Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Lysaght et al., J Am Soc Nephrol 2002
Ten
yea
r m
edic
al c
ost
s of
dia
lysi
s p
opu
lati
on
$ (
bill
ions)
1981-1990 1991-2000 2001-2010
1200
600
0
800
1000
400
200
2010
USRDS 2011 Annual Data Report Prevalence of ESRD 2009
HK : top 12 regions
with high prevalence
of ESRD
The kidney
transplantation rate
of HK is low
HK has the highest
PD:HD ratio
(~80%:20%) in the
world, primarily due
to the “PD-First”
policy
0
50000
100000
150000
200000
250000
300000
350000
2004 2005 2006 2007 2008 2009 2010 2011
No. of DM in HA
65-74 age group: 1 year/ 5 year survival:
87% / 25%
20-44 age group: 1 year / 5 year survival:
94% / 64%
Age < 40 Age 40 – 64 Age 65+
HD survival surpasses PD after 4 years Conversion from PD to HD had the best survival rates
Expand hospital HD capacity
New models of HD treatment provision HD PPP Programme Nocturnal Home HD
QMH
TWH
UCH KWH
PMH
YCH CMC
PWH
AHNH
TMH (+Satellite
Centre)
NDH 3Q2011
TKOH 4Q2012
PYNEH 4Q2013
QEH (+Satellite
Centre)
Recruited >120 patients by Mar 2012 >100 active patients
Shatin HK Kidney Foundation
To Kwa Wan Baptist Hospital Community HD Center (Commence service in1Q 2011)
Causeway Bay Fresenius NephroCare Center (Operated in St. Paul’s Hospital)
Yau Ma Tei TWGH Dialysis Center
Sham Shui Po Lions Kidney Education Centre and Research Foundation
13
14
0
10
20
30
40
50
60
70
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
NHHD CAPD
Geelong Hospital Feb 2006
Australia Home HD Visit Feb 2006
17
First NHHD Patient in Hong Kong Aug 2006
Proven clinical & social benefits as well as cost effectiveness
Started in PMH in 2006; QEH in 2007 AHNH as the 3rd NHHD training Centre since 2011
QMH will join as the 4th training Centre in 2012
2010
2011
2012
More than 20 clinical staff trained overseas Form the expertise foundation for on-going service development
Plan to develop standard Home HD Nurse Trainer curriculum in 2012/13
Triple co-payment model Patients pay $1700 / m HKKF pays $3000 / m
HA pays $120000 for patient training then $8000 / m
Social & medical indications + Patient’s choice (job, carer)
Means test applies
Currently 42 patients Limited by funds raised by HKKF
Community donation of 100 sets of machines
Patients pay $1700/ m (including consumables & water/electricity)
HA pays $120000 for patient training then $8000 /m
Medical indications for receiving
HD in HA (PD failure/existing HD)
No means test
Currently 41 patients Limited by patient training suitability
0
10
20
30
40
50
60
70
2006 2007 2008 2009 2010 2011
No. of
NH
HD
pat
ients
Year
6 1
28
15
41
62 PMH+QEH+AHNH
62 patients started NHHD at home (up to December, 2011)
Male : Female = 40 : 22
Ethnicity: Chinese 61, Caucasian 1
Mean Age: 43.3 ± 9.0 years (range 23-62)
Glomerulonephritis
41%
Alport's syndrome
3%Lupus nephritis
6%
Polycystic kidney
disease
8%
HT
8%
DM
13%Unknown
19%
Reflux nephropathy
2%
Home HD
2%
PD
34%
In Centre HD
19%
No dialysis
45%
Frequency of dialysis Alternate day
(3.5 sessions/week)
Length of dialysis/session (hours) 6 - 9
Type of dialyzer High flux (All patients)
Blood flow rate (ml/min) 150 - 300
Dialysate flow rate (ml/min) 300
Dialysate Na conc. (mmol/L) 135 - 142
Dialysate Ca conc.
