Htay Htay

Singapore General Hospital | SGH · Department of Renal Medicine

Background Worldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide. Methods This cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians...

Background Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide. Methods This cross-sectional study relied on desk research data as well as survey data from stakeholders (clini...

Background: Peritoneal dialysis (PD) and haemodialysis (HD) are two possible modalities for people with kidney failure commencing dialysis. Only a few randomised controlled trials (RCTs) have evaluated PD versus HD. The benefits and harms of the two modalities remain uncertain. This review includes both RCTs and non-randomised studies of intervent...

Introduction Kidney failure treated with hemodialysis (HD), or peritoneal dialysis (PD) is a major global health problem that is associated with increased risks of death and hospitalization. This study aimed to compare the incidence and causes of death and hospitalization during the first year of HD or PD among countries. Methods The third iterati...

Background Periplex ® is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients. Methods This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having pe...

Aims This study aimed to (i) evaluate the effectiveness of mindfulness‐based interventions in improving self‐efficacy, reducing stress and anxiety among peritoneal dialysis patients, and (ii) compare the most effective method of mindfulness based interventions. Methods This randomized three‐arm controlled trial recruited first‐time peritoneal dial...

Background: Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney function (RKF), lower peritoneal glucose exposure and reduced risk of peritonitis. The aims of this study were to analyse the association of Incremental and Full-dose PD str...

Introduction Peritoneal dialysis (PD) is home-based dialysis therapy and therefore a suitable modality for kidney failure patients, particularly, during the COVID-19 pandemic. The present study examined patients’ preferences for different PD-related services. Methods This was a cross-sectional survey study. Anonymized data from PD patients followe...

Introduction There were discrete outbreaks of SARS-CoV-2 infection in 2021 (Delta wave) and 2022 (Omicron wave) in Singapore, which affected patients receiving peritoneal dialysis (PD). Methods This study included all PD patients with COVID-19 infection from a single center between October 2021 and March 2022. The clinical presentation, management...

Peritoneal dialysis (PD) is a well‐established form of renal replacement therapy for patients with end‐stage kidney disease (ESKD), which accounts for 11% of dialysis therapy for patients with ESKD worldwide. This chapter discusses the evidence for supporting practices in the prevention and treatment of PD related infections, particularly focus on...

Peritoneal Dialysis (PD) has several advantages over hemodialysis, including preservation of vasculature for future dialysis access, an initial survival advantage, cost effectiveness, and preservation of residual renal function. This chapter summarizes the evidence to date regarding the definition, prevalence, and outcomes of urgent‐start PD. A bar...

Peritoneal dialysis (PD) is a well‐established form of kidney replacement therapy, with possible early survival advantage as compared to hemodialysis. This chapter summarizes the published studies available for neutral pH, low glucose degradation product solution, icodextrin, or amino acid‐based solutions in the treatment of peritoneal dialysis and...

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous po...

Introduction Peritoneal dialysis (PD)-related peritonitis is one of the leading causes of discontinuation of PD and is considered a critically important outcome for patients on PD. However, there is no universally accepted method of measuring this outcome in clinical trials. Methods We convened an online consensus workshop to establish a core outc...

Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries....

Background: Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. Methods: This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-cont...

Introduction: The clinical presentation and outcomes of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs) have not been well studied. Methods: We performed a meta-analysis to examine the presenting features, outcomes and the effect of treatment on outcomes of KTRs with COVID-19. Database search was performed up to 5 Sept...

Introduction Influenza and pneumococcal vaccination rates among peritoneal dialysis (PD) patients remain suboptimal, despite availability of vaccinations and health recommendations. Aim The primary aim was to improve influenza and pneumococcal vaccination rates among incident PD patients at our center to 80%. A secondary aim was to develop a susta...

Background: Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health...

Background Regeneration of peritoneal dialysis (PD) fluid using sorbent technology can provide flexibility and improve quality of life. This study examined the safety and efficacy of the automated wearable artificial kidney (AWAK) device in PD patients. Methods This pilot study included prevalent PD patients from a single center in Singapore betwe...

Purpose: The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients. Methods: This single-center pilot study recruited 50 incident PD patients to use weekly chlorhexidine dressing. The primary outcome was exit-site/tunnel infection rate. Secondary outcomes were perit...

Background: There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-star...

Background: Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients. Methods: Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorde...

Background: Patients with chronic kidney disease (CKD) who require urgent initiation of dialysis but without having a permanent dialysis access have traditionally commenced haemodialysis (HD) using a central venous catheter (CVC). However, several studies have reported that urgent initiation of peritoneal dialysis (PD) is a viable alternative opti...

Introduction An effective workforce is essential for optimal care of all forms of chronic diseases. The objective of this study was to assess workforce capacity for kidney failure (KF) care across world countries and regions. Methods Data were collected from published online sources and a survey was administered online to key stakeholders. All cou...

Relapsing, recurrent or repeat peritonitis is a devastating complication for peritoneal dialysis (PD) patients and is usually associated with poor outcomes including prolonged hospitalization, catheter removal, hemodialysis transfer, and even death. Despite its critical importance and frequent occurrence, there is limited available evidence to faci...

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. Th...

Background: Health information systems (HIS) are fundamental tools for the surveillance of health services, estimation of disease burden and prioritization of health resources. Several gaps in the availability of HIS for kidney disease were highlighted by the first iteration of the Global Kidney Health Atlas. Methods: As part of its second itera...

