Upload
lamdang
View
217
Download
2
Embed Size (px)
Citation preview
Chronic renal disease
Chronic renal failure
End-stage renal disease
Renal replacement therapy
Hemodialysis
Peritoneal Dialysis Renal transplantation
Late referral
Late renal replacement therapy
Kondisi pasien yang dikirim ke rumah sakit
• 95% need hemodialysis urgent : lung edema, encephalopathy, severe uremia, hyperkalemia, metabolic acidosis
• 5% elective dialysis
HD survival in RSSA (2009; n=107)
HD survival in RSSA (2009; n=107
6
Note : one year survival probability 49.6%
(95% CI 0.36 - 0.62)
Kidney Int. 2000 Jan;57(1):307-13
PLB
Total pasien CAPD per Des 2016 : 1994
6
1717
45
16
9
18
60
76
55
13
16
25
CAPD Px
Mapping
58
35
51
290
95
94
135
324
COE
RSSA MALANG RS SANGLAH
RSHS
RS CIKINI
RSPAD
70
CAPD patients adequation in Malang CAPD Center (n=68)
Urea clearance (wKT/V) : 1,84 ± 0,56 litre/week
Creatinine clearance (wCCr) : 61,51 ± 23,69 litre/week/m2
Standard NKF/K- DOQI : wKT/V ≥ 1.7 litre/week
wCCr ≥ 60 litre/week/m2
Membran type in Malang CAPD Center (n=68)
Tipe membran Hasil
Low 8 (12%)
Low average 32 (47%)
High average 22 (32%)
High 6 (9%)12 %
47 %
32%
9 %
Low
Low Average
High Average
High
12% pasien CAPD tidak terakomodir dengan regimen saat ini
Membran type Preferred regimen Distribution in RSSA Malang
High APD regimen 12 %
High-average Any regimen 47%
Low-average Standard dose CAPD 32%
Low High dose, long dwell CAPD 9 %
• Dari 1994 pasien CAPD di Indonesia, diduga 240 pasien dengan tipe High Membran Type.
• Pasien ini tidak terakomodir dengan APD regimen, karena tidak disediakan dalam fornas.
Causes of drop out (2013)
Economic reason
5%Recovery of RF 5%
Death 77%
Infection 7%
Transfer to other PD units
7%
• Drop Out occured in (65 dari 176) (36 %)CAPD patient
CAPD Infections (2013)
JAN FEB MAR APR MEI JUN JUL AGUST SEP OKT
3.52%
5.28%
10.56%
1.76%
3.52%
17.65%
7.04%
3.52%
10.56%
3.52%
1.76% 1.76%1.76%
Peritonitis
Tunnel
Exit site
Proportion of peritonitis in Malang CAPD Center
Year Proportion with peritonitis
Proportion without peritonitis
Peritonitis rate(episode/month)
2013 19 % 81% 77.4 months
2014 14 % 86 % 43.8 months
2015 16% 84% 17.8 months
Gram Mapping Based on Culture Result
14.21%
28.50%
12.20%
35%
73.40%
36.20%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
2015 2016 ( untillAugust )
Gram Positive
Gram Negative
No Culture
• Negative culture still high
• ISPD : Culture-negative peritonitis should not be greater than 20% of episodes
Data source : CAPD Centre RSSA
Analisa Mortalitas (CAPD Center Malang)
22
Mean survival time 20.63 bulan (95% CI 18.778 – 22.49)Angka mortalitas dengan penyebab apapun : 24/68 (35.2%)
Grafik Hazard Kematian
Korelasi Kejadian Mortalitas danStatus Nutrisi Berdasarkan Skor CNI
23
Skor CNI > 11 : RR=2.12 (95% CI 1.05-4.28),
p=0.027
*Menggunakan uji Chi-Square dengan p<0.05
Mean survival time :Skor CNI > 11 : 17.1 bulan
(95% CI 13.6 – 21.6)Skor CNI ≤ 11 : 21.7 bulan
(95% CI 19.2 – 24.2
Masalah lain
• Biaya belum tersedia atau tidak memadai di Ina-CBGs : pemeriksaan rutin, adequacy dan PET test, repair malposisi kateter CAPD, aff catheter CAPD, home visite, edukasi.
• Finance interest lebih rendah dibandingkan HD
Messages
• Telat dirujuk mendominasi pasien kiriman
• Sebagian besar pasien CAPD adalah start on HD
• Survival pasien CAPD masih rendah
• Nutrisi buruk, peritonitis rate, negative culture , pembiayaan yang belum tercover, masih jadi masalah yang penting