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|Tajuk||Renal Anaemia in CKD – Practice Points For GPs|
BY YB DATO’ SRI LIOW TIONG LAI
THE HONOURABLE MINISTER OF HEALTH, MALAYSIA
AT THE LAUNCH OF
“RENAL ANAEMIA IN CKD – PRACTICE POINTS FOR GPs”
2nd November 2012
1. Tonight marks the launch of the its guidance booklet entitled “Renal Anaemia in CKD – Practice Points for GPs” by the Malaysian Medical Association.
2. The booklet, on the early identification and management of anemia in chronic kidney disease (CKD) patients, aims to help both general practitioners (GPs) and primary care physicians manage renal anaemia, a condition that has a major impact on morbidity and mortality in these patients
3. Based on the report of the National Renal Registry 2011, in 2011, there were a total of 25,688 patients who were on dialysis. Out of these, 24, 105 patients were on hemodialysis with the other 1,583 being on peritoneal dialysis. In 2011 alone, there were 5201 new patients who had to have dialysis treatment for their ESRD.
4. In Malaysia, the incidence (i.e. “new cases”) of patients with ESRD on dialysis had nearly doubled, from 88 per million population (pmp) in 2001 to 170 pmp in 2010. Also, the prevalence (i.e. “new cases” and “old cases”) of patients with ESRD on dialysis had more than doubled, 325 per million population (pmp) in 2001 to 762 pmp in 2010.
5. The kidneys play a major role in the production of the hormone erythropoietin, which stimulates red blood cell production in the bone marrow. In Chronic Kidney Disease or CKD, the production of erythropoietin is reduced, resulting in the development of anemia. According to the 19th Report of the Malaysian Dialysis and Transplant Registry, the number of patients receiving treatment for anaemia in CKD had more than tripled between 2002 and 2011!
6. Renal anemia is associated with adverse complications such as heart failure and worsening of CKD. The early detection and treatment of renal anemia may result in improved outcomes in these patients. Thus, targeted screening and early intervention will be necessary to reduce the burden of the disease.
7. The number of nephrologists in Malaysia is limited. In the MOH, there are 40 full- fledged nephrologists and 17 trainee nephrologists. Thus, the vast majority of patients will need to be managed by doctors in the primary and secondary healthcare centres. These doctors include the General Practitioners, Family Medicine Specialists, Medical Officers and General Physicians.
8. They will need to deliver quality care to patients in order that the expected complications of CKD, including anemia, will be well-controlled before the patients’ first encounter with a nephrologist. The monitoring of patients on Erythropoiesis-stimulating Agents can also be done by GPs working in tandem with nephrologists.
9. The proper management of anemia will certainly help improve the patient’s quality of life, reduce morbidity and mortality, reduce blood transfusion requirements and delay the progression of renal disease.
10. Thus, General Practitioners play a key role in the outcomes of patients with CKD who have renal anemia. Awareness of CKD amongst General Practitioners should be increased and they should be equipped with the appropriate knowledge and means to treat these patients; thus, the development of these Practice Points for them.
11. The key messages of these Practice Points will be disseminated via a series of road shows to the various states in the country. The MMA is making the effort to educate as many GPs as possible, with no less than 10 regional launches planned in the course of the coming six months in several cities.
12. GPs are uniquely positioned to screen at-risk patients for early CKD and anaemia. These Practice Points also support an expanded role for GPs in monitoring the treatment of anaemia and helping to support the limited number of nephrologists in the country.
13. The MMA is also looking at various projects that aim at improving the management of Non-Communicable Diseases, by working hand-in-hand with the Ministry. They have identified various areas of interest, such as suicide risk, hypertension and diabetes and are actively looking at what can be done to better educate the public as well as primary healthcare providers.