Nefrologi

LOCATION : PINTU P TINGKAT 2, KLINIK PAKAR, HOSPITAL UMUM SARAWAK

HEAD OF DEPARTMENT: DR CLARE TAN HUI HONG

INTRODUCTION:

Nephrology is one of the major clinical subspecialty services in the Department of Medicine at Sarawak General Hospital. We have a Hemodialysis (HD) unit and a Continuous Ambulatory Peritoneal Dialysis (CAPD) unit. We run regular General Nephrology and CKD (chronic kidney disease) clinic, HD clinic, CAPD clinic, Transplant clinic and also visiting clinics to various district hospitals in Sarawak. The services we provide include: inpatient and outpatient Nephrology care, renal biopsy, plasmapheresis, dialysis access care, acute HD and PD, CRRT (continuous renal replacement therapy), chronic HD, CAPD, pre and post renal transplant care. We also oversee the running and provide guidance and planning in the development of Nephrology and Dialysis services in the state of Sarawak. We provide training for nephrologists and also allied health staff, and are involved in research related to Nephrology.

OBJECTIVE:

To provide comprehensive general nephrology, dialysis and renal transplantation services.
To improve quality of live and survival of patients with kidney diseases and kidney failure.
To promote the prevention, detection and early treatment of kidney diseases through close collaboration with primary healthcare providers and other relevant organizations.
To Increase public awareness of kidney disease, kidney failure and cadaveric kidney transplantation.
To trained doctors and allied health professionals in the management of kidney patients.

FUNCTION:

i. CHRONIC HEMODIALYSIS

Sarawak General Hospital is one of the earliest facilities in the country to provide long term chronic hemodialysis for patients with ESRF. The Hemodialysis Unit in Sarawak General Hospital started in December 1987 with Dr. Chew Peng Hong and Staff Nurse Goh Kim Eng. It was a small 2 machine unit located in a small little block which originally functioned as “blood bank and isolation facility”. In August 1994, the unit was moved to the the new clinical specialist block, occupying a dedicated area on the second floor. It has isolation rooms for Hep B and Hep C patients and a total of 13 HD water points. In 2008, the unit took over the area occupied by the social welfare department and expanded to included rooms for running regular hemodialysis and transplant clinics.

ii. ACUTE HEMODIALYSIS AND CRRT

Sarawak General Hospital also has facilities for acute hemodialysis in the ICU and wards using deionizer water treatment system in the early days. This was later upgraded to portable RO water system and later included Continuous renal replacement therapy (CRRT) in ICU.

iii. PERITONEAL DIALYSIS

Sarawak General Hospital provides acute peritoneal dialysis service for patients needing acute or temporary dialysis in the ward. CAPD Unit was established in 2001 and patients perform the peritoneal dialysis at home after a period of training in the hospital.

iv. TRANSPLANT

Sarawak General Hospital provides pre transplant work up for potential recipients and donors planning for living related transplant. Patients dialyzing at Sarawak General Hospital are registered with emoss (Malaysian Organ Sharing System) and we also prepare these patients for cadaveric renal transplant. We provide long term follow up for patients after renal transplant.

SERVICE PROVIDED

i. Scope Service

The scope of work of the nephrology services includes :

General nephrology and CKD care
Chronic Renal Replacement Therapy ( RRT ) i.e dialysis and transplantation.
Acute dialysis including CRRT.
Special procedures e.g plasmapheresis, renal biopsy
Patient and public education, health promotion, prevention and detection of kidney disease.
Advisory role to the state of Sarawak on all aspects of the development and practice of nephrology
Training of nephrologists, junior doctors and allied health staff in the field of the nephrology.

ii. Components Of Service

The range of services provided include :

a ) Outpatient/Ambulatory Care Services

Clinics

- General Nephrology /Chronic Kidney Disease
- Renal Transplant
- Peritoneal Dialysis (PD)
- Haemodialysis (HD)

Dialysis

- Hemodialysis
- Peritoneal Dialysis
- Ambulatory Care eg Dialysis Access care such as insertion of HD catheters, infusion of medications.

b ) Inpatient Services

- Care of patients with kidney diseases
- Renal biopsy
- Insertion of HD and PD catheters
- Acute intermittent HD and PD
- Critical care nephrology
- Plasmapheresis

c ) Training and Continuing Education

- Medical officers /physicians in training / trainee nephrologists
- Allied health personnel
- Medical students
- Patients and family

DEPARTMENT ACTIVITIES:

1. World Kidney Day – celebrated on 03.2018 (Sunday). Held at Boulevard Shopping Complex.
2. Annual State Dialysis Meeting. Held on 009.2018 (Sunday) Dewan Pesona H.U.S
3. Involving in Inovation Day Sarawak General Hospital on 24.08.2018 ( Friday )
4. Research Study :
- - A Phase 3, randomized, double blind, placebo controlled study of effficacy and safety of FG-4592 for the treatment of anaemia in chronic kidney disease patients not on dialysis.
  - A Multicentre, Multiple-dose, Active-controlled, Double-blind, Double-dummy Study to Compare the Therapeutic Efficacy and Safety of Oral Doses of Cinacalcet Hydrochloride with Intravenous Doses of Etelcalcetide (AMG 416) in Asian Hemodialysis Subjects With Secondary Hyperparathyroidism.
  - Theraputic Evaluation of Streroids in IgA Nephropathy Global Study
  - CAPD-3 trial. A randomized, open label, parallel group, multi-centre controlled study to evaluate the clinical performance and safety of Stay Safe Link in patients with ESRD on CAPD.
  - Starfruit- The forbidden fruit for ESRF patient. Reminder from a fatal case of neurotoxicity.
  - A study on the prevalence of serum 25 (OH)- Vitamin D deficiency in patients on maintenance haemodialyisis and peritoneal dialysis in Sarawak General Hospital.
  - Severe metformin associated lactic acidosis: a not so rare and potentially fatal complication.
  - Vancomycin Removal in Patients on High-Flux Intermittent Haemodialysis- VARELI.
  - Causative Organisms and Outcomes of Peritoneal Dialysis Related Peritonitis in Sarawak General Hospital, Kuching, Malaysia: A Three- year Analysis.
  - Cause and predictors of mortality in Biopsy-Proven Lupus Nephritis: The Sarawak Experience.

PICTURE ACTIVITIES