Mineral and Bone Disorder Goh Bak Leong Ching Chen Hua Kok Lai Sun Liew Yew Fong Wan Ahmad Hafiz Adnan Bin Wan Md Adnan Yudisthra AL Ganeshadeva Table 711 Phosphate Binder in HD patients 20092018 ID: 1045198
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1. CHAPTER 7Chronic Kidney Disease – Mineral and Bone DisorderGoh Bak LeongChing Chen HuaKok Lai SunLiew Yew FongWan Ahmad Hafiz Adnan Bin Wan Md AdnanYudisthra A/L Ganeshadeva
2. Table 7.1.1: Phosphate Binder in HD patients, 2009-2018YearNumber ofpatientsNumber ofpatientsOn CaCO3Number onpatientson Al(OH)3Number ofpatients onLanthanumNumber ofpatients on Sevelamer HcI n%n%n%n%201846153412608915071221257320174461840278907072229642201638144354439330626250912015354243276792208182361120143258629975926078622121201329147269269210073631080201225831236689212064838302011225122062392300517272020101970917921912703812602009180521652792340247100
3. Table 7.1.2: Phosphate Binder in PD patients, 2009-2018YearNumber ofpatientsNumber ofpatientsOn CaCO3Number onpatientson Al(OH)3Number ofpatients onLanthanumNumber ofpatients on Sevelamer HcI n%n%n%n%201857404937861081133262017540245518400942283520164702395184009921714201543333652840012539322014372832088630119341120133260280586201113231201228762452853010141202011255122078740904120201023602085882052210200922121875857045210
4. Table 7.1.3: Phosphate Binders by Sector in HD patientsYearSectorLanthanum CarbonateSevelamer HcIAluminium bindern%n%n%2018 Public2663468243319Private2182720713319NGO30939700441063 Total7931001589100161002017 Public2893554143114Private2162614011343NGO3113856645343 Total816100124710071002016 Public300412884200Private1742455800NGO25135337503100 Total72510068010031002015 Public3633816236150Private23225451000NGO3483724754150 Total94310045410021002014 Public346387831667Private2342619800NGO3253615662333 Total9051002531009100YearSectorLanthanum CarbonateSevelamer HcIAluminium bindern%n%n%2013 Public339403930650Private1972397542NGO31137836318 Total847100131100121002012 Public342461819640Private184258800NGO223306973960 Total74910095100151002011 Public3135219232368Private14023263126NGO154253946926 Total60710084100341002010 Public202473432069Private1132600517NGO11827457414 Total4331007100291002009 Public1344611001844Private622100717NGO9633001639 Total292100110041100
5. Table 7.2.1: Distribution of corrected serum calcium, HD patients 2009-2018YearNumber of patientsMeanSDMedianLQUQ% patients ≥2.1 & ≤2.37 mmol/L2018412432.20.22.32.12.4532017397592.20.22.32.12.4522016358362.20.22.22.12.4542015333672.20.22.32.12.4542014306332.30.22.32.12.4542013273002.30.22.32.12.4532012240312.30.22.32.12.4542011209502.30.22.32.12.4532010184782.30.22.32.22.4522009165592.30.22.32.22.452
6. Figure 7.2.1: Cumulative distribution of corrected serum calcium, HD patients 2009-2018
7. Table 7.2.2: Distribution of corrected serum calcium, PD patients 2009-2018YearNumber of patientsMeanSDMedianLQUQ%patients ≥2.1 & ≤2.37 mmol/L201853452.30.22.32.22.544201749632.30.22.32.22.542201645032.30.22.32.22.546201541842.30.22.32.22.544201435942.30.22.32.22.543201331462.30.22.32.22.542201227622.40.22.42.22.542201124352.40.22.42.32.538201022852.40.22.42.32.538200921272.40.22.42.22.539
8. Figure 7.2.2: Cumulative distribution of corrected serum calcium, PD patients 2009-2018
9. Table 7.2.3: Distribution of serum phosphate, HD patients 2009-2018YearNumber ofpatientsmeanSDMedianLQUQ%patients<0.8 mmol/L%patients≥0.8&<1.3mmol/L%patients≥1.3&<1.8mmol/L%patients≥1.8&<2.2mmol/L%patients≥2.2mmol/L2018413561.80.51.71.42.11154028172017399721.80.51.71.42.01144226162016361981.80.51.71.42.01154128162015336791.70.51.71.42.01164126162014310521.70.51.71.42.01164225162013278871.80.51.71.42.01164225172012244531.80.51.71.42.01154125172011213351.80.51.71.42.11154026182010186991.80.51.71.42.11144026192009169411.80.51.71.42.1115402618
10. Figure 7.2.3: Cumulative distribution of serum phosphate, HD patients 2009-2018
