www.nephrothai.org trt registry data 2004 trt registry subcommittee nephrology society of thailand
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TRT Registry Data 2004TRT Registry Data 2004
TRT Registry Subcommittee
Nephrology Society of Thailand
www.nephrothai.org
Renal Replacement Therapy Services Renal Replacement Therapy Services Mapping for Centers in Thailand 2004Mapping for Centers in Thailand 2004
NB: HD Available in 100%, CAPD and KT only in some centersNB: HD Available in 100%, CAPD and KT only in some centers
SouthNorthNEEastCentralBKK and perimetro126 41.9
33 11.0
18 6.0
42 14.0
51 16.9
31 10.3
301 100.0
Count Percent
BKK and perimetro
Central
East
NE
North
South
Total
Perimet: Nonthaburi, Nakornpatom Pathumtani, Samutprakarn and Samutsakorn
TRT Registry 2004
www.nephrothai.org
CAPD Service Mapping 2004CAPD Service Mapping 2004(Number of Centers in Thailand)(Number of Centers in Thailand)
South
North
NE
East
Central
BKK and perimetro
31 55.44 7.14 7.15 8.98 14.34 7.1
56 100.0
Count PercentBKK and perimetroCentralEastNENorthSouthTotal
TRT Registry 2004
www.nephrothai.org
KT Service Mapping 2004KT Service Mapping 2004(Number of Centers in Thailand)(Number of Centers in Thailand)
20 74.12 7.42 7.42 7.41 3.7
27 100.0
Count PercentBKK and perimetroEastNENorthSouthTotal
South
North
NE
East
BKK and perimetro
TRT Registry 2004
www.nephrothai.org
HD Centers in Thailand in 2004HD Centers in Thailand in 2004Classified by OwnershipClassified by Ownership
University Center
Private
Military Service
Government Cevil Service
Foundation
10 3.3107 35.5
20 6.6151 50.2
13 4.3301 100.0
Count PercentFoundationGovernment Cevil ServiceMilitary ServicePrivateUniversity CenterTotal
TRT Registry 2004
www.nephrothai.org
CAPD Centers in Thailand in 2004CAPD Centers in Thailand in 2004Classified by OwnershipClassified by Ownership
2 3.632 57.1
7 12.56 10.79 16.1
56 100.0
Count PercentFoundationGovernment Cevil ServiceMilitary ServicePrivateUniversity CenterTotal
University Center
Private
Military Service
Government Cevil Service
Foundation
TRT Registry 2004
www.nephrothai.org
KT Centers in Thailand in 2004KT Centers in Thailand in 2004Classified by OwnershipClassified by Ownership
8 29.62 7.4
11 40.76 22.2
27 100.0
Count PercentGovernment Cevil ServiceMilitary ServicePrivateUniversity CenterTotal
University Center
Private
Military Service
Government Cevil Service
TRT Registry 2004
www.nephrothai.org
Number of HD CentersNumber of HD CentersClassified by NST AccreditationClassified by NST Accreditation
181 60.122 7.398 32.6
301 100.0
Count PercentNot yetUndergoingYesTotal
YesUndergoingNot yet
TRT Registry 2004
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Number of HD CentersNumber of HD CentersNot Yet Accreditated or Not Undergoing Process Not Yet Accreditated or Not Undergoing Process
by NST in 2004by NST in 2004
57 31.529 16.0
9 5.029 16.037 20.420 11.0
181 100.0
Count PercentBKK and perimetroCentralEastNENorthSouthTotal
SouthNorthNEEastCentralBKK and perimetro
