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

Table 5.1: Stock and flow of Paediatric Renal Replacement Therapy (RRT), Year New HD patients New PD patients New Transplants HD deaths PD deaths Transplant deaths On HD at 31 st December On PD at 31 st December Functioning transplant at 31 st December

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

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

Source: 21 st MDTR Report 2013, NRR Table 5.2: Paediatric dialysis and transplant rates per million age related population, Year Incidence Rate New HD New PD New Transplant All RRT Prevalence Rate at 31 st December On HD On PD Functioning Graft All RRT

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

Source: 21 st MDTR Report 2013, NRR Table 5.3(a): Dialysis treatment rate by state, per million state age related population, State 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

Source: 21 st MDTR Report 2013, NRR Table 5.3(b): New dialysis patients by state, State 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

Source: 21 st MDTR Report 2013, NRR Table 5.4: Number of new dialysis and transplant patients by gender, a) New Dialysis Year MaleFemale n%n% b) New Transplant Year MaleFemale n%n%

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

Source: 21 st MDTR Report 2013, NRR Table 5.5: New RRT rate, per million age related population by age group, Year New RRT rate, pmp Age group (years)

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

Source: 21 st MDTR Report 2013, NRR Table 5.6: New dialysis by treatment modality, Year HDCAPDCCPD n%n%n%

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

Source: 21 st MDTR Report 2013, NRR Table 5.7: New dialysis by sector, Year GovernmentNGOPrivate n%n%n%

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

Source: 21 st MDTR Report 2013, NRR Table 5.8: Primary renal disease by sex among new dialysis patients, Primary Renal Disease MaleFemaleAll n%n%n% Glomerulonephritis FSGS Refux nephropathy SLE Obstructive uropathy Renal dysplasia Hereditary nephritis Cystic kidney disease Metabolic Others Unknown

Source: 21 st MDTR Report 2013, NRR Table 5.9: Types of renal transplantation, Year n%n% Commercial cadaver Commercial living donor 2223 Living related donor Cadaver Living emotionally related 1111 TOTAL

Source: 21 st MDTR Report 2013, NRR Table 5.10(a): Patient survival by dialysis modality analysis (not censored with change of modality), Modality Interval (months) TransplantPDHD n% survivalSEn% survivalSEn% survivalSE

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

Source: 21 st MDTR Report 2013, NRR Table 5.10(b): Patient survival by dialysis modality analysis (censored with change of modality), Modality Interval (months) TransplantPDHD n% survivalSEn% survivalSEn% survivalSE

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

Table 5.11: Causes of death in dialysis patients, Year Causes of Death n%n% Cardiovascular Died at home Sepsis PD peritonitis 0000 GIT bleed 1211 Cancer 0000 Liver disease 0000 Withdrawal 1222 Others Unknown TOTAL Source: 21 st MDTR Report 2013, NRR

Table 5.12: Dialysis technique survival by modality, Modality Interval (months) PDHD n% survivalSEn% survivalSE

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

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

Table 5.14: Transplant graft survival, Interval (month)n% survivalSE

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

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

Table 5.16: Vascular access on haemodialysis, Access types n%n% Wrist AVF BCF* Venous graft Artificial graft cuffed catheter non-cuffed catheter TOTAL

Source: 21 st MDTR Report 2013, NRR Table 5.17(a): Distribution of prescribed Kt/V, HD patients Year Number of patients MeanSDMedianLQUQ % patients ≥ 1.3 % patients ≥ 1.8 % patients ≥

Source: 21 st MDTR Report 2013, NRR Table 5.17(b): Distribution of delivered Kt/V, HD patients Year Number of patients MeanSDMedianLQUQ % patients ≥ 1.3 % patients ≥ 1.8 % patients ≥

Source: 21 st MDTR Report 2013, NRR Table 5.17(c): Distribution of URR, HD patients Year Number of patients MeanSDMedianLQUQ % patients ≥ 65%

Source: 21 st MDTR Report 2013, NRR Table 5.18: Treatment for anaemia, HD patients Year Number of patients % on Erythropoietin % received blood transfusion % on oral iron % received parenteral iron

Table 5.19: Distribution of transferrin saturation on Erythropoietin, HD patients Year Number of patients MeanSDMedianLQUQ % Patients ≥20 % Source: 21 st MDTR Report 2013, NRR

Table 5.20: Distribution of transferrin saturation on Erythropoietin, PD patients Year Number of patients MeanSDMedianLQUQ % Patients ≥20 %

Source: 21 st MDTR Report 2013, NRR Table 5.21: Distribution of ESA dose (u/kg/wk), Year Number of patients MeanSDMedianLQUQ