Renal registry in Hong Kong—the first 20 years

Leung, Chi Bon; Cheung, Wai Lun; Li, Philip Kam-Tao

doi:10.1038/kisup.2015.7

Cited by 76 publications

(94 citation statements)

References 6 publications

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“…According to the Hong Kong Renal Registry, the PD peritonitis rate has improved from 1 per 25 patient months in 2001 to 1 per 35 patient months in 2011 [5]. A similar phenomenon was also observed in Australia and New Zealand with the PD peritonitis rate improving from 0.63 episodes per patient year in 2003 and 2004 to 0.43 episodes per patient year in 2011 [17].…”

Section: Why Pd First?mentioning

confidence: 81%

“…On the basis of cost-effectiveness, the Committee promoted PD as the first-line dialysis modality for all patients with chronic kidney disease who require dialysis therapy, and this also marked the beginning of the PD-first policy. Under this policy, all patients requiring dialysis therapy are treated with PD first unless medical contraindications exist [3,4,5]. All patients with chronic kidney disease who require dialysis will be introduced to both PD and HD during pre-dialysis education, but the Hong Kong Hospital Authority will only reimburse patients for HD if they have medical contraindications for PD.…”

Section: Pd-first Policy In Hong Kongmentioning

confidence: 99%

“…The number of patients requiring dialysis in the Hong Kong Hospital Authority system keeps growing steadily every year [5]. With the PD-first policy in Hong Kong, the growth of the PD population is much faster than for the patient population using other modes of renal replacement therapy.…”

Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

“…As of February 2014, of 1,250 HD patients in Hong Kong, more than 230 (>18%) were recruited into the programme to receive HD treatment in the community. In addition to expanding the inpatient HD facilities, Hong Kong is also using the Nocturnal Home Haemodialysis Programme to increase the number of patients who can be put on HD, especially for those who are found to be high-risk PD patients [5,31,32]. …”

Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

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Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Choy

2015

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In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

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Section: Why Pd First?mentioning

confidence: 81%

Section: Pd-first Policy In Hong Kongmentioning

confidence: 99%

Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

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Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Choy

2015

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“…After all, Asia is diversified with different ethnic groups, cultures and medical practices. This highlights the importance of establishing a comprehensive renal registry, not only to compare the patterns of diseases and outcomes of renal patients with those in other countries, but also because the data collected over time are crucial to medical policy planning and resources allocation by each government [52]. There is a general lack of renal registries in Asian countries which makes an accurate estimation of the number of individuals needing RRT impossible [53].…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis in Asia

Kwong¹,

Li²

2015

Kidney Dis

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Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

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