TRT Registry 2004
www.nephrothai.org
18 HD Centers (6%) 18 HD Centers (6%) are Out-Hospital Centersare Out-Hospital Centers
13 72.22 11.11 5.61 5.61 5.6
18 100.0
Count PercentBKK and perimetroCentralNENorthSouthTotal
3 16.715 83.318 100.0
Count PercentFoundationPrivateTotal
11 61.11 5.66 33.3
18 100.0
Count PercentNot yetUndergoingYesTotal
NST Accreditation (2004)NST Accreditation (2004)
TRT Registry 2004
www.nephrothai.org
In Hospital Dialysis Center with Different Owner (Contracted HD Center)
181 75.458 24.21 .4
240 100.0
Count Percentโรงพยาบาลดำาเนิ นิการเองเอกชนิเช�าดำาเนิ นิการมู�ลนิ ธิ โรคไตTotal
TRT Registry 2004
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In Hospital Centers and HD Accreditation
181 104 10 6758 39 7 121 1 0 0
240 144 17 79
Total Count Not yet Count Undergoing Count Yes Countโรงพยาบาลดำาเนิ นิการเองเอกชนิเช�าดำาเนิ นิการมู�ลนิ ธิ โรคไตTotal
TRT Registry 2004
www.nephrothai.org
Distribution of HD Machines Distribution of HD Machines by Locationby Location
0
10
20
30
40
50
60
Co
un
t
0 10 20 30 40 50 60Total HD machines
298
1
58
1931
126
1
58
1044
31
2
8
140
18
2
13
127
42
2
15
219
51
1
40
259
30
2
12
142
Count
Minimum
Maximum
Sum
Tota... Total... Tota... Tota... Tota... Tot... Tot... Total BKK & Peri Central East NE North South
6.5 5.3 298 1.0 58.0 1931.0 5.06.1 3.9 272 1.0 26.0 1668.0 5.0
12.6 14.4 18 2.0 58.0 226.0 7.0
Mean Std. Dev. Count Minimum Maximum Sum MedianTotal HD machines, TotalTotal HD machines, .ศู�นิย�ในิรพTotal HD machines, .ศู�นิย�นิอกรพ
11.7%
100% 54.1% 7.3% 6.6% 11.3% 13.4% 100% 54.1% 7.3% 6.6% 11.3% 13.4% 7.4%7.4%
TRT Registry 2004
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Number of HD Machines in 2004Classified by Type of Ownership
6 5 298 1 58 1931 5
16 15 10 4 58 155 12
5 3 106 1 18 578 5
7 4 20 2 15 144 7
6 5 149 1 40 923 5
10 6 13 2 23 131 8
Mean Std. Dev. Count Minimum Maximum Sum Median
Total HD machines, Total
Total HD machines, Foundation
Total HD machines, Government Cevil Service
Total HD machines, Military Service
Total HD machines, Private
Total HD machines, University Center
8%
30%
7%7%
48%
Foundation Gov Cevil Service Mil Services Univ Center Private ServiceTRT Registry 2004
Foundation
Gov Cevil Serv
Mil ServiceUniv
Private
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Cost of HD/SessionCost of HD/Session
0
10
20
30
40
50
60
70
80
90
Co
un
t
0 500 1000 1500 2000 2500 3000 3500 4000 4500Cost of HD/session
TRT Registry 2004
NumberOf Units
Bhts
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Cost of HD/Session (Bht)Cost of HD/Session (Bht)Classified by Type of OwnershipClassified by Type of Ownership
0
500
1000
1500
2000
2500
3000
Cel
l M
ean
Cost of HD/session-500
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Un
its
Cost of HD/session
University Center
Private
Military Service
Government Cevil Service
Foundation
2153 521 30 299 0 4000 2
1555 526 166 10 1000 2300 0
2248 521 51 106 0 3500 1
2580 614 137 20 1000 3000 0
2091 423 35 150 1500 4000 1
