Table 11.2.7 (h): Median URR among HD patients, HD centres 2006-2012 Year Number of centers Min5 th CentileLQMedianUQ95 th CentileMax 200621455.464.268.971.574.378.294.4 200724556.165.369.671.874.87895.5 200831040.463.568.571.674.477.993.6 20093506064.468.771.874.17793.3 201039754.664.86971.373.876.794 201146445.264.668.871.774.377.996.8 201252556.365.168.671.77477.596 Source: 20 th MDTR Report 2012, NRR

33. Figure 11.2.7 (h): Variation in median URR among HD patients, HD centres 2012 Source: 20 th MDTR Report 2012, NRR

34. Table 11.2.7 (i): Proportion of HD patients with URR ≥ 65%, HD centres 2006-2012 Year Number of centers Min5 th CentileLQMedianUQ95 th CentileMax 20062140506979.58897100 2007245155171828997100 20083100436982.59098100 2009350224569818997100 2010397134869829098100 2011464049698290100 2012526175068808998100 Source: 20 th MDTR Report 2012, NRR

35. Figure 11.2.7 (i): Variation in proportion of patients with URR ≥ 65% among HD centres 2012 Source: 20 th MDTR Report 2012, NRR

36. Table 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 Source: 20 th MDTR Report 2012, NRR

37. Figure 11.3.1(a): Unadjusted technique survival by year of entry, 1993-2012 Source: 20 th MDTR Report 2012, NRR

38. Table 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1993-2012 Source: 20 th MDTR Report 2012, NRR

39. Figure 11.3.1(b): Unadjusted technique survival by year of entry (censored for death & transplant), 1997-2012 Source: 20 th MDTR Report 2012, NRR

40. Table 11.3.2(a): Unadjusted technique survival by age, 1993-2012 Source: 20 th MDTR Report 2012, NRR

41. Figure 11.3.2(a): Unadjusted technique survival by age, 1997-2012 Source: 20 th MDTR Report 2012, NRR

42. Table 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1993-2012 Source: 20 th MDTR Report 2012, NRR

43. Figure 11.3.2(b): Unadjusted technique survival by age (censored for death & transplant), 1997-2012 Source: 20 th MDTR Report 2012, NRR

44. Table 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 Diabetes status Interval (month) Non-DiabeticDiabetic n% SurvivalSEn% SurvivalSE 02324610027980100 62071594024566930 121855190021160860 241496683015567730 361226477011343620 48100377208032520 6081746605649440 7266396103859360 8453305602501290 9642845201623240 10834174801010190 1202712440640150 Source: 20 th MDTR Report 2012, NRR

45. Figure 11.3.3(a): Unadjusted technique survival by diabetes status, 1993-2012 Source: 20 th MDTR Report 2012, NRR

46. Table 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 Diabetes status Interval (month) Non-DiabeticDiabetic n% SurvivalSEn% SurvivalSE 02324610027980100 620715990245661000 121855199021160990 241496699015567990 361226498011343980 48100379808032970 6081749705649970 7266399703859960 8453309702501960 42849601623960 10834179601010950 1202712950640940 Source: 20 th MDTR Report 2012, NRR

47. Figure 11.3.3(b): Unadjusted technique survival by diabetes status (censored for death & transplant), 1993-2012 Source: 20 th MDTR Report 2012, NRR