Ka-Foon Chau

Hong Kong Renal Registry Report 2010

This report examines the characteristics and trends of dialysis and renal transplant patients among the resident population of Hong Kong who were managed by hospitals or dialysis centers of the Hospital Authority of Hong Kong, and who accounted for approximately 95% of all patients who received renal replacement therapy (RRT) in the territory. Patients who received RRT solely in the private sector were not included in this report. Data trends from 1996 to 2009 are presented. In 2009, 930 new patients were accepted into RRT programs and the incident rate was 132.4 patients per million population (pmp). This is lower than the incident rate in 2008, which was 148.2 pmp. The point prevalence as of December 31, 2009 was 7,580, with a prevalence rate of 1,078.8 pmp. There were 3,401 patients on peritoneal dialysis (PD, 44.9%), 945 patients on hemodialysis (HD, 12.5%), and 3,234 patients living with a functioning renal transplant. The PD to HD ratio was 81.5:18.5 for patients on dialysis treatment at Hospital Authority centers. PD-first policy continued. The overall mortality rate among RRT patients was 10.7 patients per 100 patient-years exposed. There was a decreasing trend in mortality among PD patients. Infection and cardiovascular complications were the most common causes of death. Renal transplant was the modality with the best survival. The 5-year cumulative patient survival rate for patients on transplant treatment was 88%, whereas the corresponding patient survival rates for PD and HD patients were 37% and 34.2%, respectively. More than 80% of RRT patients with reports on rehabilitation were active and had normal activities.

Hong Kong Renal Registry 1995–1999

Abstract This report was based on the data from the Renal Registry of the Hospital Authority of Hong Kong, accounted for 90% to 95% of all the patients on renal replacement therapy (RRT) in Hong Kong. Patients who received RRT under the private sectors were not included in this report. The data were as of 31 March 1999. There were 11 renal units, five satellite centers and four major renal transplant centers. The number of patients on RRT was 4268 [627 patients per million (pmp)], of which 58% (2490 patients, 360 pmp) were on peritoneal dialysis (PD), 13% (576 patients, 85 pmp) on hemodialysis (HD) and 28% (1202 patients, 177 pmp) with functioning kidney transplants (TX). The net increase of the number of patients on RRT from previous year was 10%. The incidence of end-stage renal failure was 762 (112 pmp). The median age of the existing patients on RRT was 52, of which 33% were above the age of 61 years. The median age of the new patients was 56 years, of which 50% were above the age of 61 years. The major causes of renal failure for existing patients were glomerulonephritis 32%, unknown 26% and diabetes 21%. For the new cases, 34% were due to diabetic nephropathy. Of all the patients on RRT, 10% were serologically positive for hepatitis B infection while 6% were positive for hepatitis C infection. Of all the patients on dialysis, 81% were on PD, of which 92% were on continuous ambulatory peritoneal dialysis (CAPD). Of the CAPD patients, 13% were still using “connect” systems, 75% were using “disconnect” systems and 12% using UV flash systems. Nineteen percent of all the patients on dialysis were on HD, of which 54% were on hospital based HD, 21% on satellite center based HD, 9% on charitable center based HD and 3% on home HD. Of the 1202 patients with kidney transplants, 629 (52%) were transplanted in Hong Kong. Of these, 325 (52%) were cadaveric kidney transplantation. For the year ending 31 March 1999, 113 patients (17 pmp) received a kidney transplantation, of which 58 transplants were performed in Hong Kong (30 cadaveric kidneys and 28 living related kidneys). Thirty-one percent of all the patients on RRT were receiving erythropoietin therapy. The annual crude mortality rate for all RRT was 7% (8% for PD, 14% for HD and 1.6% with TX). The major causes of death were cardiovascular (24%), infection (22%) and cerebral vascular accident (6%). The 1 and 5 year patient survivals for kidney transplants performed in Hong Kong between 1 April 1993 to 31 March 1998 were 98%, 96% for living related kidney and 94%, 89% for cadaveric kidney. The 1 and 5 year graft survivals were 92%, 88% (censored), 91%, 85% (not censored) for living related kidney and 89%, 83% (censored), 86%, 79% (not censored) for cadaveric kidney. The overall peritonitis rate for all CAPD systems for the 7 months ending 31 March 1999 was one episode per 21 months. The peritonitis rate of the new disconnect systems was one episode per 20 to 27 months. The point prevalence rate of RRT (1997 data) for Hong Kong was within 15% range of that for Australia, Canada and most European countries, but only 40% to 60% of that for Japan, USA and Taiwan. The percentage of dialysis patients being treated with PD was highest in the world.