11. Table 7.2.4: Distribution of serum phosphate, PD patients 2009-2018YearNumber ofpatientsmeanSDMedianLQUQ%patients<0.8 mmol/L%patients≥0.8&<1.3mmol/L%patients≥1.3&<1.8mmol/L%patients≥1.8&<2.2mmol/L%patients≥2.2mmol/L201853541.70.51.61.32.0122402214201749831.70.51.61.31.9223412013201645371.60.51.61.31.9225411913201542041.60.51.61.31.9125431912201436211.60.51.61.31.9126421912201331491.60.51.51.31.9226431811201227731.60.51.51.31.9227421811201124611.60.51.51.31.9227411911201022871.60.51.51.21.9228401812200921391.60.51.51.21.9227411812
12. Figure 7.2.4: Cumulative distribution of serum phosphate, PD patients 2009-2018
13. Table 7.2.5: Distribution of corrected calcium x phosphate product, HD patients 2009-2018YearNumber of patientsmeanSDMedianLQUQPercent patients with calcium phosphate product:<3.5mmol2/L2≥3.5 & <4.5mmol2/L2≥4.5 & <5.5mmol2/L2≥5.5mmol2/L22018410744.01.13.93.24.636352092017396733.91.13.83.24.637351892016356483.91.13.83.24.637351992015332113.91.13.83.14.638341992014304753.91.13.83.14.639341992013270954.01.13.83.24.637341992012238244.01.13.83.24.6373419102011208064.01.23.93.24.7363420102010183644.11.23.93.24.8343421112009164324.01.23.93.24.736342011
14. Figure 7.2.5: Cumulative distribution of corrected calcium x phosphate product, HD patients 2009-2018
15. Table 7.2.6: Distribution of corrected calcium x phosphate product, PD patients 2009-2018YearNumber ofpatientsmeanSDMedianLQUQPercent patients with calcium phosphate product:<3.5mmol2/L2≥3.5 & <4.5 mmol2/L2≥4.5 & <5.5 mmol2/L2≥5.5mmol2/L2201853333.91.23.73.04.642311810201749523.91.23.73.04.54331179201644863.81.23.62.94.54630159201541713.81.23.63.04.44630159201435803.81.23.62.94.44730158201331263.71.23.52.94.44929148201227543.81.23.62.94.44829159201124283.81.23.62.94.54629169201022733.81.23.62.94.547291510200921223.81.23.62.94.546291511
16. Figure 7.2.6: Cumulative distribution of corrected calcium x phosphate product, PD patients 2009-2018
17. Table 7.2.7(a): Variation in corrected median serum calcium level among HD centres 2009-2018 YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20187341.92.12.22.22.32.42.620177201.52.12.22.22.32.42.520166961.82.12.22.22.32.42.520156752.02.12.22.32.32.42.520146412.02.12.22.32.32.42.520136002.02.12.22.32.32.42.520125462.02.12.22.32.32.42.620114881.72.12.22.32.32.42.620104301.82.22.22.32.32.42.520093871.52.12.22.32.32.42.6
18. Figure 7.2.7(a): Variation in median serum calcium level among HD patients, HD centres 2018
19. Table 7.2.8(a): Variation in corrected median serum calcium level among PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018402.12.22.32.32.42.52.62017382.12.12.32.32.42.52.52016372.12.22.32.32.42.42.52015352.12.12.22.32.42.52.52014322.12.12.32.32.42.52.62013282.12.22.32.32.42.52.52012282.22.22.32.32.42.52.62011262.12.32.32.42.42.52.62010252.22.32.32.42.52.52.52009232.22.32.32.32.42.52.6
20. Figure 7.2.8(a): Variation in median serum calcium level among PD patients, PD centres 2018
21. Table 7.2.7(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20187341334.046.053.060.072.0852017720035.046.053.060.070.59320166961136.048.055.563.073.09020156751035.047.055.062.073.09420146411333.047.055.062.073.0882013600833.047.055.063.074.0902012546832.047.055.064.075.0932011488033.046.054.062.073.0932010430029.044.052.061.073.0932009387027.044.053.061.071.090
22. Figure 7.2.7(b): Variation in proportion of patients with serum calcium 2.1 to 2.37mmol/L, HD centres 2018
23. Table 7.2.8(b): Proportion of patients with serum calcium 2.1 to 2.37mmol/L, PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20184089.532.542.050.561.57020173899.031.044.050.059.0602016372124.039.049.052.057.0642015351417.033.047.052.058.0602014321316.030.042.051.058.0642013281010.032.041.550.059.07020122869.031.542.550.561.0712011261017.031.036.544.058.0622010251418.028.035.049.056.0582009231213.031.041.051.059.065
24. Figure 7.2.8(b): Variation in proportion of patients with serum calcium 2.1 to 2.37mmol/L, PD centres 2018
