MyMedR

Progression and outcomes of non-dialysis dependent chronic kidney disease patients: A single center longitudinal follow-up study

Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH, Jummaat F

Nephrology (Carlton), 2017 Jan;22(1):25-34.

PMID: 26718476 DOI: 10.1111/nep.12713

AIM: Despite increase global prevalence of End stage renal disease (ESRD) and subsequent need for renal replacement therapy (RRT), relatively little is known about disease progression and prognosis of earlier stages of CKD. Current study was conducted to examine rate of CKD progression, predictors of ESRD and death.

METHODS: A total 621 patients with estimated glomerular filtration rate (eGFR) of 15-59ml/min/1.73m(2) (CKD stage 3 & 4) were selected and followed up for 10 years or until ESRD or death, whichever occurred first. Subjects who did not meet inclusion criteria were excluded (n=1474).

RESULTS: Annual cumulative decline in eGFR was 3.01±0.40 ml/min/1.73m(2) . Overall disease progression was observed in 60% patients while 18% died. Among patients with CKD stage 3, 21% progressed to stage 4, 10% to stage 5ND (non-dialysis) and 31% to RRT while mortality was observed in 16% patients. On the other hand, 8% patients with CKD stage 4 progressed to stage 5ND, 31% to RRT and mortality was observed in 24% cases. Patients with CVD, higher systolic blood pressure, elevated phosphate levels, heavy proteinuria, microscopic hematuria and use of diuretics were more likely to develop ESRD. Advancing age, low eGFR, low systolic blood pressure, low hemoglobin and baseline diabetes were found to be significant predictors of mortality while being female reduced risk of mortality.

CONCLUSION: Our data suggest that, in this CKD cohort, patients were more likely to develop ESRD than death. Prime importance should be given to mild forms of CKD to retard and even reverse CKD progression.

Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries

Tan J

Nephrology (Carlton), 2014 May;19(5):288-95.

PMID: 24641721 DOI: 10.1111/nep.12228

Brunei Darussalam is a small South East Asian country with a high prevalence and incidence of end stage kidney disease (ESRD). This study aims to compare key performance indicators recorded in the Brunei Dialysis and Transplant Registry and department records against international practice. Registries from the USA (USRDS), UK (UK Renal Registry), Australasia (ANZDATA), Europe (ERA-EDTA Registry) and Malaysia (MDTR) were used for comparisons.

A national survey of renal replacement therapy prescribing practice for acute kidney injury in Malaysian intensive care units

Jamal JA, Mat-Nor MB, Mohamad-Nor FS, Udy AA, Lipman J, Roberts JA

Nephrology (Carlton), 2014 Aug;19(8):507-12.

PMID: 24802363 DOI: 10.1111/nep.12276

To describe renal replacement therapy (RRT) prescribing practices in Malaysian intensive care units (ICU), and compare this with previously published data from other regions.

Intravenous calcitriol versus paricalcitol in haemodialysis patients with severe secondary hyperparathyroidism

Abdul Gafor AH, Saidin R, Loo CY, Mohd R, Zainudin S, Shah SA, et al.

Nephrology (Carlton), 2009 Aug;14(5):488-92.

PMID: 19298641 DOI: 10.1111/j.1440-1797.2008.01058.x

Secondary hyperparathyroidism (SHPT) is common among haemodialysis patients. Intensive treatment with calcitriol is often complicated by hypercalcaemia, hyperphosphataemia and elevated calcium phosphorus (Ca X PO(4)) product. Paricalcitol is a vitamin D analogue developed to overcome some of the limitations of calcitriol therapy. The study objectives were to compare the response of intact parathyroid hormone (iPTH) and the incidence of hypercalcaemia, hyperphosphataemia and elevated Ca X PO(4) product in patients with severe SHPT treated with either i.v. calcitriol or i.v. paricalcitol.

Arterial thrombosis and critical limb ischaemia in a case of nephrotic syndrome

Koh KH, Tan C, Tan S, Ngu L

Nephrology (Carlton), 2009 Sep;14(6):622.

PMID: 19712262 DOI: 10.1111/j.1440-1797.2008.01001.x

Review article: Use of renal registry data for research, health-care planning and quality improvement: what can we learn from registry data in the Asia-Pacific region?

