Hong Kong Renal Registry Report 2012

SummaryThis report examined 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, and accounted for approximately 95% of all patients receiving renal replacement therapies (RRTs) in the territory. Patients receiving RRTs solely in the private sector were not included in this report. Data trends from 1996 to 2011 are presented. In 2011, 1115 new patients were accepted into RRT programs, and the incident rate was 157 patients per million populations (pmp). An increasing trend was noted. The incident rate was 95.1 pmp at the commencement of the annual report in 1996. The point prevalence on December 31, 2012 was 8197 with a prevalence rate of 1152.5 pmp. Overall, there were 3573 patients (43.6%) on peritoneal dialysis (PD) and 1246 patients (15.2%) on hemodialysis (HD), and 3378 patients (41.2%) were living with a functioning renal transplant. The PD/HD ratio was 74.2:25.8. The “PD First” policy was continued. The overall mortality rate among RRT patients was 9.95 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 rates. The 5 years cumulative patient survival rate for patients on transplant treatment was 89.6%, whereas the corresponding patient survival rates for PD and HD patients were 50.7% and 55.7%, respectively. More than 70% of RRT patients with reports on rehabilitation were active and had normal daily activities

Renal transplantation in patients with primary immunoglobulin A nephropathy

Background. Opinions on the clinical course and outcome of renal transplantation in patients with primary immunoglobulin A nephropathy (IgAN) have been controversial. Methods. We conducted a retrospective single-centre study on 542 kidney transplant recipients over the period 1984&ndash;2001. Long-term outcome and factors affecting recurrence in recipients with primary IgAN were analysed. Results. Seventy-five patients (13.8%) had biopsy-proven IgAN as the cause of renal failure, and their mean duration of follow-up after transplantation was 100 &plusmn; 5.8 months. Fourteen (18.7%) of the 75 patients had biopsy-proven recurrent IgAN, diagnosed at 67.7 &plusmn; 11 months after transplantation. The risk of recurrence was not associated with HLA DR4 or B35. Graft failure occurred in five (35.7%) of the 14 patients: three due to IgAN and two due to chronic rejection. Three (4.9%) of the 61 patients without recurrent IgAN had graft failure, all due to chronic rejection. Graft survival was similar between living-related and cadaveric/living-unrelated patients (12-year graft survival, 88 and 72%, respectively, P = 0.616). Renal allograft survival within the first 12 years was better in patients with primary IgAN compared with those with other primary diseases (80 vs 51%, P = 0.001). Thereafter, IgAN patients showed an inferior graft survival (74 vs 97% in non-IgAN patients, P = 0.001). Conclusions. Our data suggested that around one-fifth of patients with primary IgAN developed recurrence by 5 years after transplantation. Recurrent IgA nephropathy in allografts runs an indolent course with favourable outcome in the first 12 years. However, the contribution of recurrent disease to graft loss becomes more significant on long-term follow up.<br /

Hong Kong Renal Registry 1995–1999

AbstractThis 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