Treatment Options For Kidney Patients other than Hemodialysis

The Ministry of Health Malaysia has adopted a “Peritoneal Dialysis First” (PD First) policy since 2013, which means new patients requiring dialysis treatment will be considered for Peritoneal Dialysis as a first option, before Hemodialysis. 
 
While awareness of Peritoneal Dialysis is still relatively low, interest in this form of treatment is increasing.
 
There are three Renal Replacement Therapy treatment options for kidney patients who are diagnosed with Chronic Kidney Disease (CKD):-
1.    Kidney Transplant
Replacing the failed kidney with a compatible kidney from another organ donor.
2.    Hemodialysis (HD)
Dialysis of the blood to remove toxic substances or metabolic wastes from the bloodstream.
3.    Peritoneal Dialysis (PD)
The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (toxic substances or metabolic wastes) are exchanged from the blood.

 
Automated Peritoneal Dialysis (APD) works in the same way as Continuous Ambulatory Peritoneal Dialysis (CAPD).  The peritoneal membrane filters the waste and excess into the dialysis solution.  The difference is that fluid exchanges are all done at night or when the patient is sleeping, leaving the rest of the patient’s day free.
 
Based on the latest Malaysian Dialysis and Transplant Registry 2013, kidney failure is increasing at an alarming rate with more than 6,000 new patients being dialyzed in 2013, with 1 in every 885 Malaysians receiving Renal Replacement Therapy which includes Hemodialysis, Peritoneal Dialysis or Transplant. 
 
According to Dato' Dr. Zaki Morad Mohd Zaher, Chairman of National Kidney Foundation and Consultant Nephrologist of Ampang Puteri Specialist Hospital, APD has an advantage in patient treatment as it can be administered while the patient sleeps and can be done at home.  Patients are no longer required to go through 4 hours of hemodialysis in a dialysis center and do not have to travel to the dialysis centre three to four times a week. This improves the quality of life and daytime productivity of not just the kidney patients but also their respective caregivers.

Comparison chart of the various dialysis treatment below:-

Modality	Automated Peritoneal Dialysis (APD)	Continuous Ambulatory Peritoneal Dialysis (CAPD)	Hemodialysis (HD)
Equipment	Cycler (machine) which is used to pump and drain the solution from the peritoneum.	Tubes and clamps.	Dialysis machine and dialyzer (filter).
Frequency	Once a DAY (usually at night)	Daily, 4 to 5 times a DAY	3 to 4 times a WEEK
Duration	8 to 12 hours during sleep (depending on prescription)	45 minutes during exchange	3 to 5 hours (excluding travelling time to and fro the HD center)
Location	At home	At home	At the HD center
Personnel	Self / Caregiver	Self / Caregiver	Professionally-trained nurses
Risk	Peritonitis / Exit site infection	Peritonitis/ Exit site infection	Arrhythmia, cardiac arrest, catheter-related bloodstream infection (CRBSI), various infectious outbreaks from HD center.

 
The benefits of APD over Hemodialysis (HD) are:-
>      Treatment can be done at home.
>      Treatment can be carried out during your sleep, day or night.
>      More day time freedom for the patient and caregivers
>      Kidney function can be better retained.  In HD, kidney function will   deteriorate rapidly.
>      Lesser strain to the heart, no risk of cardiac arrest during treatment.
>      Greater dietary freedom.
>      Better overall Quality of Life
 
Dato' Dr. Zaki Morad Mohd Zaher explained that there are several providers currently available in Malaysia, with Lucenxia specializing on APD treatment modality.
 
Lucenxia’s INTELLIS project is endorsed as a National Key Economic Area Healthcare Entry Point Project under the Economic Transformation Programme.  Its Intelligent Automated Peritoneal Dialysis cycler is designed for the treatment to be administered at the patient’s home, while the patient is asleep. 

 
“The patients opting for Lucenxia Intellis APD treatment only need to undergo a training on how to use the machine, and they should be able to do it subsequently by themselves in the comfort and privacy of their own home.  Our team is also ready to provide assistance when required,” said Mr. Low Chin Guan, Managing Director of Lucenxia (M) Sdn Bhd. 
 
Qualified kidney patients may seek to participate in clinical trials currently conducted at public hospitals in Kuala Lumpur, Petaling Jaya, Penang, Ipoh, Seremban, Kota Bharu and Kuala Terengganu.  Interested patients and caregivers are invited to approach these hospitals for further details.