Lim TO, Goh A, Lim YN, Morad Z

Nephrology (Carlton), 2008 Dec;13(8):745-52.

PMID: 19154324 DOI: 10.1111/j.1440-1797.2008.01044.x

We review renal registry data from the Asia-Pacific region with an emphasis on their uses in health care and in dialysis care in particular. The review aims to demonstrate the information value of registry data. While renal registry provides a useful data resource for epidemiological research, there are severe methodological limitations in its application for analytical or therapeutic research. However, it is the use of renal registry data for public health and health-care management purposes that registry really comes into its own, and it is primarily for these that governments have invested in national patient and disease registries. We apply data from several renal registries in the Asia-Pacific region to illustrate its wide application for planning dialysis services, for evaluating dialysis practices and health outcomes, with a view to improving the quality of dialysis care. In the course of preparing the review, we have found that the quality and accessibility of renal registry data were highly variable across the region. Given the value of renal registry, every country in the Asia-Pacific region should establish one or should ensure that their current registries are better resourced and developed. Greater data sharing and collaboration among registries in the region could help advance the nephrology to serve our patients better.

Abstracts of the 11th Asian Pacific Congress of Nephrology, incorporating the 15th Asian Colloquium in Nephrology and 2nd Asian Forum of CKD Initiative. May 5-8, 2008. Kuala Lumpur, Malaysia

Nephrology (Carlton), 2008 May;13 Suppl 1:A1-98.

PMID: 18412802 DOI: 10.1111/j.1440-1797.2008.00953.x

Randomized trial on the therapeutic equivalence between Eprex and GerEPO in patients on haemodialysis

Goh BL, Ong LM, Sivanandam S, Lim TO, Morad Z, Biogeneric EPO Study Group

Nephrology (Carlton), 2007 Oct;12(5):431-6.

PMID: 17803464

Treatment of renal anaemia with epoetin is well established. However, epoetin is expensive. Biogeneric epoetin with proven efficacy would reduce cost and improve access to therapy. We conducted this first ever comparative study of a biogeneric and the original product.

Serum IL-6 and IL-1-ra with sequential organ failure assessment scores in septic patients receiving high-volume haemofiltration and continuous venovenous haemofiltration

Ghani RA, Zainudin S, Ctkong N, Rahman AF, Wafa SR, Mohamad M, et al.

Nephrology (Carlton), 2006 Oct;11(5):386-93.

PMID: 17014550

Sepsis is characterized by an uncontrolled release of pro-inflammatory and anti-inflammatory mediators leading to immunoparalysis, cellular and humoral dysfunction, multiorgan dysfunction and death. This study evaluated the efficacy of high-volume haemofiltration (HVHF) compared with continuous venovenous haemofiltration (CVVH) in removing these inflammatory mediators. Clinical responses were assessed with the sequential organ failure assessment (SOFA) score.

Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia

Hooi LS, Lim TO, Goh A, Wong HS, Tan CC, Ahmad G, et al.

Nephrology (Carlton), 2005 Feb;10(1):25-32.

PMID: 15705178 DOI: 10.1111/j.1440-1797.2005.00360.x

BACKGROUND: This is a multi-centre study to determine cost efficiency and cost effectiveness of the Ministry of Health centre haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) programme.
METHODS: Forty-four haemodialysis and 11 CAPD centres were enrolled in this study in 2001. Sixty patients, 30 from each modality, were evaluated. Micro-costing was used to determine costs.
RESULTS: The number of haemodialyses conducted ranged from 402 to 23,000 procedures per year, while for CAPD, output ranged from 70 to 2300 patient months/year. Cost ranged from RM79.61 to RM475.79 per haemodialysis treatment, with a mean cost of RM169 per HD (USD 1 = RM 3.80). The cost of CAPD treatment ranged from RM1400 to RM3200 per patient month, with a mean of RM2186. Both modalities incurred similar outpatient costs. The cost of erythropoeitin per year is RM4500 and RM2500 for haemodialysis and CAPD, respectively. The number of life years saved is 10.96 years for haemodialysis and 5.21 years for CAPD. Cost per life year saved is RM33 642 for haemodialysis and RM31 635 for CAPD. The cost for land, building, equipment, overheads, and staff were higher for haemodialysis, while consumables and hospitalization cost more for CAPD. Sensitivity analysis was performed for two discount rates (3 and 5%), varying erythropoietin doses and maximum and minimum overheads. Relative cost effectiveness of haemodialysis and CAPD was unchanged in all sensitivity scenarios, except for overhead costs, which influenced the cost effectiveness of HD.
CONCLUSION: It is economically viable to promote the use of both CAPD and haemodialysis because the cost effectiveness of both are nearly equal.