25. Table 7.2.9(a): Variation in median serum phosphate level among HD centres, 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20187381.21.51.61.81.92.02.220177230.71.51.61.71.82.02.320166961.21.51.61.71.82.02.320156741.21.51.61.71.82.02.520146451.31.51.61.71.82.02.320136071.31.51.61.71.82.02.420125551.11.51.61.71.82.02.620114921.01.51.61.71.82.02.620104371.31.51.61.81.82.02.720093921.01.51.61.71.82.02.4
26. Figure 7.2.9(a): Variation in median serum phosphate level among HD patients, HD centres 2018
27. Table 7.2.10(a): Variation in median serum phosphate level among PD centres, 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018401.41.41.61.71.71.81.92017381.41.41.51.61.71.82.12016371.41.41.51.61.71.91.92015351.41.41.51.61.71.92.12014321.41.41.51.61.81.91.92013281.41.41.51.61.71.91.92012281.31.41.51.61.71.91.92011261.31.31.51.61.71.91.92010251.31.31.41.61.81.81.82009231.31.41.51.61.71.92.2
28. Figure 7.2.10(a): Variation in median serum phosphate level among PD patients, PD centres 2018
29. Table 7.2.9(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax201820172016201520142013201220112010200973892638.046.054.06792201772382739.047.056.073972016696152839.548.055.56787201567402941.049.056.0671002014645142940.049.056.06783201360772840.049.056.06884201255562940.048.056.068100201149202739.046.054.067100201043742638.046.054.06776200939262739.046.554.06585
30. Figure 7.2.9(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, HD centres 2018
31. Table 7.2.10(b): Proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018403739.543.550.054.565.5792017382632.044.050.055.066.0712016372833.046.051.056.063.0662015351736.045.051.057.065.0712014322729.042.548.058.062.0622013282836.046.550.555.064.0772012282634.048.051.559.063.0722011263537.047.052.060.077.0812010253739.044.052.058.065.0702009232038.048.054.058.065.069
32. Figure 7.2.10(b): Variation in proportion of patients with serum phosphate 1.13-1.78 mmol/L, PD centres 2018
33. Table 7.2.9(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax201873803.09.014.019.032.071201772303.08.013.019.029.047201669603.09.014.019.030.061201567404.010.015.021.032.070201464504.010.015.021.032.059201360703.09.014.020.032.048201255503.09.014.020.032.046201149202.09.014.020.029.083201043700.08.014.019.028.047200939202.09.014.021.031.046
34. Figure 7.2.9(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, HD centres 2018
35. Table 7.2.10(c): Proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20184088.514.520.026.537.540201738410.018.022.026.032.03620163768.016.024.028.035.03720153500.016.022.029.038.03820143224.012.021.529.039.04020132855.013.023.529.035.03720122834.016.521.031.535.04820112600.015.022.534.044.05020102578.016.024.032.042.043200923412.019.025.031.035.043
36. Figure 7.2.10(c): Variation in proportion of patients with serum phosphate 0.8-1.3 mmol/L, PD centres 2018
37. Table 7.2.11(a): Variation in corrected median calcium x phosphate product HD centres, 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20187342.73.33.63.94.24.55.220177192.33.23.63.94.14.55.220166962.23.23.63.94.14.55.020156742.63.33.63.84.14.55.620146392.73.23.63.84.14.45.020135942.83.33.63.84.14.65.920125432.73.33.63.84.14.55.720114862.03.33.73.94.24.65.720104303.03.43.73.94.24.76.020093832.33.33.73.94.14.76.1
38. Figure 7.2.11(a): Variation in median corrected calcium x phosphate product among HD patients, HD centres 2018
39. Table 7.2.12(a): Variation in corrected median calcium x phosphate product PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018403.33.43.63.84.14.44.52017383.13.33.53.84.04.54.72016373.03.33.53.64.04.34.42015353.03.23.43.63.94.44.52014323.13.23.43.74.14.54.72013283.23.23.33.83.94.34.52012283.13.13.53.84.14.24.52011262.93.03.43.84.04.64.62010253.13.23.33.84.04.44.62009233.33.33.53.73.94.64.8
40. Figure 7.2.12(a): Variation in median corrected calcium x phosphate product among PD patients, PD centres 2018
