Displaying publications 1 - 20 of 67 in total

  1. Tan PC, Morad Z
    Perit Dial Int, 2003 Dec;23 Suppl 2:S206-9.
    PMID: 17986550
    Clinical disciplines in which the nurse plays as pre-eminent a role in total patient care as in peritoneal dialysis (PD) are few. The PD nurse is readily identified by the patient as the principal source of advice on day-to-day aspects of treatment, as a resource manager for supplies of PD disposables and fluids, and as a general counselor for all kinds of advice, including diet, rehabilitation, and medication, among others. The PD nurse is thus the key individual in the PD unit, and most activities involve and revolve around the nursing staff. It is therefore not surprising that most nephrologists pay considerable attention to the selection of PD nurses, particularly in long-term PD programs such as continuous ambulatory peritoneal dialysis (CAPD). The appointment of a PD nurse depends on finding an individual with the right attributes, broad general experience, and appropriate training.
    Matched MeSH terms: Peritoneal Dialysis/nursing*
  2. Goh BL, Ganeshadeva YM, Chew SE, Dalimi MS
    Semin Dial, ;21(6):561-6.
    PMID: 18764787 DOI: 10.1111/j.1525-139X.2008.00478.x
    Traditionally peritoneal dialysis (PD) catheter was implanted by surgeons using mini-laparotomy or open technique in Malaysia. We introduced peritoneoscopic Tenckhoff catheter insertion technique since the beginning of our PD program. Data were collected from the start of our PD program in February 2006 until April 2008. All Tenckhoff catheters were inserted by nephrologists using the peritoneoscope technique. We also compare the penetration rate of PD versus hemodialysis (HD) in our center, as well as comparing to national PD penetration rate. There were 83 patients who underwent 91 peritoneoscope Tenckhoff catheter insertion procedures from March 2006 until April 2008. The patients were mostly female (66%) with the mean age of 51.99 +/- 1.78 years and the majority (67%) of them were diabetics. All together there were 749.7 patient-months at risk and the overall peritonitis rate was 1 in 93.7 patient-months. The 1-year catheter survival was 86.5%. Primary catheter failure (defined as failure of the catheter within 1 month of insertion) occurred in 16 procedures (17.6%). The main cause of catheter malfunction was catheter tip migration and omentum wrap. The penetration ratio of PD when compared with HD in our center is 44.8%, which is about 4.5 times the national average. With our integrated care approach where nephrologist was heavily involved from the outset of renal replacement therapy discussion, PD access implantation to the assistance of spoke person to whom new patient can identify with, we were able to achieve PD penetration rate which far exceeds that of the national average.
    Matched MeSH terms: Peritoneal Dialysis/instrumentation*; Peritoneal Dialysis/standards*
  3. Goh BL
    Contrib Nephrol, 2017;189:79-84.
    PMID: 27951553
    BACKGROUND: The success rate of peritoneal dialysis (PD) catheter insertion is known to vary among different operators and may be influenced by many factors such as patient and various situational factors. Traditionally, surgeons have inserted Tenckhoff catheters by mini-laparotomy or an open technique. However, with recent advances in endoscopic instrumentation and video capabilities, peritoneoscope Tenckhoff catheter insertion has become a viable approach in interventional nephrologist-initiated PD access programmes.

    SUMMARY: Nephrologist-initiated peritoneoscopic PD access programs have had a positive impact on PD penetration. The technique has been associated with a better primary success rate, superior catheter survival, less postoperative pain, shorter hospital stay, and shorter catheter break-in time compared with the conventional surgical technique. The role of interventional nephrologists in peritoneoscope Tenckhoff catheter placement is still perceived to be a relatively new advance, investigational by some, and many nephrologists and surgeons alike remain sceptical of the value of this recent option. Crucial questions often raised are how many procedures one needs to perform before being considered competent and who should be credentialed to perform the procedure or supervise trainees performing it. The evaluation of technical proficiency in a specific operation is difficult and complex. Cumulative summation (CUSUM) analysis is one option for tracking the success and failure of technical skill and examining trends over time. Key Messages: The author's facility has had good outcomes with a nephrologist-initiated peritoneoscopic PD access programme. Quality control of PD catheter insertion can be performed using CUSUM charting to monitor for primary catheter dysfunction, primary leak, and primary peritonitis.

