Friday, 14 February 2020

About Stock X

Malaysia's population is increasing. Certainly, its elderly population is also increasing because of increased life expectancy.

I think no one will disagree with me if I say that chronic degenerative diseases such as hypertension, diabetes mellitus, heart attack, stroke, cancer, kidney failure etc are getting not only more common, but also affecting younger age group.

Kidney failure, one disease that many people fear of, is no doubt getting more prevalent no matter you like it or not.

From Malaysia National Renal Registry data, there were 7,663 new dialysis patients and total 39,711 active dialysis patients in year 2016.

Even though new dialysis patients drop slightly for the first time in don't know how many years in 2016, total patients on dialysis treatment is on a steady rise without fail, doubling from approximately 17,000 patients in 2007 to 40,000 patients in 2016.

Unfortunately, we only have data up to year 2016, even though now we are already in 2020.

Nevertheless, base on this trend, if I just add average 8,000 new cases each year, end of 2020 will see 72,000 patients on active dialysis.

For someone who has end stage kidney failure, the only "cure" is kidney transplant. If not, dialysis is the only other option to prolong life.

In Malaysia, when talking about dialysis, almost everyone will straight away think of "cuci mesin", “洗肾中心”, "dialysis center", which is hemodialysis (HD).

In HD, a patient is connected to a dialysis machine and the machine filter the metabolic waste from blood and circulate the clean blood back to the patient.

Not many people realize that there is another way of dialysis called peritoneal dialysis (PD).

In PD, fluid (dialysate) is drained into a patient's abdomen where an abdominal structure called peritoneum acts as a natural filter. After a few hours, the fluid with toxin and waste is drained out.

Peritoneal Dialysis (PD)

According to National Kidney Registry Malaysia, approximately 90% of kidney failure patients are on HD, while the rest of 10% on PD. Obviously HD is overwhelmingly a more popular choice among Malaysians.

These figures remain rather constant throughout the years, but we can see that PD might be on a slow rise.

Between HD & PD, which one is better, safer or more efficient?

Each methods has its pros and cons, and I'm not going to go into such details here.

In short, actually PD is equally good, if not better than HD according to various researches.

Since PD is at least equally good, why are so many patients treated with HD rather than PD in Malaysia? It's more about government's policy & hospital "culture".

Basically in Malaysia, when a patient is diagnosed with end stage kidney failure and needs long term dialysis, doctors will straight away prepare the patient for HD without talking much about PD to the patient.

If everything is OK, patient will start HD. Only if HD is really not suitable or failed, then the patient will do PD.

Some HD patients don't even know the existence of PD after undergoing dialysis for many years!

So in Malaysia, it's "HD First" policy even though I don't think this is officially in place.

There are generally 2 types of PD: Continuous Ambulatory Peritoneal Dialysis (CAPD) & Automated Peritoneal Dialysis (APD).

In CAPD which is usually home based, patients need to manually drain the fluid into their abdomen through a permanent catheter fixed at abdomen, leave the fluid inside (dwell) for 4 hours then come back to drain out the fluid and put in fresh fluid again. This cycle goes on and usually 4 cycles are needed per day, everyday.

Patients with HD have to travel to dialysis center 3 days a week, with each day 4 hours of dialysis. If we include transport and waiting time, 5-6 hours might be needed for a HD session.

So in CAPD, you have 4 hours to move around freely when the fluid is in your abdomen. You have to come back home to drain out the fluid. In HD, you're stuck to dialysis machine at least 12 hours a week, the rest of the time you can freely move around.

HD needs transport to a dialysis center with big needles poked into your arm every time you are connected to the machine. CAPD can be done by own self at home 4 cycles a day everyday. Which one would you prefer if you're going for dialysis?

Most patients who stay in rural area need PD because no investors will want to set up a dialysis center in rural area just to treat a few patients, and transport to a dialysis center in town is costly and inconvenience.

If you don't want or can't go to dialysis center for HD, and don't like the hassle of draining the dialysis fluids in and out 4-5 times a day, then Automated Peritoneal Dialysis (APD) is the solution.

APD is just like CAPD which can be done at home using peritoneum in the abdomen as filter. The difference is, APD is done at night while you're sleeping using a machine (cycler) to drain the fluids in and out automatically.

So, after waking up in the morning, you are free to move everywhere. You just need to connect to the machine when you're going to bed at night. Basically it does not affect your day time activities. You can go KLCC shopping for a whole day without the need to come back home after 4 hours.

Even when you are traveling to other places for few days or weeks, you don't need to face difficulty in searching for dialysis centers to slot you in, you can carry the portable APD machine with you.

Personally I think APD is the best way of dialysis. However, it is the least used method in our country by miles.

Some readers should have known by now what is my "Stock X". Obviously, it is related to this APD.

Only 10% of dialysis patients are on PD, and even less patients are on APD. Will it be enough to support Stock X's business of APD home-based dialysis?

I'll discuss more in the next post.