One year experience of nocturnal home haemodialysis with an alternate night schedule in Hong Kong

Aim:  Nocturnal home haemodialysis (NHHD) was started in Hong Kong in 2006. The experience of 1 year of NHHD with an alternate night schedule in two local centres is reported.

Hong Kong Registry Report 2004

This report is based on data (up to 31 March 2004) from the Renal Registry of the Hospital Authority of Hong Kong, and accounts for 90-95% of all patients receiving renal replacement therapy (RRT) in the territory. Patients receiving RRT in the private sector are not included in this report. The number of patients receiving RRT was 6,054 (889 per million population [pmp]), of whom 51.6% (3,123, 451 pmp) were receiving peritoneal dialysis (PD), 10.9% (662, 97 pmp) hemodialysis (HD), and 37.5% (2,269, 334 pmp) had functioning kidney transplants. The net increase from the previous year in the number of patients receiving RRT was 3.1%. The incidence of end-stage renal failure in patients undergoing RRT was 954 (140 pmp). The median ages of existing and new patients receiving RRT were 55 and 56 years, respectively. There was a trend towards an increasing number of elderly dialysis patients. Diabetes was the third major cause of renal failure among existing RRT patients and the most common cause of renal failure in new cases. The rate of serologic positivity for hepatitis B infection in RRT patients was 9.68%, while that for hepatitis C infection was 3.28%. In Hong Kong, most patients were put on PD when RRT was required. Of all patients on dialysis, 83% were on PD, of whom 94.8% were on continuous ambulatory peritoneal dialysis (CAPD). Most CAPD patients were on disconnect systems. HD was used in 17.5% of all patients on dialysis. Of the 2,269 patients with functioning kidney transplants, 836 (36.8%) were transplanted in Hong Kong. Of these, 495 (59.2%) had undergone cadaveric kidney transplantation. Of all patients receiving RRT, 30% were receiving erythropoietin. For the year ending 31 March 2004, the annual crude mortality rate for all RRT was 10% (15.3% for PD, 13% for HD, and 1.9% for transplantation). The major causes of death were infection, cardiovascular disease, and cerebrovascular accident. The 1- and 5-year survival rates for patients with kidney transplantation performed in Hong Kong between 1 April 1997 and 31 March 2003 were 98.6% and 96.5%, respectively, for living related kidney transplants, and 96.1% and 91.2%, respectively, for cadaveric kidney transplants. The 1- and 5- year graft survival rates were 91.1% and 86.1% (death censored) and 90.5% and 85.6% (death not censored) for living related kidney transplants, and 89% and 83% (death censored) and 86% and 79% (death not censored) for cadaveric kidney transplants. The overall peritonitis rate for all chronic PD systems for the year ending 31 March 2004 was one episode per 27.7 months.

An Unusual Organism for CAPD-Related Peritonitis: Kocuria kristinae

4. Martinaud C, Gisserot O, Gaillard T, Brisou P, de Jaureguiberry JP. [Bacteremia caused by Kocuria kristinae in a patient with acute leukaemia]. [In French] Med Mal Infect 2008; 38:334–5. 5. Ma ES, Wong CL, Lai KT, Chan EC, Yam WC, Chan AC. Kocuria kristinae infection associated with acute cholecystitis. BMC Infect Dis 2005; 5:60. 6. Lee JY, Kim SH, Jeong HS, Oh SH, Kim HR, Kim YH, et al. Two cases of peritonitis caused by Kocuria marina in patients undergoing continuous ambulatory peritoneal dialysis. J Clin Microbiol 2009; 47:3376–8. 7. Kaya KE, Kurtoglu Y, Cesur S, Bulut C, Kinikli S, Irmak H, et al. [Peritonitis due to Kocuria rosea in a continuous ambulatory peritoneal dialysis case.] [In Turkish] Mikrobyol Bul 2009; 43:335–7. 8. Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. ISPD Guidelines/Recommendations. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010; 30:393–423 doi:10.3747/pdi.2010.00132

Subcutaneous Nodules Attributed to Nocardiosis in a Renal Transplant Recipient on Tacrolimus Therapy

We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection. The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses. The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction. She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline. We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently ‘cold’ subcutaneous nodules without any systemic upset. An associated brain lesion should be excluded even in patients without neurological symptoms.