41. Table 7.2.11(b): Proportion of patients with corrected calcium x phosphate <4.5 mmol2/L2, HD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018734324862.072.081.0901002017719305064.073.083.0941002016696365064.074.082.0921002015674315065.073.080.0911002014639305265.074.081.0901002013594204864.073.081.0901002012543295063.072.080.0921002011486204661.071.079.091100201043084460.069.077.0881002009383254461.071.079.090100
42. Figure 7.2.11(b): Variation in proportion of patients with corrected calcium x phosphate product <4.5 mmol2/L2, HD centres 2018
43. Table 7.2.12(b): Proportion of patients with corrected calcium x phosphate <4.5 mmol2/L2, PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018404753.564.071.079.085.5882017384349.064.073.079.084.0892016375256.067.076.080.089.0922015354750.067.074.080.087.0892014324649.068.075.079.587.0892013284961.066.573.082.089.0942012284655.066.571.583.590.0912011264547.063.072.580.092.0952010254850.070.075.080.089.0892009234048.064.076.081.085.086
44. Figure 7.2.12(b): Variation in proportion of patients with corrected calcium x phosphate product <4.5 mmol2/L2, PD centres, 2018
45. Table 7.3.1(a): Treatment of hyperparathyroidism in HD patients, 2007-2016 (To be Updated)YearNumber ofpatientsNumber ofPatients on calcitriolNumber ofpatients on ParicalcitolNumber of patientshad Para-thyroidectomy n%n%n%20071290649533860018012008154026346416701741200917976779043931167120101958490944616011711201122310107654813911771201225670118044626612641201329115139774821213171201432470168265223213131201535338190655416502481201638082210855520412721
46. Table 7.3.1(b): Treatment of hyperparathyroidism in PD patients, 2007-2016 (To be Updated)YearNumber ofpatientsNumber ofpatientson calcitriolNumber ofpatients on ParicalcitolNumber of patientshad Para-thyroidectomy n%n%n%2007357710332990221200840441210308026120093482123235501602010384415314040110201149671841372402102012575221623862148120136511220234280381201474242720371005412015797929613715042120167481282738110421
47. Table 7.3.2(a): Distribution of iPTH, HD patients 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & <300 pg/ml≥300 & <500 pg/ml≥500pg/ml201836481231.9321.588.534.8305.261141115201735595257.2337.2108.338.8351.157151217201629269265.3344.1111.038.5372.156151218201527471300.8346.9169.647.2433.848171521201424881296.9356.9159.744.3417.549171420201321360233.6315.7100.034.2312.059151214201218808291.9340.1167.746.9410.347181519201116276223.5311.987.629.5305.061141214201014320235.3319.098.430.5319.258151115200912518270.0337.2141.140.4367.452181317
48. Figure 7.3.2(a): Cumulative distribution of iPTH, HD patients 2009-2018
49. Table 7.3.2(b): Distribution of iPTH, diabetic HD patients, 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & >300 pg/ml≥300 & >500 pg/ml≥500pg/ml201822122203.5284.176.733.5267.064131112201721162228.3300.394.837.3312.759151214201616915235.8308.595.836.7331.658141215201515336272.2316.1150.944.7394.750171518201413830266.3321.7144.641.4376.351181517201311448199.8272.384.031.7268.16215111120129796252.5296.3144.642.3362.05118151520118193183.2265.567.525.0241.66613101020107111190.3270.475.426.0256.06415111020095968222.2290.9113.034.0293.357191212
50. Figure 7.3.2(b): Cumulative distribution of iPTH, diabetic HD patients 2009-2018
51. Table 7.3.2(c): Distribution of iPTH, non-diabetic HD patients, 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & >300 pg/ml≥300 & >500 pg/ml≥500pg/ml201814359275.8367.5111.138.0374.956141119201714433299.6381.0130.941.9418.553151221201612354305.6383.8137.042.4430.052151221201512135336.9379.2192.552.3499.645161425201411051335.3393.2181.348.6488.04616132420139912272.5355.4123.038.3373.05515121820129012334.7377.5197.652.9481.84417152420118083264.2348.0113.436.0365.55515131720107209279.7355.0130.037.5393.35315122020096550313.7369.1174.848.7442.747171522
52. Figure 7.3.2(c): Cumulative distribution of iPTH, non-diabetic HD patients 2009-2018