Randomized controlled trial to compare the efficacy and safety of oral paricalcitol with oral calcitriol in dialysis patients with secondary hyperparathyroidism

Ong LM, Narayanan P, Goh HK, Manocha AB, Ghazali A, Omar M, et al.

Nephrology (Carlton), 2013 Mar;18(3):194-200.

PMID: 23311404 DOI: 10.1111/nep.12029

The objective of the study was to compare the efficacy and safety of oral paricalcitol with oral calcitriol for treating secondary hyperparathyroidism.

Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis

Ong LM, Hooi LS, Lim TO, Goh BL, Ahmad G, Ghazalli R, et al.

Nephrology (Carlton), 2005 Oct;10(5):504-10.

PMID: 16221103 DOI: 10.1111/j.1440-1797.2005.00444.x

BACKGROUND: The aim of the present study was to evaluate the efficacy of mycophenolate mofetil in the induction therapy of proliferative lupus nephritis.
METHODS: Forty-four patients from eight centres with newly diagnosed lupus nephritis World Health Organization class III or IV were randomly assigned to either mycophenolate mofetil (MMF) 2 g/day for 6 months or intravenous cyclophosphamide (IVC) 0.75-1 g/m(2) monthly for 6 months in addition to corticosteroids.
RESULTS: Remission occurred in 13 out of 25 patients (52%) in the IVC group and 11 out of 19 patients (58%) in the MMF group (P = 0.70). There were 12% in the IVC group and 26% in the MMF group that achieved complete remission (P = 0.22). Improvements in haemoglobin, the erythrocyte sedimentation rate, serum albumin, serum complement, proteinuria, urinary activity, renal function and the Systemic Lupus Erythematosus Disease Activity Index score were similar in both groups. Twenty-four follow-up renal biopsies at the end of therapy showed a significant reduction in the activity score in both groups. The chronicity index increased in both groups but was only significant in the IVC group. Adverse events were similar. Major infections occurred in three patients in each group. There was no difference in gastrointestinal side-effects.
CONCLUSIONS: MMF in combination with corticosteroids is an effective induction therapy for moderately severe proliferative lupus nephritis.

Losartan reduces the costs of diabetic end-stage renal disease: an Asian perspective

Seng WK, Hwang SJ, Han DC, Teong CC, Chan J, Burke TA, et al.

Nephrology (Carlton), 2005 Oct;10(5):520-4.

PMID: 16221106

To evaluate losartan and conventional antihypertensive therapy (CT) compared with CT alone on the cost associated with end-stage renal disease (ESRD) in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan.

Plasma Neutrophil Gelatinase-Associated Lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis

Md Ralib A, Mat Nor MB, Pickering JW

Nephrology (Carlton), 2017 May;22(5):412-419.

PMID: 27062515 DOI: 10.1111/nep.12796

AIM: Sepsis is the leading cause of intensive care unit (ICU) admission. Plasma Neutrophil Gelatinase Associated-Lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI) detection; however, it is also increased with inflammation and few studies have been conducted in non-Caucasian populations and/or in developing economies. Therefore, we evaluated plasma NGAL's diagnostic performance in the presence of sepsis and systemic inflammatory response syndrome (SIRS) in a Malaysian ICU cohort.

METHODS: This is a prospective observational study on patients with SIRS. Plasma creatinine (pCr) and NGAL were measured on ICU admission. Patients were classified according to the occurrence of AKI and sepsis.

RESULTS: Of 225 patients recruited, 129 (57%) had sepsis of whom 67 (52%) also had AKI. 96 patients (43%) had non-infectious SIRS, of whom 20 (21%) also had AKI. NGAL concentrations were higher in AKI patients within both the sepsis and non-infectious SIRS cohorts (both P

Fulltext Novel calcium infusion regimen after parathyroidectomy for renal hyperparathyroidism

Tan JH, Tan HC, Loke SC, Arulanantham SA

Nephrology (Carlton), 2017 Apr;22(4):308-315.

