1. CHAPTER 2 DIALYSIS IN MALAYSIA Goh Bak Leong Lim Yam Ngo Ong Loke Meng Ghazali Ahmad Lee Day Guat Source: 20 th MDTR Report 2012, NRR

2. Table 2.1.1(a): Stock and flow- HD Patients 1993-2012 Year1993199419951996199719981999200020012002 New HD patients29542054575997011331366164818232066 Died79106121160243306401515711832 Transplanted3543294849485694116124 Lost to Follow-up00222645714 Dialysing at 31 st December 1204149519012477319840044945603670598181 Year2003200420052006200720082009201020112012 New HD patients2259261028303277355240304359470453165121 Died1017116413341643175619152275266428812719 Transplanted10714510196729197908765 Lost to Follow-up1015 3918 4256102136 Dialysing at 31 st December 9339107081216613740155051758719620216182392426067 Source: 20 th MDTR Report 2012, NRR

3. Table 2.1.1(b): Stock and flow- PD Patients 1993-2012 Year1993199419951996199719981999200020012002 New PD patients63114154212184147196205291309 Died2341586777 10295141129 Transplanted2378101213121119 Lost to Follow-up1001000121 Dialysing at 31 st December 192247332444506544605666779926 Year2003200420052006200720082009201020112012 New PD patients370291315397515569548539614709 Died197156182177231277321349363356 Transplanted12132225182115121714 Lost to Follow-up6143535642 Dialysing at 31 st December 1066112411731317154817491880198021672523 Source: 20 th MDTR Report 2012, NRR

4. Table 2.1.2(a): HD Treatment Rate per million population 1993-2012 Year1993199419951996199719981999200020012002 Acceptance rate15212636455160707684 Prevalence rate617492117147179216257293331 Year2003200420052006200720082009201020112012 Acceptance rate89101107122131146156167186175 Prevalence rate369413459512570639703765838889 Source: 20 th MDTR Report 2012, NRR

5. Table 2.1.2(b): PD Treatment Rate per million population 1993-2012 Year1993199419951996199719981999200020012002 Acceptance rate3671087991213 Prevalence rate10121621232426283237 Year2003200420052006200720082009201020112012 Acceptance rate15111215192120192224 Prevalence rate42434449576467707686 Source: 20 th MDTR Report 2012, NRR

6. Table 2.1.3: Dialysis Treatment Rate by state, per million population 1993-2012 Source: 20 th MDTR Report 2012, NRR

7. Table 2.2.1: Number of dialysis centres, HD machines and treatment capacity, 2000-2012 Source: 20 th MDTR Report 2012, NRR

8. Figure 2.2.1(a): Number of dialysis centres, 1993-2012 Source: 20 th MDTR Report 2012, NRR

9. Figure 2.2.1(b): Number of HD capacity, 1993-2012 Source: 20 th MDTR Report 2012, NRR

10. Figure 2.2.1(c): Number of dialysis patients, 1993-2012 Source: 20 th MDTR Report 2012, NRR

11. Figure 2.2.1(d): HD capacity to patient ratio, 1993-2012 Source: 20 th MDTR Report 2012, NRR

12. Table 2.2.2(a): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2003 Source: 20 th MDTR Report 2012, NRR

13. Table 2.2.2(b): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2007 Source: 20 th MDTR Report 2012, NRR

14. Table 2.2.2 (c): Number of dialysis centers, number of HD machines and treatment capacity, HD capacity to patients ratio and number of dialysis patients by state, 2012 Source: 20 th MDTR Report 2012, NRR

15. Figure 2.2.2(a): Distribution of hemodialysis centres by State, 2003- 2012 0 10 20 30 40 50 60 70 80 90 Number of dialysis centres JoKLKdKeMeNsPPPhPlPrSbSeSwTr 2003200720122003200720122003 20072012 2003200720122003 2007 2012200320072012200320072012200320072012 200320072012 2003 2007201220032007 2012 200320072012 200320072012 2003 20072012 State Source: 20 th MDTR Report 2012, NRR

16. Figure 2.2.2(c): Distribution of patients per million State population, 2003-2012 Source: 20 th MDTR Report 2012, NRR 0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 Dialysis patients/million population JoKLKdKeMeNsPPPhPlPrSbSeSwTr 200320072012200320072012200320072012 20032007 2012 200320072012200320072012200320072012200320072012200320072012 200320072012200320072012 2003 200720122003 20072012200320072012 State