    Matched MeSH terms: Peritoneal Dialysis/methods*; Peritoneal Dialysis/trends
  4. Wong KW
    Med. J. Malaysia, 2013 Apr;68(2):179-80.
    PMID: 23629573 MyJurnal
    We report a case of melioidosis presenting as peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 47-year-old man, a lorry driver, with end-stage renal disease due to diabetes mellitus on CAPD presented in PD-related peritonitis. He was started on intraperitoneal cloxacillin and ceftazidime, and changed to intraperitoneal vancomycin and meropenam after day 5 due to nonresponse. Burkholderia pseudomallei was identified from the dialysate culture. He was treated with intraperitoneal meropenam for two weeks, and IV ceftazidime for 4 weeks. He responded, and the Tenckhoff catheter was not removed. He was discharged well and continued on oral sulfamethoxazole/trimethoprim for six months. This patient had done his PD exchanges in a lorry.
    Matched MeSH terms: Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory
  5. Lim TO, Lim YN, Wong HS, Ahmad G, Singam TS, Morad Z, et al.
    Med. J. Malaysia, 1999 Dec;54(4):442-52.
    PMID: 11072461
    We determine the cost effectiveness of centre and home haemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis (IPD) treatment in the Ministry of Health (MOH) programme. The viewpoint taken for this evaluation is that of MOH. Cost categories identified were capital cost, dialysis operational cost, medical cost and general hospital cost. Cost estimates were mostly based on actual resource utilisation. Life years saved were estimated based on Dialysis Registry data on 2480 HD and 732 CAPD patients. Overall, the cost-effectiveness ratio (CER) of centre HD was RM21620/life year saved. Those of home HD, CAPD and IPD were RM23375, RM30469 and RM36016 respectively. Sensitivity analyses did not change the ranking of the CER. We conclude the MOH dialysis programme was cost-effective, and among the various dialysis modalities centre HD was the most cost-effective.
    Matched MeSH terms: Peritoneal Dialysis/economics*; Peritoneal Dialysis, Continuous Ambulatory/economics*
  6. Zainal D, Loo CS
    Singapore Med J, 1995 Aug;36(4):379-82.
    PMID: 8919150
    Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.
    Matched MeSH terms: Peritoneal Dialysis/adverse effects; Peritoneal Dialysis/statistics & numerical data*; Peritoneal Dialysis, Continuous Ambulatory/adverse effects; Peritoneal Dialysis, Continuous Ambulatory/statistics & numerical data*
  7. Sivathasan S, Mushahar L, Yusuf WS
    Perit Dial Int, ;34(1):143-6.
    PMID: 24525611 DOI: 10.3747/pdi.2012.00332
    Matched MeSH terms: Peritoneal Dialysis, Continuous Ambulatory*
  8. Cader RA, Gafor HA, Mohd R, Kong NC, Ibrahim S, Wan Hassan WH, et al.
    J Clin Nurs, 2013 Mar;22(5-6):741-8.
    PMID: 23039369 DOI: 10.1111/j.1365-2702.2012.04298.x
    To assess the degree of overhydration in our peritoneal dialysis patients and to examine the factors contributing to overhydration.
    Matched MeSH terms: Peritoneal Dialysis, Continuous Ambulatory*
  9. Fan KS, Suleiman AB
    Med. J. Malaysia, 1985 Jun;40(2):101-6.
    PMID: 3834279
    226 peritoneal dialyses were performed on 100 patients. 28 patients presented with acute renal failure. Uraemia was the most frequent indication for dialysis. Peritonitis was an important complication and Acinetobacter species accounted for 51.5% of the positive cultures. Other complications included poor dialysate drainage and hypokalemia. Mortality was mainly due to causes unrelated to peritoneal dialysis.
    Matched MeSH terms: Peritoneal Dialysis/adverse effects*
  10. Sreenevasan G
    Br J Urol, 1970 Dec;42(6):741.
    PMID: 5497398
    Matched MeSH terms: Peritoneal Dialysis/mortality*
  11. Chai, Win Lin, Phang, Yuen Hoong, Chong, Hwee Cheng
    Tumoral calcinosis is an uncommon condition which
    has been described to exist in primary and secondary
    forms. A lack of awareness of this entity can lead to
    unnecessary procedures and incorrect management.