Renal replacement therapy for chronic hepatitis B carrier: a subgroup analysis from the Hong Kong Renal Registry 1995–1999

Abstract This report is a subgroup analysis of the hepatitis B surface antigen (HBsAg) positive patients from 1995 to 1999, based on the data from the Renal Registry of the Hospital Authority of Hong Kong, which accounted for approximately 90% to 95% of all the patients on renal replacement therapy (RRT) in Hong Kong. As of 31 December 1999, there were 452 HBsAg positive patients (66 per million populations). During 1999, there were 96 new HBsAg positive patients (14 per million populations [pmp]). Of all the patients on RRT, 10% were HBsAg positive. The median age of the HBsAg positive patients on RRT was 49 years, and 28% were above 61-year-old. For new HBsAg positive patients who commenced on RRT during 1999, the median age was 53 years, and 34% were above 61-year-old. The major causes of renal failure of the prevalent patients were glomerulonephritis (GN) (38%) and diabetes (17%). For the new patients who entered into the program in 1999, the major causes of renal failure were diabetic nephropathy (27%) and proven GN (20%). In the HBsAg positive patients on RRT, 4.5% also had chronic hepatitis C infection, and 21% were diabetics. The modes of RRT for the HBsAg positive patients were peritoneal dialysis (PD) (60%), hemodialysis (HD) (12%) and transplant (TX) (28%). Eleven percent, 9% and 10% of all the patients on PD, HD, with kidney transplant were HBsAg positive respectively. During 1999, 9.3% of the new patients with kidney transplant were HBsAg positive. The annual crude mortality rate for 1999 was 7.1% (7.7% for PD, 13.2% for HD and 3.2% with TX). The major causes of death were infection (31%), cardiovascular disease (19%) and liver failure (9%). For cadaveric kidney transplants, the 1- and 5-year patient survival with transplant were both 90%, with history of transplant were both 73%. The 1- and 5-year graft survival were both 73% (censored) and 65% (not censored) respectively. The data were compared with all patients on RRT regardless of HBsAg status.

Multicentric Castleman's disease complicated by secondary renal amyloidosis

Castleman’s disease (CD) is a heterogeneous group of lymphoproliferative disorders of unknown cause. Histologically, it can be classified as hyaline vascular, plasma cell type or mixed types. Renal manifestations associated with CD are heterogeneous, including minimal change disease, membranous, mesangio-proliferative, crescentic, membrano-proliferative glomerulonephritis, interstitial nephritis, and amyloidosis. 1 Here we describe a patient with multicentric CD of plasma cell type who developed acute-on-chronic renal failure caused by renal amyloidosis 15 years after onset of CD.

Blood Glucose Overestimation Using Hemoglucostix in a Diabetic Patient on Icodextrin-based Peritoneal Dialysis

Icodextrin is a newly available glucose-free peritoneal dialysis solution that can be used in diabetic patients with poor glycemic control. It is less readily absorbed from the peritoneal cavity and, hence, has the advantage of reduced glucose absorption. This new osmotic agent, however, is not metabolically inert. Absorption of icodextrin can result in accumulation of oligosaccharide metabolites that interfere with some laboratory tests. We report a patient suffering from spurious hyperglycemia after using this new osmotic agent. Various mechanisms of hemoglucostix are discussed to provide information to clinicians on one important potential complication of this new osmotic agent.

Renal replacement therapy for patients with diabetes mellitus in Hong Kong

Abstract Diabetes mellitus is becoming the most common cause of end-stage renal failure in Hong Kong. This review is based on data from the Hong Kong Renal Registry from 1995 through 2000. As of March 31, 2000, a total of 1026 patients with diabetes mellitus were on renal replacement therapy. A total of 809 patients had diabetic nephropathy as primary disease and 217 had diabetes mellitus as comorbidity. The prevalence of renal replacement therapy for patients with diabetes mellitus was 151 per million population. For the year ending March 31, 2000, there were 342 new patients with diabetes mellitus requiring renal replacement therapy. Of all the patients on renal replacement therapy, 23% were diabetic. The patients with diabetes mellitus were older (median age, 63 years), and had a higher incidence of hypertension (85%), ischemic heart disease (24%), cerebrovascular disease (9%), and peripheral vascular disease (3%). The modes of renal replacement therapy for patients with diabetes mellitus were peritoneal dialysis (81%), hemodialysis (9%), and transplant (10%). The annual crude mortality rate of patients with diabetes mellitus was 16% (peritoneal dialysis, 17%; hemodialysis, 18%; transplant, 1%) compared with 6% for patients without diabetes mellitus (peritoneal dialysis, 8%; hemodialysis, 12%; transplant, 1%). The major causes of death were cardiovascular disease (33%), infection (28%), and cerebrovascular event (8%). The 1-and 5-year survival rates of dibetic patient were 89% and 32% for peritoneal dialysis, 73% and 26% for hemodialysis, and 94% and 87% for transplant, respectively. The 1-and 5-year graft survival rates were 88% and 82% (death not censored), and 91% and 91% (death censored), respectively.