Peritoneal Dialysis - a viable Treatment Option

In Malaysia, the bulk of chronic and End-Stage-Renal-Disease (ESRD) patients requiring dialysis is driven by Type 2 diabetics. As the number of diabetics increases each year, so does the number of ESRD patients. Chronic kidney disease affects between 9 and 15% of people in West Malaysia, depending on the Study design and disease definition (Kidney Int 2013 Jun 12. doi: 10.1038/ki.2013.220)

As of 2012,  a staggering 28,590 dialysis patients were registered with the National Renal Registry (NRR). Basing on the trend of increase over the last 12 years, the projected number of new dialysis patients is estimated to reach 8,000 per year by 2020.

In 2012, there were 199 new patients on dialysis per million population compared with only 3 undergoing transplant per million population. Transplantation is both expensive and skill intensive. Additionally, the waiting time for a kidney transplant is very long due to the low number of donors.

In Hong Kong, almost 80% of dialysis patients utilise Peritoneal Dialysis (PD) compared to only 8% in Malaysia. The common arguments against PD include the need for a clean room during the exchange, high initial cost and infection.

The reason PD has not taken off in Malaysia is also partly due to the pervasiveness of campaigns publicising haemodialysis (HD) to ESRD patients. However, it is observed that, with the rising cost of manpower and consummables for HD, the best way forward is to increase the use of PD among ESRD patients.

The Ministry of Health, Malaysia  estimated in 2005, that the use of PD would translate into a RM 2000 savings per patient. With increased overhead and management costs and the rise in dialysis patients, this would translate into hefty savings in the long run. Additionally, a local study carried out in the Kuala Lumpur Hospital on patients opting for PD showed that they also stood to save up to 22.7 hours a month on top of savings on transportation.

PD has yet to see widespread use even though it is as effective as HD. Thus the Government is driving PD as a treatment option. PD, compared with HD, also offers patients more freedom, flexibility and mobility.

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