17. Figure 2.2.2(b): Distribution of dialysis patients by State, 2003-2012 Source: 20 th MDTR Report 2012, NRR

18. Figure 2.2.2(d): HD capacity to patient ratio by State, 2003-2012 0.5 1 1.5 2 2.5 3 3.5 4 4.5 HD capacity : patient ratio JoKLKdKeMeNsPPPhPlPrSbSeSwTr 200320072012200320072012200320072012 200320072012 2003200720122003200720122003200720122003200720122003200720122003 20072012200320072012 20032007 201220032007 2012200320072012 State Source: 20 th MDTR Report 2012, NRR

19. Table 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 Sector PrivateNGOPublic Cumulative HD capacity Cumulative HD patients Cumulative HD capacity Cumulative HD patients Cumulative HD capacity Cumulative HD patients 2000420031204920342742352883 2001446532765320369047253244 2002510537666200418053503716 2003571541686720448558304033 2004707552057275481069804882 2005890066477920521081155724 2006995574398670568783605884 20071106582159405608684605962 20081267094269780633085406012 2009144651076110165654785406012 2010159001173010675685686406068 2011174501283711010703086906110 2012180351315911205708887556157 Source: 20 th MDTR Report 2012, NRR

20. Figure 2.2.3(a): Growth in HD and HD patients in Private, NGO and Public sectors, 2000-2012 Source: 20 th MDTR Report 2012, NRR

21. Table 2.2.3: Number of dialysis centres, HD machines and treatment capacity by sector, 2000-2012

22. Figure 2.2.3(a)(i): Distribution of dialysis centres by Sector, 1993-2012 Source: 20 th MDTR Report 2012, NRR

23. Figure 2.2.3(b)(ii): Distribution of HD capacity by Sector, 1993-2012 Source: 20 th MDTR Report 2012, NRR

24. Figure 2.2.3(b)(iii): Distribution of dialysis patients by Sector, 1993- 2012 Source: 20 th MDTR Report 2012, NRR

25. Figure 2.2.3(b)(iv): HD capacity to patient ratio by Sector, 1993-2012 Source: 20 th MDTR Report 2012, NRR

26. Table 2.3.1(a): Dialysis Treatment Rate by Gender, per million male or female population 1993-2012 Gender 1993199419951996199719981999200020012002 Male 2233395163 819297110 Female 17233245495660738894 Gender 2003200420052006200720082009201020112012 Male 122128139155171193204215239231 Female 96110111134144159169180204192 Source: 20 th MDTR Report 2012, NRR

27. Figure 2.3.1(a): Dialysis Treatment Rate by Gender 1993-2012 Source: 20 th MDTR Report 2012, NRR 0 30 60 90 120 150 180 210 240 Treatment rate, per million population '93'94'95'96'97'98'99'00'01'02'03'04'05'06'07'08'09'10'11'12 Year MaleFemale

28. Table 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 Year1993199419951996199719981999200020012002 New Dialysis patients 358534699971115412801562185321142375 % Male 58605654575359575455 % Female 42404446434741434645 Dialysing at 31st December 1396174222332921370445485550670278389107 % Male 60 58565756 55 % Female 40 42444344 45 Year2003200420052006200720082009201020112012 New Dialysis patients2629290131453674406745994907524359305830 % Male58555755 56 55 56 % Female42454345 44 45 44 Dialysing at 31st December10405118321333915057170531933621500235982609128590 % Male55 % Female45 Source: 20 th MDTR Report 2012, NRR

29. Figure 2.3.1(b): Gender Distribution of Dialysis Patients 1993-2012 (ii) Dialysing patients at 31 st December(i)New Dialysis patients Source: 20 th MDTR Report 2012, NRR 0 10 20 30 40 50 60 Proportion of patients '93'94'95'96'97'98'99'00'01'02'03'04'05'06'07'08'09'10'11'12 Year MaleFemale 0 10 20 30 40 50 60 Proportion of patients '93'94'95'96'97'98'99'00'01'02'03'04'05'06'07'08'09'10'11'12 Year MaleFemale

30. Table 2.3.2 (a): Dialysis Treatment Rate by Age Group, per million age group population 1993-2012 Age groups (years) 1993199419951996199719981999200020012002 ≤14 1213233445 15-24 510 1416 17182228 25-34 23183239404244474552 35-44 385259678081849810297 45-54 5987120154167171222249248270 55-64 68142162226292313367433503527 ≥ 65 5578106166205219289347443506 Age groups (years) 2003200420052006200720082009201020112012 ≤14 4565668776 15-24 25273032 3035313328 25-34 49475160 71 818475 35-44 98109104132119145134140154164 45-54 272300291451352393400417456466 55-64 578579640662758757808860926934 ≥ 65 5886606718158539731032102511721045 Source: 20 th MDTR Report 2012, NRR

