53
CHAPTER 14 NEPHROLOGY FACILITIES AND DEVICES
Edited by :
Dato’ Dr. Zaki Morad
1
, Dr. Ong Loke Meng
2
With contributions from :
Dr. Goh Bak Leong
3
, Dr. Hooi Lai Seong
4
, Dr. Lim Yan Ngo
5
, Dato’ Dr. Rozina Ghazalli
2
, En. A. Suhaili b. Shahri
5
, Sr. Lee Day Guat
6
, Tn. Hj. Mohd Sulaiman B. Dalimi
3
, Tn Haji Wazir Hussin
7
, En. Chua Kee Long
1 Ampang Puteri Specialist Hospital,2 Hospital Pulau Pinang, 3 Hospital Serdang, 4 Hospital Sultanah Aminah, 5 Hospital Kuala Lumpur, 6 Pusat Penyelidikan Klinikal HKL, 7 Hospital Tengku Ampuan Rahimah.
INTRODUCTION
Nephrology as a distinct specialty developed in this country in the 1970s. From the very beginning, the public image of nephrology was haemodialysis HD treatment and the machines associated with it.
Both haemodialysis and peritoneal dialysis treatment maintain their pre-eminent place in Nephrology practice because they consume a disproportionate share of the budget. A signiicant proportion of the
cost of care in Nephrology goes to purchasing and maintaining the dialysis machines. The National Renal Registry has captured data on dialysis practice in the country for the last ifteen years. They
have data not only on the numbers but also the utility of these machines. Such information is useful in planning for services and as a guide for purchases in the future.
Apart from the HD machines there are other machines that are used in dialysis practice but have not been captured in this irst attempt. They include water treatment machines or more popularly called
the Reverse Osmosis machine, dialyzer reprocessor machine, dialyzer rinsing machines and other related equipment. It is hoped that subsequent endeavours will include these machines to give a
comprehensive picture of the dialysis program in the country.
Doctors in general do not have deep interest in the workings of these machines. Yet they place their patients regularly under these machines. It is hoped that the Medical Device Directory will spur
greater interest amongst doctors and other healthcare providers who regularly use these machines on how these machines work, their cost, their eficient usage and more importantly their impact on the
patients’ health.
54
RESULTS
Table 1: Available Therapeutic and Diagnostic Facilities in Nephrology
Population Peritoneal Dialysis Unit
Chronic Haemodialysis Unit No in million
No pmp
No pmp
Malaysia 26.64
31 100
1 455
100 17
Sector
Public -
25 81
146 32
Private -
6 19
309 68
State
Johor 3.17
4 10
1 63
14 20
Kedah Perlis 2.11
1 3
32 7
15 Kelantan
1.53 2
7 1
18 4
12 Melaka
0.73 2
7 3
20 4
27 Negeri Sembilan
0.96 2
7 2
19 4
20 Pahang
1.45 2
7 1
17 4
12 Perak
2.28 3
10 1
50 11
22 Terengganu
1.04 1
3 1
10 2
10 Pulau Pinang
1.49 2
7 1
42 9
28 Sabah
3 2
7 1
26 6
9 Sarawak
2.36 1
3 1
29 6
12 Selangor W.P. Kuala Lumpur
6.43 9
30 1
129 28
20
Table 1 shows the distribution of peritoneal dialysis PD and haemodialysis HD centres in the country. The information was obtained from the National Medical Device survey and the National
Renal Registry NRR 1. In the survey the overall response rate was 57 with 66 response from the public sector and 46 from the private sector. The response rate in the NRR was 100.
The public sector is the major providers of PD while the private sectors the major provider of HD. Twenty-ive 80.6 of the 31 PD units are located in public sector. PD units with both adult
and paediatric nephrologists are regarded as separate units. On the other hand, two-thirds of the haemodialysis centres are private comprising non-governmental organization and HD units in private
sector while 32 146 are in the public sector.
There is a wide variation in distribution of PD and HD centres in Malaysia. The number of HD centres in each state ranged from 9 to 28 centres per million population pmp. The states with the
lowest population least served were Sabah, Terengganu and Kelantan. Most 71 of the PD centres are located in west coast states of West Malaysia. Only 3 9.7 centres are located in East Malaysia.
The dominance of HD over PD can largely explained by the increase in HD centres runned by non- governmental organizations following the introduction of government subsidy for haemodialysis.