1900 742 206 13 1000 3000 0
Mean Std. Dev. Std. Error Count Minimum Maximum # Missing
Cost of HD/session, Total
Cost of HD/session, Foundation
Cost of HD/session, Government Cevil Service
Cost of HD/session, Military Service
Cost of HD/session, Private
Cost of HD/session, University Center
Bht Bht
TRT Registry 2004
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Cost of HD/Session (Bht)Cost of HD/Session (Bht)Classified by In-Hospital vs Out-Hospital CenterClassified by In-Hospital vs Out-Hospital Center
2153 521 30 299 0 4000 2
2186 511 31 273 0 4000 2
1639 369 87 18 1000 2200 0
Mean Std. Dev. Std. Error Count Minimum Maximum # Missing
Cost of HD/session, Total
Cost of HD/session, .ศู�นิย�ในิรพCost of HD/session, .ศู�นิย�นิอกรพ
-500
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Cost of HD/session
.ศู�นิย�นิอกรพ .ศู�นิย�ในิรพ
0
250
500
750
1000
1250
1500
1750
2000
2250
2500
Cost of HD/session
Bht Bht
TRT Registry 2004
www.nephrothai.org
Center Distribution withCenter Distribution withAdditional Charge for DialyzerAdditional Charge for Dialyzer
Total Number Percent of CentersCenter Charge with Additional Charge
Foundation 10 0 0
Governmental 107 37 34.6Cevil Hospital
Military Hospital 20 4 20
University Hospital 13 6 46.2
Private 151 29 19.2
Total 301 76 25.2
TRT Registry 2004
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Center Distribution withCenter Distribution withAdditional Charge for DialyzerAdditional Charge for Dialyzer
Total Number Percent of Centers
Center Charge with Additional Charge
In Hospital Center 275 74 26.9
Out Hospital Center 18 1 5.6
Total 301 76 25.2
TRT Registry 2004
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Number of Full Time NephrologistNumber of Full Time Nephrologist
0
10
20
30
40
50
60
70
80
90
0 2 4 6 8 10 12 14
1168
012
2221
199
05
560
MeanCountMinimumMaximumSumMedian
FulltimeNephrologists Full-time Dialysis Physician with 4 mo training
Number of Centers
Number of Full-Time Nephrologists TRT Registry 2004
www.nephrothai.org
Distribution of Nephrologists
TRT Registry 2004
0
.5
1
1.5
2
FulltimeNephrologists-2
0
2
4
6
8
10
12
14
FulltimeNephrologists
South
North
NE
East
Central
BKK and perimetro
1.3 1.6 .1 168 0.0 12.0 222.0
1.7 1.9 .2 87 0.0 12.0 144.0
.8 .7 .2 18 0.0 2.0 15.0
1.4 1.1 .3 13 0.0 4.0 18.0
1.2 1.5 .4 16 0.0 5.0 19.0
.8 1.1 .3 19 0.0 4.0 15.0
.7 .8 .2 15 0.0 3.0 11.0
Mean Std. Dev. Std. Error Count Minimum Maximum Sum
FulltimeNephrologists, Total
FulltimeNephrologists, BKK and perimetro
FulltimeNephrologists, Central
FulltimeNephrologists, East
FulltimeNephrologists, NE
FulltimeNephrologists, North
FulltimeNephrologists, South
NB: Count = number of centers Sum = number of nephrologists
64.9%64.9%
www.nephrothai.org
Distribution of Full-timeDistribution of Full-timeCertified Senior Renal NursesCertified Senior Renal Nurses
%100 70 3.5 4.5 8.2 9.6 4.2
2 3 186 0 20 4263 4 93 0 20 2981 1 15 0 4 151 1 13 0 3 191 1 24 0 4 352 2 24 0 8 411 1 17 0 3 18