31. Figure 2.3.2 (a): Dialysis Treatment Rate by Age Group 1993-2012 Source: 20 th MDTR Report 2012, NRR

32. Table 2.3.2(b): Percentage Age Distribution of Dialysis Patients 1993- 2012 Source: 20 th MDTR Report 2012, NRR

33. Figure 2.3.2(b): Age Distribution of New Dialysis Patients 1993-2012 (ii) Dialysing patients at 31 st December(i) New Dialysis Patients Source: 20 th MDTR Report 2012, NRR

34. Table 2.3.3: Method and Location of Dialysis Patients 1993-2012 Year1993199419951996199719981999200020012002 New Dialysis patients358534699971115412801562185321142375 % Centre HD72697375828786888586 % Home and office HD111053222111 % PD172122 161112111413 Dialysing at 31 st December1311163921162781352343535321642174898689 % Centre HD65697276798385878889 % Home and office HD2218139754332 % PD13 15 1412111099 Year2003200420052006200720082009201020112012 New Dialysis patients2629290131453674406745994907524359305830 % Centre HD8590 8987 8889 87 % Home and office HD1000111111 % PD1410 1112 1110 12 Dialysing at 31 st December9955112931272814361162701843220506224572479127142 % Centre HD899091 9291 % Home and office HD2111111111 % PD9988888878 Source: 20 th MDTR Report 2012, NRR

35. Figure 2.3.3: Method and Location of Dialysis Patients 1993-2012 (ii) Dialysing patients at 31 st December (i) New Dialysis Patients Source: 20 th MDTR Report 2012, NRR

36. Table 2.3.4: Funding for Dialysis Treatment 1993-2012 Source: 20 th MDTR Report 2012, NRR

37. Figure 2.3.4: Funding for Dialysis Treatment 1993-2012 (ii) Dialysing patients at 31 st December (i) New Dialysis Patients Source: 20 th MDTR Report 2012, NRR

38. Table 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 Year1993199419951996199719981999200020012002 New Dialysis patients358534699971115412801562185321142375 % Public centre656454 534139354038 % NGO centre18192625273432333129 % Private centre17 2021202529322933 Dialysing at 31 st December 1396174222332921370445485550670278389107 % Government centre7672656056514643 42 % NGO centre1114182225283031 % Private centre1314171819212426 27 Year2003200420052006200720082009201020112012 New Dialysis patients2629290131453674406745994907524359305830 % Public centre35333533 322928 27 % NGO centre30 27292725 232220 % Private centre353738 404346495053 Dialysing at 31 st December 10405118321333915057170531933621500235982609128590 % Public centre403938 373534323130 % NGO centre31 3029 28 272625 % Private centre29303233343738414345 Source: 20 th MDTR Report 2012, NRR

39. Figure 2.3.5: Distribution of Dialysis Patients by Sector 1993-2012 (ii) Dialysing patients at 31 st December (i) New Dialysis Patients Source: 20 th MDTR Report 2012, NRR

40. Table 2.4: Primary Renal Diseases 1993-2012 Year1993199419951996199719981999200020012002 New Dialysis patients358534699971115412801562185321142375 % Unknown cause36 3936313027262827 % Diabetes Mellitus202825293540 444549 % GN/SLE2416 1513121198 % Polycystic kidney3232211121 % Obstructive Nephropathy4566444333 % Toxic Nephropathy1101001010 % Hypertension10 99 13 119 % Others1232222122 Year2003200420052006200720082009201020112012 New Dialysis patients2629290131453674406745994907524359305829 % Unknown cause262524 252627282925 % Diabetes Mellitus52535557 5857 58 % GN/SLE7665544434 % Polycystic kidney1111111111 % Obstructive Nephropathy3222222111 % Toxic Nephropathy0000000000 % Hypertension10 999988711 % Others2221111111 Source: 20 th MDTR Report 2012, NRR

41. Figure 2.4: Primary Renal Diseases for New Dialysis Patients 1993- 2012 Diabetes MellitusUnknown cause Toxic Nephropathy, Hypertension & OthersGN and SLE Polycystic kidneyObstructive Nephropathy Source: 20 th MDTR Report 2012, NRR