PMID: 26952689 DOI: 10.1111/nep.12761

AIM: Calcium infusion is used after parathyroid surgery for renal hyperparathyroidism to treat postoperative hypocalcaemia. We compared a new infusion regimen to one commonly used in Malaysia based on 2003 K/DOQI guidelines.

METHODS: Retrospective data on serum calcium and infusion rates was collected from 2011-2015. The relationship between peak calcium efflux (PER) and time was determined using a scatterplot and linear regression. A comparison between regimens was made based on treatment efficacy (hypocalcaemia duration, total infusion amount and time) and calcium excursions (outside target range, peak and trough calcium) using bar charts and an unpaired t-test.

RESULTS: Fifty-one and 34 patients on the original and new regimens respectively were included. Mean PER was lower (2.16 vs 2.56 mmol/h; P = 0.03) and occurred earlier (17.6 vs 23.2 h; P = 0.13) for the new regimen. Both scatterplot and regression showed a large correlation between PER and time (R-square 0.64, SE 1.53, P

Updates on baseline characteristics of the omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study

Viecelli AK, Pascoe EM, Polkinghorne KR, Hawley CM, Paul-Brent PA, Badve SV, et al.

Nephrology (Carlton), 2017 10;22(10):823-824.

PMID: 27188542 DOI: 10.1111/nep.12823

Baseline characteristics of the omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study

Viecelli AK, Pascoe EM, Polkinghorne KR, Hawley CM, Paul-Brent PA, Badve SV, et al.

Nephrology (Carlton), 2016 Mar;21(3):217-28.

PMID: 26205903 DOI: 10.1111/nep.12573

The Fish oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial investigated whether 3 months of omega-3 polyunsaturated fatty acids, either alone or in combination with aspirin, will effectively reduce primary access failure of de novo arteriovenous fistulae. This report presents the baseline characteristics of all study participants, examines whether study protocol amendments successfully increased recruitment of a broader and more representative haemodialysis cohort, including patients already receiving aspirin, and contrasts Malaysian participants with those from Australia, New Zealand and the United Kingdom (UK).

Fulltext Recommendations by the Asian Pacific society of nephrology (APSN) on the appropriate use of HIF-PH inhibitors

Yap DYH, McMahon LP, Hao CM, Hu N, Okada H, Suzuki Y, et al.

Nephrology (Carlton), 2021 Feb;26(2):105-118.

PMID: 33222343 DOI: 10.1111/nep.13835

Renal anaemia is a common and important complication in patients with chronic kidney disease (CKD). The current standard-of-care treatment for renal anaemia in CKD patients involves ensuring adequate iron stores and administration of erythropoietin stimulating agents (ESA). Hypoxia inducible factor (HIF) is a key transcription factor primarily involved in the cellular regulation and efficiency of oxygen delivery. Manipulation of the HIF pathway by the use of HIF-prolyl hydroxylase inhibitors (HIF-PHI) has emerged as a novel approach for renal anaemia management. Despite it being approved for clinical use in various Asia-Pacific countries, its novelty mandates the need for nephrologists and clinicians generally in the region to well understand potential benefits and harms when prescribing this class of drug. The Asian Pacific society of nephrology HIF-PHI Recommendation Committee, formed by a panel of 11 nephrologists from the Asia-Pacific region who have clinical experience or have been investigators in HIF-PHI studies, reviewed and deliberated on the clinical and preclinical data concerning HIF-PHI. This recommendation summarizes the consensus views of the committee regarding the use of HIF-PHI, taking into account both available data and expert opinion in areas where evidence remains scarce.

ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE - EXECUTIVE SUMMARY

Liew A, Bavanandan S, Prasad N, Wong MG, Chang JM, Eiam-Ong S, et al.

Nephrology (Carlton), 2020 10;25 Suppl 2:3-11.

PMID: 33111476 DOI: 10.1111/nep.13763

ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE

Liew A, Bavanandan S, Prasad N, Wong MG, Chang JM, Eiam-Ong S, et al.

Nephrology (Carlton), 2020 10;25 Suppl 2:12-45.

PMID: 33111477 DOI: 10.1111/nep.13785

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