    We report a case of a patient on peritoneal dialysis who
    presented with multiple painful joint swellings to the
    orthopaedic department. An initial diagnosis of septic
    arthritis was made, then revised to chronic tophaceous
    gout and referred to the rheumatology unit.
    Matched MeSH terms: Peritoneal Dialysis
  12. Tan SY
    Perit Dial Int, 2008 Jun;28 Suppl 3:S49-52.
    PMID: 18552263
    Although peritoneal dialysis (PD) is an effective alternative to hemodialysis (HD) and indeed, in terms of survival, superior to HD in first year of dialysis, the utilization rate for PD remains low. Although the utilization rate of PD varies considerably, the worldwide penetration rate appears to be falling. Still, in rapidly developing countries such as China, the PD penetration rate is rising-an encouraging sign. Clearly, considerable room for improvement remains, particularly with the take-on rate of PD, and one of the potentially influential factors is the role of research activities in improving both the quantity and quality of life of patients on PD.
    Matched MeSH terms: Peritoneal Dialysis/adverse effects; Peritoneal Dialysis/utilization*
  13. Li PK, Lui SL, Leung CB, Yu AW, Lee E, Just PM, et al.
    Perit Dial Int, 2007 Jun;27 Suppl 2:S59-61.
    PMID: 17556331
    With the number of end-stage renal disease (ESRD) patients growing, one of the crucial questions facing health care professionals and funding agencies in Asia is whether funding for dialysis will be sufficient to keep up with demand. During the ISPD's 2006 Congress, academic nephrologists and government officials from China, Hong Kong, India, Indonesia, Japan, Macau, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam participated in a roundtable discussion on dialysis economics in Asia. The focus was policy and health care financing. The roundtable addressed ESRD growth in Asia and how to obtain enough funding to keep up with the growth in patient numbers. Various models were presented: the "peritoneal dialysis (PD) first" policy model, incentive programs, nongovernmental organizations providing PD, and PD reimbursement in a developing economy. This article summarizes the views of the participant nephrologists on how to increase the utilization of PD to improve on clinical and financial management of patients with ESRD.
    Matched MeSH terms: Peritoneal Dialysis/economics*; Peritoneal Dialysis/utilization*
  14. Morad Z, Lee DG, Lim YN, Tan PC
    Perit Dial Int, ;25(5):426-31.
    PMID: 16178472
    Matched MeSH terms: Peritoneal Dialysis/economics*; Peritoneal Dialysis/statistics & numerical data*
  15. Ng EK, Goh BL, Hamdiah P
    Med. J. Malaysia, 2012 Apr;67(2):151-4.
    PMID: 22822633 MyJurnal
    In-centre intermittent peritoneal dialysis (IPD), a decade-old modality commonly associated with acute (stab) PD, continues to play an undeniably important role of providing "temporary" renal replacement therapy (RRT) in Malaysia. In our center, IPD is commenced after insertion of Tenckhoff catheter by interventional nephrologists as an interim option until a definitive RRT is established. This study aims to describe our experience and evaluate the viability of this modality as a bridging therapy. We retrospectively analyzed 39 IPD patients from January 2007 to December 2009; looking at demographics, cause of end-stage renal disease, duration on the program, length of hospitalization, PD-related infection profile, biochemical parameters and clinical outcomes. We accumulated a total experience of 169 patient-months, the average age of patients was 54.6 +/- 11.6 years, 84.6% of them diabetics. The median duration of a patient in the program was 88 days with accumulated in-hospital stay of 45 days. Eventually 48.7% of the patients secured placement for long-term haemodialysis while 20.5% were converted to CAPD. The mortality rate was 7.7% while the peritonitis rate was at 1 per 18.8 patient months. Our study shows that IPD is a viable interim option with a low infection rate and good clinical outcome.
    Matched MeSH terms: Peritoneal Dialysis/methods*; Peritoneal Dialysis/mortality
  16. Cheng IK
    Perit Dial Int, 1996;16 Suppl 1:S381-5.