55
Table 2: Available Medical Devices in Nephrology
Population Haemodialysis
machine Peritoneal Dialysis
Cycler Continuous Renal
Replacement Therapy CRRT machine
No in million No
pmp No
pmp No
pmp
Malaysia 26.64
5008 100
188 112
100 4
61 100
2
Sector
Public -
1388 28
107 96
44 72
Private -
3620 72
5 4
17 27
State
Johor 3.17
730 15
230 6
5 2
4 7
1 Kedah Perlis
2.11 337
7 160
7 6
3 4
5 1
Kelantan 1.53
143 3
93 1
1 1
3 3
1 Melaka
0.73 219
4 300
3 3
4 4
3 3
Negeri Sembilan 0.96
216 4
225 5
4 5
2 3
2 Pahang
1.45 182
4 126
3 3
2 3
3 1
Perak 2.28
553 11
243 8
7 4
3 5
1 Terengganu
1.04 115
2 111
1 2
1 Pulau Pinang
1.49 472
9 317
8 7
5 8
12 5
Sabah 3
202 4
67 4
4 1
2 3
1 Sarawak
2.36 307
6 130
4 4
2 5
8 2
Selangor W.P Kuala Lumpur
6.43 1532
31 238
63 56
10 28
47 4
Table 2 shows the distribution of HD, PD cycler and continuous renal replacement therapy CRRT machines.
There were more HD machines 188 pmp compared with PD cyclers 4 pmp. However the survey included only PD cyclers in health facilities and home based machines for patients on automated PD
were not included. There were 5008 188 pmp HD machines range 67 - 317 machines pmp, 112 PD cyclers range 0 - 10 pmp and 61 CRRT machines range 1-5 pmp in Malaysia. 72.3 of the
haemodialysis, 27.9 of CRRT machines but only 4.5 of PD cyclers were located in the private sector.
There was a wide variation of distribution of HD machines among the states in Malaysia. The west coast states of West Malaysia had the highest number of machines. Selangor and Federal Territory
had the highest absolute number of HD machines 1532 while Penang was the highest population served 317 pmp. The least served states were Sabah 67 pmp, Kelantan 93 pmp and Terengganu
111 pmp.
A vast majority 95.5 of the PD cyclers are located in the public sector. Selangor and the Federal Territory of Kuala Lumpur FTKL had the highest number of PD cyclers: 63 10 pmp. The
surveyhowever included only the cyclers located in health facilities and did not include cyclers used at home by patients. Furthermore the number of PD cyclers under estimates the use of peritoneal
dialysis as continuous ambulatory peritoneal dialysis does not require the use of PD cycler.
72.1 of CRRT machines are in the public sector with the best served states in west coast of Peninsular Malaysia Selangor FTKL, Penang and Melaka. This is not unexpected as CRRT is an expensive
modality in the treatment of acute renal failure.
56
Summary
This is the irst report on the nephrology and urology services available in the country. There may be gaps in the data collected and this be illed with subsequent reports.
HD penetration is better compared with PD in Malaysia. The private sector is the major provider of HD facilities while the public sector is the major provider of PD. There is an inequity in distribution
of nephrology facilities in the country with the highest population served in the West Coast of states of West Malaysia Penang, Selangor FT and Perak and the lowest in Sabah, Terengganu and
Kelantan. Future planning should include increasing the number of PD centres as the demand for
human resource, cost and ofice space is less.
References
1. 15
th
report of the Malaysian Dialysis and Transplant Registry 2007.
57
CHAPTER 15 UROLOGY FACILITIES AND DEVICES
Authors :
Dr. Murali Sundram Abdullah
1
, Dr. Clarence Lei Chang Moh
2
1 Hospital Kuala Lumpur, 2 Normah Medical Centre.
REPORT
Response Rates
Of the 92 hospitals purported to provide urology services, 73 responded to the survey. To our knowledge, of these 92 hospitals, only 50 have full time resident urologists offering the full range of
general urology services. Of these 52 hospitals, roughly 23 37 are private institutions.
Table 1: Available Diagnostic and Therapeutic Facilities in Urology
Population Stone Center
Renal Transplant Center
Robotic Centre Urodynamic
Laboratory
No in million No
pmp No
pmp No
pmp No
pmp
Malaysia 26.64
47 100
2 7
100 3
100 7
100
Sector
Public -
12 25
4 57
- 2
67 -
3 43
- Private
- 35
75 3
43 -
1 33
- 4
57 -
State
Johor 3.17
4 9
1
1 14
Kedah Perlis 2.11
3 6
1
1 14
Kelantan 1.53
1 2
1
Melaka 0.73
3 6
4
1 14
1 Negeri Sembilan
0.96
2 4
2
Pahang 1.45
2 4
1
Perak 2.28
3 6
1
Terengganu 1.04
1 2
1
Pulau Pinang 1.49
6 13
4
Sabah 3
2 4
1
Sarawak 2.36
3 6
1
1 33
1 14
Selangor W.P. Kuala Lumpur
6.43
17 36
3
7 100
1 2
67 3
43