53. Table 7.3.3(a): Distribution of iPTH, PD patients 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & >300 pg/ml≥300 & >500 pg/ml≥500pg/ml20184095271.6308.0171.551.3370.04622161620173989263.6305.8163.552.8344.54724141520163651287.9305.2195.571.3387.04223171820153465262.8299.7154.251.0362.54920141620142934268.7289.5176.061.0369.04522171620132594213.0250.4134.052.0284.0532414920122256274.2291.7188.464.0384.34322191620112035249.1282.5160.550.0343.04823161420101897261.2293.4164.051.4371.04820161620091818271.1293.0174.368.0381.045221616
54. Figure 7.3.3(a): Cumulative distribution of iPTH, PD patients 2009-2018
55. Table 7.3.3(b): Distribution of iPTH, diabetic PD patients, 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & >300 pg/ml≥300 & >500 pg/ml≥500pg/ml20182182213.4242.4141.042.6297.15223151020172125211.3239.4140.046.1282.65225131020161959233.8240.0160.066.0314.44825161120151839211.9241.5125.045.5288.75522131120141541222.8234.1148.253.3313.05023151120131311177.1208.4113.045.0228.0582610620121090211.9226.3138.554.1301.051241692011962200.6232.4130.745.0279.853251672010863204.3225.9131.241.5298.554211592009865199.2203.6134.557.5268.05325139
56. Figure 7.3.3(b): Cumulative distribution of iPTH, diabetic PD patients, 2009-2018
57. Table 7.3.3(c): Distribution of iPTH, non diabetic PD patients, 2009-2018YearNumber of PatientsMeanSDMedianLQUQPercent patients with iPTH:<150pg/ml≥150 & >300 pg/ml≥300 & >500 pg/ml≥500pg/ml20181913337.9357.5228.267.0475.84020172320171864323.3358.1206.566.0437.74122162120161692350.4356.5243.085.3501.63721172520151626320.4345.3204.061.3465.54319162320141393319.4333.4216.569.7453.04020192220131283249.7282.5162.061.3344.54821191220121166332.3331.4245.482.6464.53621212220111073292.7314.6202.059.0419.04421162020101034308.8332.2199.561.4450.4431916222009953336.3342.4234.383.8462.538201923
58. Figure 7.3.3(c): Cumulative distribution of iPTH, non diabetic PD patients, 2009-2018
59. Table 7.3.4(a): Variation in iPTH among HD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20187207.229.344.265.8273.1442.3758.1201770211.430.447.791.5289.0460.5669.8201664916.429.747.1114.9279.8468.61271.7201562811.331.173.3201.4306.1456.9803.5201459311.728.860.1183.1301.0466.01082.0201352110.022.344.697.3252.0426.7998.5201248511.431.773.3186.9287.7452.2768.320114233.318.840.591.7233.5420.71217.520103655.518.539.7102.3242.2394.8629.020093242.025.861.7161.3264.5416.01007.9
60. Figure 7.3.4(a): Variation in median iPTH among HD patients, HD centres, 2018
61. Table 7.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax201872000.05.512.020.031.552201770200.07.013.020.030.053201664900.07.013.021.030.046201562800.09.016.022.031.056201459302.010.016.023.033.054201352100.06.013.022.034.060201248503.010.017.024.033.053201142300.06.013.020.032.060201036500.06.014.022.033.048200932400.09.518.024.535.046
62. Figure 7.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 2018
63. Table 7.3.5(a): Variation in median iPTH among PD patients 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax20183422.331.1126.0215.8319.8473.2643.820173534.635.3108.0185.0285.0516.9654.320163638.865.9138.6211.9313.4530.3645.520153438.842.0115.8202.3296.0490.5521.020142940.641.0115.8215.0299.5374.5402.020132637.041.769.2188.3258.5293.0467.020122634.845.0137.5266.3324.5478.5495.520112425.926.899.1201.7290.3421.5434.520102428.530.0117.8211.5285.2512.0783.220092236.056.5143.5206.8258.5462.51047.0
64. Figure 7.3.5(a): Variation in median iPTH among PD patients, PD centres, 2018
65. Table 7.3.5(b): Variation in proportion of patients with iPTH 150-300pg/ml, PD centres 2009-2018YearNumber of centresMin5th CentileLQMedianUQ95th CentileMax2018340512.021.527.036502017354416.023.032.038382016364817.023.527.534402015346713.019.028.036412014290614.020.024.033502013263411.023.032.0383820122611016.019.026.031312011243413.522.529.031392010240413.520.027.03140200922101116.021.527.02828
66. Figure 7.3.5(b): Variation in proportion of patients with iPTH 150-300pg/ml, PD centres 2018