Mean Std. Dev. Count Minimum Maximum SumFull-time Certified Senior Renal Nurse, TotalFull-time Certified Senior Renal Nurse, BKK and perimetroFull-time Certified Senior Renal Nurse, CentralFull-time Certified Senior Renal Nurse, EastFull-time Certified Senior Renal Nurse, NEFull-time Certified Senior Renal Nurse, NorthFull-time Certified Senior Renal Nurse, South
115 centers (38.2%) have no certified senior renal nurses
TRT Registry 2004
www.nephrothai.org
Ratio of HD Patients / GNRatio of HD Patients / GN
0
.5
1
1.5
2
2.5
3
Ratio Patient / GN0
1
2
3
4
5
6
7
8
9
10
11
Ratio Patient / GN
South
North
NE
East
Central
BKK and perimetro
TRT Registry 2004
2.5 1.1 .1 289 1.0 10.0 12
2.7 1.1 .1 121 1.0 10.0 5
2.3 1.2 .2 32 1.0 6.0 1
2.3 .8 .2 18 1.0 4.0 0
2.5 .8 .1 39 1.0 4.0 3
2.2 .9 .1 49 1.0 5.0 2
2.3 1.2 .2 30 1.0 7.0 1
Mean Std. Dev. Std. Error Count Minimum Maximum # Missing
Ratio Patient / GN, Total
Ratio Patient / GN, BKK and perimetro
Ratio Patient / GN, Central
Ratio Patient / GN, East
Ratio Patient / GN, NE
Ratio Patient / GN, North
Ratio Patient / GN, South
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Ratio of HD Patients / GNRatio of HD Patients / GN
0
.5
1
1.5
2
2.5
3
3.5
4
Ratio Patient / GN0
1
2
3
4
5
6
7
8
9
10
11
Ratio Patient / GN
University Center
Private
Military Service
Government Cevil Service
Foundation
2.5 1.1 .1 289 1.0 10.0 12
2.8 .8 .2 10 2.0 4.0 0
2.0 .8 .1 103 1.0 7.0 4
3.4 1.8 .4 19 2.0 10.0 1
2.7 .9 .1 147 1.0 6.0 4
2.2 .8 .2 10 1.0 4.0 3
Mean Std. Dev. Std. Error Count Minimum Maximum # Missing
Ratio Patient / GN, Total
Ratio Patient / GN, Foundation
Ratio Patient / GN, Government Cevil Service
Ratio Patient / GN, Military Service
Ratio Patient / GN, Private
Ratio Patient / GN, University Center
TRT Registry 2004
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Ratio of HD Patients / GNRatio of HD Patients / GN
0
.5
1
1.5
2
2.5
3
3.5
Ratio Patient / GN0
1
2
3
4
5
6
7
8
9
10
11
Ratio Patient / GN
.ศู�นย์�นอกรพ .ศู�นย์�ในรพ
2.5 1.1 .1 289 1.0 10.0 122.5 1.1 .1 266 1.0 10.0 93.1 1.0 .2 17 1.0 4.0 1
Mean Std. Dev. Std. Error Count Minimum Maximum # MissingRatio Patient / GN, TotalRatio Patient / GN, .ศู�นิย�ในิรพRatio Patient / GN, .ศู�นิย�นิอกรพ
TRT Registry 2004
www.nephrothai.org
Alived Patients at the End of 2004Reported by 258 Centers all over Thailand
61%
6%
5%
12%
11%5% BKK and Perimetro
Central
East
North-East
North
South
43 66 258 2 778 11208
64 94 105 6 778 6670
26 25 28 4 138 727
36 21 16 10 78 572
34 45 40 4 273 1356
30 28 42 5 140 1273
23 17 27 2 73 610
Mean Std. Dev. Count Minimum Maximum Sum
prevalence 2004, Total
prevalence 2004, BKK and perimetro
prevalence 2004, Central
prevalence 2004, East
prevalence 2004, NE
prevalence 2004, North
prevalence 2004, South
TRT Registry 2004
www.nephrothai.org
New Patients (HD+CAPD) in 2004Reported by 258 Centers all over Thailand
52%
8%5%
14%
15%6% BKK and Perimetro
Central
East
North-East
North
South
14 17 258 0 137 3645
18 20 105 0 137 1878
11 9 28 0 49 308
10 8 16 0 24 165
13 16 40 0 72 510
13 17 42 0 100 563
8 8 27 0 35 221
