dr khin thida thwin m.b;b.s, m.med.sc(int.med),mrcp(uk ...hdf-j.jp/pdf/04khin thida thwin...
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Dr Khin Thida Thwin
M.B;B.S, M.Med.Sc(Int.Med),MRCP(UK),
FRCP(Edin),Dr.Med.Sc(Nephro)
Professor & Head
Dept: of Renal Medicine Snapya General Hospital,
Yangon
14 state and divisions
Total land area -676,578 sq kilometers
In 2009-10
total populations - 59.13 millions
growth rate - 1.29 %.
Population
Male
Female
49.72 %50.28 %
Male
Female
60
62
64
66
68
70
72
Urban
Rural
Male
Female
65.1
Age in y
ears
70.5
63.9
67.4
0 500 1000 1500 2000
Gov: Hospitals
P&S Health centers
RHC
2010-11
1988-89
1558
924
1337
839
631
86
64
In – Yangon ( YGH, SGH, YCH, Defense Service
GH I )
- Naypyitaw ( 1000 beded GH & Defense
Service GH)
- Mandalay ( MGH)
- Pyinoolwin (Civil GH & Defense Service
GH)
13 tertiary centers with 30 nephrologists
YGH(1500 bed )
SPH(300 bed)
No of Bed 75 25
No of Nephrologists 3 1
No of Senior SHO 2 (post graduate training)
1
No of junior SHO 4 1
No of Nursing staffs 17 8
The available options of renal replacement therapy –
1. haemodialysis2. acute peritoneal dialysis 3. CAPD4. kidney transplant.
No facility of haemofiltration yet
started in - military hospital ( DSGH I ) since
1970
- civilian hospital (YGH) since 1996
dialysis centers
- government hospitals 13
- private hospitals 16
Average numbers of HD patients
- government hospitals 400 / year
- private hospitals x 10 >
Mean survival rate - 7 years
HD centers Asia Royal YGH SPH
No of HD machine 20 6 4
No of working day/wk 7 5 5
No of Treatment section/day 3 2 2
No of patients/wk 420 60 40
2009 2010
Hosp: Total P/ts
AKI CKD
Asia Royal
1862 13 1849
YGH 124 47 77
SPH 23 8 15
Hosp: Total P/ts
AKI CKD
Asia Royal
2270 15 2255
YGH 167 18 149
SPH 36 15 21
Retrospective data analysis for 2009- 2010
Government centers
- Yangon General Hospital (teaching hospital for University of Medicine I )
- Sanpya Thingankyun Hospital (teaching hospital for University of Medicine II )
Causes 2009 2010
No: Percentage No: Percentage
DM 97 27.2 % 124 22.22 %
Hypertension 7 1.96 % 8 1.43 %
CGN 27 7.58 % 31 5.55 %
Others 225 63.2 % 395 70.78 %
Total CKD 356 100 558 100
CKD/Total admission
356/975 36.51 % 558/1284
43.45 %
Causes 2009 2010
No: Percentage No: Percentage
Hypertension 22 26.51 % 30 27.78 %
DM 14 16.9 % 25 23.15 %
CGN 14 16.9 % 17 15.74 %
Others 33 39.76 % 36 33.33 %
Total CKD 83 100 108 100
CKD/Total admission
83/290 28.6 % 108/339 31.86 %
Hospitals 2009 2010
YGH 20.51 20.25
SPH 18.1 19.4
Only few patients can effort to take EPO regularly
Average cost for EPO (4,000 units) – US$ 42/ vial
Average cost for HD - 42 US $ / section
Promising renal replacement therapy for acute kidney failure
in tertiary centers and some district general hospitals
Use rigid peritoneal catheter and keep for 48 to 72 hrs with every hr cycle
causes of acute kidney injury are varied with the individual centers
Retrospective data analysis for 2009- 2010
Government centers
- Yangon General Hospital (teaching hospital for University of Medicine I )
- Sanpya Thingankyun Hospital (teaching hospital for University of Medicine II )
Causes 2009 2010
No: Percentage No: Percentage
Viper Snake B 80 33.9 % 110 42.8 %
Leptospirosis 13 5.5 % 20 7.8 %
Malaria 40 16.9 % 21 8.2 %
Sepsis 14 5.9 % 25 9.7 %
Gastroenteritis 30 12.7 % 21 8.2 %
Drugs 7 3 % 5 1.9 %
Ac on Chr RF 20 8.4 % 35 13.23 %
Others 32 13.56 % 21 8.17 %
AKI/Total admission
92 30.2 % 142 37.9 %
Causes 2009 2010
No: Percentage No: Percentage
Viper Snake B 68 73.9 % 107 75.4 %
Leptospirosis 3 3.3 % 14 9.9 %
Malaria 2 2.2 % 9 6.3 %
Sepsis 5 5.4 % 8 5.6 %
Gastroenteritis 12 13 % 2 1.4 %
Drugs 2 2.2 % 2 1.4 %
AKI/Total admission
92 30.2 % 142 37.9 %
Dialysis mordality 2009 2010
PD 114 48.3 % 167 65 %
HD 47 19.9 % 18 7 %
No intervention
75 31.8 % 72 28 %
Mortality 67/236 28.4% 58/257 22.6%
Dialysis mordality 2009 2010
PD 61 66.3 % 58 40 %
HD 1 1 % 10 7 %
PD + HD 4 4.3% 5 3.5%
No intervention
26 28.3 % 69 48.5 %
Mortality 15/92 16.3 % 24/142 16.9 %
started in Myanmar since 1997 and had finished 42 patients in Civilian hospital
One year graft survival was 86% and 5 year graft survival rate was 77.4%
In Military hospital since 1995 with the help of experts from UK and became independently done in 2010
total numbers of patients were 31
Usual immunosuppressive combination was Cysclosporine, Azathioprin and corticosteroids
In recent years, Mycophenolate mofetil has been used in place of Azathioprin as the reason of reducing acute rejection and availability of drug in myanmar
Museum of previous king’s palace, Bagan
Thank you