    PMID: 8728228
    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last three years from the straight-line systems with or without germicidal connection devices to the disconnect systems. In China and India, where PD has been introduced only recently, the disconnect systems are used almost exclusively. The disconnect systems are also the most popular systems in use in Japan and Taiwan. As data concerning the cost-effectiveness of different PD systems becomes available, it is likely that trend towards a more liberal use of disconnect systems will continue in the future. The usage of low calcium peritoneal dialysate and the average number of daily CAPD exchanges also vary among the Asian countries. Low calcium peritoneal dialysate has been introduced only in Japan, Hong Kong, and Singapore, with the highest utilization rate (90%) recorded in Singapore. The Philippines had the lowest average number of daily peritoneal exchanges (6L) among the countries surveyed, followed by Hong Kong (6.4L), China and Indonesia (7L), and the rest (8L). The use of a lower number of exchanges was introduced in some countries, initially, mainly as a cost-saving measure based on the assumption that Asians are of small body build. The justification for the continued use of a lower number of exchanges among Asian patients is debatable, but is supported by the acceptable, long-term clinical outcome of patients given this form of dialysis prescription. It is suggested that long-term prospective studies on dialysis adequacy and clinical outcome should be done in different ethnic groups in Asia to see if the similar guidelines with regard to dialysis adequacy can be applied uniformly to Orientals and Caucasians.
    Matched MeSH terms: Peritoneal Dialysis/economics*; Peritoneal Dialysis/utilization
  17. Ahmadi S, Amin-Nordin S, Neela VK, Hamat RA, Goh BL, Nor LA, et al.
    Perit Dial Int, 2015 Dec;35(7):767-9.
    PMID: 26703853 DOI: 10.3747/pdi.2013.00154
    Matched MeSH terms: Peritoneal Dialysis, Continuous Ambulatory/adverse effects*
  18. Keng TC, Ng KP, Tan LP, Chong YB, Wong CM, Lim SK
    Ren Fail, 2012;34(6):804-6.
    PMID: 22506572 DOI: 10.3109/0886022X.2012.678208
    Peritonitis is well recognized as the Achilles tendon of peritoneal dialysis (PD). Reoccurrence of peritonitis due to the same organism, defined as either repeat or relapsing peritonitis under the 2005 guidelines by the International Society for Peritoneal Dialysis, often results in PD technique failure. Rothia dentocariosa, a low-virulent human oropharynx commensal, is a rarely reported pathogen in human infection, particularly infective endocarditis. R. dentocariosa PD-related peritonitis is exceedingly uncommon yet potentially results in repeat or relapsing peritonitis which requires catheter removal. We report a case of R. dentocariosa repeat and relapsing peritonitis in a PD patient who was treated successfully with antimicrobial therapy.
    Matched MeSH terms: Peritoneal Dialysis/adverse effects*
  19. Ng EK, Goh BL, Chew SE, Tan CC, Ching CH, Sha'ariah MY, et al.
    Semin Dial, ;25(5):569-73.
    PMID: 22353629 DOI: 10.1111/j.1525-139X.2012.01051.x
    The demands for timely catheter insertion have spurred the growth of peritoneoscopic catheter insertion program by nephrologists in Malaysia. We performed a multicenter analysis to study its impact on the growth of peritoneal dialysis (PD) population. Data were collected retrospectively from five centers at the point of program initiation until December 2009. In Center 1, with this program, PD population continued to grow from 25 patients in 2006 to 120 in 2009. In center 2, the program began in 2005, but comprised only 28.6% of total insertions. From 2007 onwards, nephrologists had overtaken the surgeon, inserting from 85% to 97% of the total insertions. In center 3, with the program at its infancy, a modest growth in its PD population was shown. In center 4, nephrologists maintained an annual average of 41.8% of total catheter insertions, and thus maintaining a stable PD population. In center 5, surgeon-assisted PD catheter insertions helped to maintain the growth of its PD, seeing lesser impact from this program. Subanalysis showed that 1-year catheter survival in Center 1 was 85.4%. This study on PD catheter insertion program by nephrologists showed the greatest impact on new center and center experiencing suboptimal catheter insertions by traditional providers.
    Matched MeSH terms: Peritoneal Dialysis/instrumentation*
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