Mean Std. Dev. Count Minimum Maximum Sum
incidence 2004, Total
incidence 2004, BKK and perimetro
incidence 2004, Central
incidence 2004, East
incidence 2004, NE
incidence 2004, North
incidence 2004, SouthTRT Registry 2004
www.nephrothai.org
Number of Alived PatientsReported from 258 Centers allover Thailand
33 36 258 2 418 8640
45 49 105 5 418 4741
24 25 28 4 138 684
31 17 16 10 73 500
26 23 40 4 133 1047
25 21 42 4 109 1066
22 17 27 2 73 602
15 21 36 1 93 554
17 21 18 1 72 308
9 7 3 2 15 27
12 10 4 2 25 48
18 33 7 1 93 123
22 24 2 5 39 44
2 0 2 2 2 4
25 84 81 1 670 2014
39 112 42 1 670 1621
2 1 10 1 3 16
6 9 4 1 20 24
17 48 11 1 160 186
16 39 10 1 124 163
1 0 4 1 1 4
Mean Std. Dev. Count Minimum Maximum Sum
HD Alived 2004, Total
HD Alived 2004, BKK and perimetro
HD Alived 2004, Central
HD Alived 2004, East
HD Alived 2004, NE
HD Alived 2004, North
HD Alived 2004, South
CAPD Alived 2004, Total
CAPD Alived 2004, BKK and perimetro
CAPD Alived 2004, Central
CAPD Alived 2004, East
CAPD Alived 2004, NE
CAPD Alived 2004, North
CAPD Alived 2004, South
KT Alived, Total
KT Alived, BKK and perimetro
KT Alived, Central
KT Alived, East
KT Alived, NE
KT Alived, North
KT Alived, South
NB Per center: mean, std dev, min and max Count: number of centers Sum: total number of patients
TRT Registry 2004
www.nephrothai.org
New PatientsReported from 258 Centers all-over Thailand
NB Per center: mean, std dev, min and max Count: number of centers Sum: total number of patients TRT Registry 2004
15 17 238 1 137 3460
18 21 97 1 137 1784
11 9 27 3 49 298
13 7 13 4 24 163
12 15 38 1 72 446
14 17 39 1 100 548
9 8 24 2 35 221
8 11 24 1 53 185
7 5 14 1 15 94
3 2 3 2 6 10
2 • 1 2 2 2
13 23 5 1 53 64
15 • 1 15 15 15
• • 0 • • •
8 17 44 1 91 353
12 21 23 1 91 278
1 5E-1 8 1 2 10
1 0 2 1 1 2
8 17 6 1 42 49
3 4 4 1 9 13
1 • 1 1 1 1
Mean Std. Dev. Count Minimum Maximum Sum
HD incidence 2003, Total
HD incidence 2003, BKK and perimetro
HD incidence 2003, Central
HD incidence 2003, East
HD incidence 2003, NE
HD incidence 2003, North
HD incidence 2003, South
CAPD Incidence 2003, Total
CAPD Incidence 2003, BKK and perimetro
CAPD Incidence 2003, Central
CAPD Incidence 2003, East
CAPD Incidence 2003, NE
CAPD Incidence 2003, North
CAPD Incidence 2003, South
KT in 2003, Total
KT in 2003, BKK and perimetro
KT in 2003, Central
KT in 2003, East
KT in 2003, NE
KT in 2003, North
KT in 2003, South
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Number of Patients by Service OwnershipReported by 258 Centers all-over Thailand
43 66 258 2 778 11208
106 126 9 40 432 954
22 15 103 4 86 2260
56 52 16 7 197 890
44 34 118 2 182 5145
163 223 12 9 778 1959
Mean Std. Dev. Count Minimum Maximum Sum
prevalence 2004, Total
prevalence 2004, Foundation
prevalence 2004, Government Cevil Service
prevalence 2004, Military Service
prevalence 2004, Private
prevalence 2004, University Center
9%
20%
8%
46%
17% Foundation
GCS
Mil Serv
Private
Univ Service
TRT Registry 2004
www.nephrothai.org
