Tze-Hoi Kwan

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 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.

Ultrasonography in the management of exit site infections in peritoneal dialysis patients

Aim:  To assess the efficacy of using ultrasonography (USG) in monitoring the progress of exit site infection (ESI) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Fatal case of Aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis (Case Report)

SUMMARY:  Cytomegalovirus (CMV) disease is common in postrenal transplant recipients, and may predispose the patients to secondary bacterial or fungal infections. However, simultaneous coinfection is rare and often makes diagnosis difficult. We report a case of CMV pneumonitis in a renal transplant recipient presenting with elevated CMV pp65 antigen level and abnormal chest radiograph. Despite potent and broad‐spectrum antimicrobial therapy, his condition deteriorated rapidly – he soon went into respiratory failure, septic shock and died several days later. Transbronchial biopsy and bronchoalveolar lavage obtained before the patients death showed evidence of invasive pulmonary aspergillosis with concomitant CMV pneumonitis. High index of suspicion and early and empirical initiation of antifungal therapy may be necessary for successful management of fulminant pneumonia in solid organ transplant recipients.

An unusual case of both upper and lower gastrointestinal bleeding in a kidney transplant recipient.

Background. Tuberculosis (TB) is an uncommon opportunistic infection in immunocompromised patients. Extrapulmonary infection involving the intestine is rare and poses diagnostic difficulties.

Water treatment for hemodialysis

Abstract Water treatment plays a vital role in the delivery of safe and effective hemodialysis (HD). Ensuring that water quality meets the American Association for the Advancement of Medical Instrumentation standards and recommendations (or equivalent) is necessary to reduce the incidence of chemical hazards and endotoxemia associated with the use of water for HD. This review will discuss the principles of water treatment for HD, the essential components of water purification, the recommended system monitoring and maintenance procedures, and some of the historical incidents of adverse reactions that resulted from the use of contaminated dialysis water.

The impact of CAPD on sexual life of renal patients

Abstract Uremia and dialysis are notorious to have adverse effect on the sexual life of renal patients. To assess the magnitude of this impact in patients on continuous ambulatory peritoneal dialysis (CAPD), married couples with one of the partner on CAPD aged less than 50 years old were studied by questionnaires. Fifty-six questionnaires returned from 28 spouses. Out of 28 patients, 53.6% indicated a decrease in satisfaction to sexual life, 71.4% had decrease in libido and 78.6% had decrease in frequency of sexual intercourse upon commencement of CAPD. Out of 11 male patients, 10 had perceived deterioration in sexual potency, seven indicated a decrease in the ease of achieving orgasm and three had complete loss of morning erection. Up to 50% of patients attributed the decrease in their libido to the fear of pulling the peritoneal dialysis (PD) catheters. Of all couples, 21.4% and 14.3% agreed to the notion that normal sexual life jeopardizes the health of male and female CAPD patients respectively; 28.6% agreed that sexual life could accelerate the deterioration of residual renal function; 14.3% felt that having sex with renal patients would be deleterious to the health of spouse. Another 16.1% thought that patients on CAPD should not have sexual life while 30.4% believed that end-staged renal failure (ESRF) would inevitably lead to loss of sexual function. Couples with complete cessation of sexual activities after CAPD tend to agree with or being uncertain about the above-mentioned notions. In conclusion, we confirmed that CAPD patients were adversely affected in various aspects of their sexual life. Misconception concerning the negative impact of sexual activities on the health of renal patients is common. Education and counseling should have definite role in the removal of myths and improvement of sexual rehabilitation amongst patients on CAPD.