1.75 mmol/L 20 patients
1.5 mmol/L 40 patients
1.25 mmol/L 2 patients
Dialysate HCO3 conc. (mmol/L) 30 -35
No of Training Sessions
Patient education levels: P= Primary ; S= Secondary ; T= Tertiary Range: 18-45 Mean=28.6 SD=7
32
11.3411.2911.1311.0511.1311.0411
10.49
9.37
0
5
10
15
0 3 6 9 12 15 18 21 24
Months
Hb level (g/dL)
P <0.01
n = 23
20%
33
84.35
72.6169.37
72.06
62.1658.04
51.84
113.29
85.01
0
20
40
60
80
100
120
140
0 3 6 9 12 15 18 21 24
Months
EPO do
se (U/kg/wk)
P <0.01
n = 21
7/21 (33%) patients able to stop EPO
54%
34
1.471.4
1.49 1.491.59
1.521.47
2.23
1.51
0
1
2
3
0 3 6 9 12 15 18 21 24
Months
PO4 (mmol/L)
P <0.001
n = 23
34%
35
5.07
3.44 3.373.5 3.51
3.73 3.623.43
3.46
0
2
4
6
8
0 3 6 9 12 15 18 21 24
Months
Ca x PO4 (m
mol2 /L2)
P <0.001
n = 23
32%
36 Months
Mean dose of C
a carbonate
(g/da
y of el
emental Ca)
Alum
innum h
ydroxide (g/day)
0.8
0.6
0.5 0.5
0.4
0.3
0.2
1.6
1
0.3 0.3
0.1 0.10
0.1 0.1
0.7
2.4
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0 3 6 9 12 15 18 21 24
0
0.5
1
1.5
2
2.5
3
CaCO3
Al(OH)3
18/21 (86%) patients taken off PO4 binder Only 1/23 (4%) patients require addition of PO4 into dialysate
88% decrease
P <0.01
n = 13
n = 6
96% decrease
37 Months
PTH (pmol/L)
22.11
27.63 27.86
43.33
25.99
0
10
20
30
40
50
60
0 6 12 18 24
n = 21
P = 0.244
38
61.261.9
62.6 62.7 63 63.2 63.5 63.8 64
40
50
60
70
80
0 3 6 9 12 15 18 21 24
Months
Dry we
ight
(kg) P <0.01
n = 23
39
9.37
9.959.52
9.85
3.67
0
2
4
6
8
10
12
14
0 6 12 18 24
Months
spKt/V
P <0.001
n = 23
2.7 times
40
146
141
137
133
139 139
136 137135
80
100
120
140
160
180
0 3 6 9 12 15 18 21 24
Months
SBP (m
mHg)
P <0.05
n = 23
41
90
8785
82
86 85 8486
84
40
60
80
100
120
0 3 6 9 12 15 18 21 24
Months
DBP (m
mHg)
P <0.05
n = 23
42
2.12
1.7 1.7 1.71.6
1.3 1.3
2.6
0
1
2
3
0 3 6 9 12 15 18 21 24
Months
No. of anti-HT
P <0.01
n = 23
10/23 (43%) patients able to stop taking anti-HT
43
214.4 213.2
191.7
150
200
250
0 12 24
Months
LVMI (g/m2 )
P <0.05
n = 17
44
67.469.7
67.9
10
30
50
70
90
0 12 24
Months
Ejection Fraction (%)
P = 0.798
n = 17
Baldree Haemodialysis Stressor Scale Chinese Version, Mok, Esther 2001
50
55
60
65
70
75
80
85
90
95
100
Pre NHHD Post NHHD
Percentage (%) of patients attained vocational rehabilitation ( part or full time)
47
9/62 patients discontinued NHHD due to:
6 received renal transplant
2 died - 1 died of AMI and 1 died of sepsis
1 returned UK
Decrease in EPO dosage
Improvement in BP control
Improvement in phosphate control
Decrease in CaPO4 product
Increase in dry weight
Decrease in Left Ventricular Mass Index
Improvement in QOL
Good vocational rehabilitation potentials
Cost effective
HK$0
HK$50,000
HK$100,000
HK$150,000
HK$200,000
HK$250,000
HK$300,000
HK$350,000
Hospital HD HD PPP NHHD-JC
(First Year)
NHHD-JC
(Subsequent
Years)
CAPD APD-JC (First
Year)
APD-JC
(Subsequent
Years)
Patient Payment Charity Funded HA Funded
(Per Year)
Decreasing number of high-risk PD patients Primarily due to multi-facet expansion of HD services
(% All PD Patients) (12.8%)
(7.9%) (8.7%)
51
Fear of self-cannulation
Lack of patient motivation
Unwillingness to change from in-center modality
Small household size
Costs
Insufficient awareness of patients and medical professionals
54
Taiwan
Beijing, China
Seoul, Korea
Hong Kong Kidney Foundation Ltd
The Hong Kong Jockey Club Charities Trust
Renal Staff:
Queen Elizabeth Hospital: Dr. CS Li
Dr. KF Chau
Dr. Joseph Wong
Ms. Rosaline Yip
Ms. Chris Ching
Ms. Janet Li
Princess Margaret Hospital: Dr. HL Tang
Dr. KS Fung
Ms. Candic Tang
Ms. Irene Kong
Ms YH Chow
Ms. LF Ho
Alice Ho Miu Ling Nethersole Hospital
Queen Mary Hospital