New Patients by Service OwnershipReported by 258 Centers all-over Thailand
6%
20%
7%
62%
5%Foundation
GCS
Mil Serv
Private
Univ Service
14 17 258 0 137 3645
25 23 9 5 71 223
7 6 103 0 34 734
16 19 16 0 65 255
19 21 118 0 137 2257
15 15 12 2 58 176
Mean Std. Dev. Count Minimum Maximum Sum
incidence 2004, Total
incidence 2004, Foundation
incidence 2004, Government Cevil Service
incidence 2004, Military Service
incidence 2004, Private
incidence 2004, University Center
TRT Registry 2004
www.nephrothai.org
Patient Data from 258 CentersPatient Data from 258 Centers(Survey at Dec 31th, 2003, estimate total Thai population 64 M)(Survey at Dec 31th, 2003, estimate total Thai population 64 M)
total % per M pop
• Point Prevalence– HD 8640 77.1 135.0– PD 554 4.9 8.7– KT with functioning graft 2014 18.0 31.5– Total 11208 100.0 175.2
• Incidence– HD 3460 86.5 54.1– PD 185 4.6 2.9– KT 353 8.8 5.5– Total 3998 100.0 62.5
TRT Registry 2004* KT data from 3 University Hospitals were missing
HD Prevalence adjusted factor: average patients / center = 33.5HD Incidence adjusted factor: average patients / center = 13.4
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Estimation for 2003Estimation for 2003(Survey at Dec 31th, 2003, estimated total Thai population 64 M)(Survey at Dec 31th, 2003, estimated total Thai population 64 M)
total % per M pop
• Point Prevalence– HD 11990 79.9 187.3– PD 1000 6.7 15.6– KT with functioning graft 2014 13.4 31.5– Total 15004 100.0 234.4
• Incidence– HD 4800 90.6 75.0– PD 144 2.7 2.3– KT 353 6.7 5.5 – Total 5297 100.0 82.8
TRT Registry 2004
www.nephrothai.org
USRDS Data: International Report 2001
Point Prevalence of ESRD on Renal Replacement Therapy
Thailand 2003Thailand 2003HD 187 pMpHD 187 pMpCAPDCAPD 16 pMp 16 pMpKT 32 pMpKT 32 pMpRRT 234 pMpRRT 234 pMp
TRT Registry 2004
www.nephrothai.org
USRDS Data: International Report
2001 Incidence of ESRD on Renal
Replacement Therapy
Thailand 2003Thailand 2003HD 75.0pMpHD 75.0pMpCAPDCAPD 2.3 pMp 2.3 pMpKT 5.5 pMpKT 5.5 pMpRRT 82.8 pMpRRT 82.8 pMp
TRT Registry 2004
www.nephrothai.org
Patient DataPatient Data
TRT Registry 2004
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Problem in Analysis
• Completion of patient data– Total record received 7243 records– Reconfirmed data 4333 records
(59.8%)
TRT Registry 2004
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Reconfirmed DataReconfirmed Data
2156 49.8414 9.6274 6.3607 14.0551 12.7331 7.6
4333 100.0
Count PercentBKK and PerimetroCentralEastNorthNorth-EastSouthTotal
2159 49.62192 50.44351 100.0
Count PercentFemaleMaleTotal
373 8.73899 91.34272 100.0
Count PercentCAPDHemodialysisTotal
TRT Registry 2004
www.nephrothai.org
Causes of Renal Replacement Therapy 2003
HT, 1043, 26%
CGN, 558, 14%
Other, 448, 11%
Unknown, 613,
15%
DM, 1348, 34%
TRT Registry 2004
www.nephrothai.org
Mortality in 2003
Reported only in 161 patients(1.4% of 11208 alived patients)
TRT Registry 2004
Cardiovascular causes 50 patientsCerebrovascular causes 17 patientsInfections 36 patientsMalignancy 3 patients