Background: Urgent-start peritoneal dialysis (PD), defined as initiation of PD within two weeks of catheter insertion, has been emerging as an alternative mode of dialysis initiation for patients with chronic kidney disease (CKD) requiring urgent dialysis without established permanent dialysis access. Recently, several small studies have reported...

Background and objectives People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternat...

PurposeEarly technique failure is a serious complication for peritoneal dialysis (PD) patients. The study aimed to examine the incidence, causes, and risk factors associated with early technique failure. Methods This retrospective study included all incident PD patients in a hospital in Singapore from 2013 to 2017. The primary outcome was early tec...

Background Beta-trace protein (BTP) is a novel marker for residual kidney function (RKF) without need for urinary collection. We aimed to examine its utility as a tool for estimating RKF in incident peritoneal dialysis (PD) patients. Methods This was a post hoc analysis of incident PD patients from the balANZ trial cohort. The outcomes evaluated w...

Rationale & Objective Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe. Study Design A cross-sectional survey. Setting & Participants Stakeholders including clinicians, policymakers, and patient representatives in 182 countries co...

Rationale & Objective Hemodialysis (HD) is the most common form of kidney replacement therapy. The study aimed to examine the use, availability, accessibility, affordability and quality of HD care worldwide. Study Design A cross-sectional survey Setting & Participants Stakeholders (clinicians, policymakers, consumer representatives) in 182 countr...

This registry‐based study evaluated the contribution of center characteristics to kidney transplant outcomes in adult first kidney transplant recipients in Australia and New Zealand between 2004 and 2014. Primary outcomes were mortality and graft failure Secondary outcomes were transplant complications. Overall, 6970 transplants from 17 centers wer...

Background: Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with anxiety symptoms and disorders among CKD patients. Methods: Articles evaluating the prevalence and risk factors associated with anxiety symptoms and disorders among CKD patie...

Background and Aims Peritonitis in peritoneal dialysis (PD) patients can be directly related to PD or secondary to intrabdominal infection (secondary peritonitis). The indication and role of imaging of abdomen during peritonitis in PD patients is unclear. Method This was a single center, retrospective study, including all the first episode of peri...

Background and Aims Anxiety is a common psychopathology that affects patients with chronic kidney disease (CKD) and has been associated with poor quality of life and clinical outcomes. This review aimed to summarize the prevalence of anxiety symptoms and disorders among CKD patients. Method A literature search for observational studies, which repo...

Background Medication adherence plays an essential role in slowing the progression of chronic kidney disease (CKD). This review aims to summarise factors affecting medication adherence among these pre-dialysis CKD patients.MethodsA systematic review of the literature was performed in Medline®, Embase®, SCOPUS® and CINAHL®. Peer-reviewed, English la...

Peritoneal dialysis (PD) requires patients to develop a variety of self-management skills in order to effectively deliver and manage their dialysis at home. eHealth interventions may provide patients with accessible information to develop the skills and knowledge they require to manage their treatment. This review aims to identify and evaluate ‘act...

Peritoneal dialysis (PD) is the dialysis modality of choice for many regions. The application of innovative technology has led to the development of new PD devices that reduce the environmental and economic costs of the therapy, as well as miniaturized devices that provide greater freedom for patients.

Rationale & Objective Outcomes reported in trials involving patients with autosomal dominant polycystic kidney disease (ADPKD) are heterogeneous and rarely include patient-reported outcomes. We aimed to identify critically important consensus-based core outcome domains to be reported in trials in ADPKD. Study Design An international 2-round online...

Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities...

Background The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods This multicentre registry study included all...

Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. Design International cross sectional survey. Setting International Society of Nephrology (ISN) survey of 182 countries from July to September...

Background: Peritonitis is one of the limiting factors for the growth of peritoneal dialysis (PD) worldwide and is a major cause of technique failure. Several studies have examined the effectiveness of various catheter-related interventions for lowering the risk of PD-related peritonitis. This is an update of a review first published in 2004. Obj...

Introduction: Long-term use of peritoneal dialysis catheter is associated with complications such as infection and malfunction, necessitating removal of catheter with subsequent reinsertion or permanent transfer to haemodialysis. This study aims to investigate the outcome in patients who underwent reinsertion. Methods and materials: A single-cen...

Background Peritonitis is the leading cause of technique failure among peritoneal dialysis (PD) patients. The study aimed to examine the microbiological characteristics of PD-related peritonitis in a tertiary hospital in Singapore. Methods A retrospective, cross-sectional study was performed at Singapore General Hospital (SGH). Data of patients dia...

Background: Biocompatible peritoneal dialysis (PD) solutions, including neutral pH, low glucose degradation product (GDP) solutions and icodextrin, have previously been shown to favourably influence some patient-level outcomes, albeit based on generally sub-optimal quality studies. Several additional randomised controlled trials (RCT) evaluating b...

Background: The incidence of elderly patients receiving peritoneal dialysis (PD) has increased. This study aimed to examine the clinical presentation and outcomes of peritonitis in elderly PD patients compared with younger PD patients. Methods: This single-center, retrospective, observational cohort study included all adult PD patients who develop...

There is a growing, global burden of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy. Although peritoneal dialysis (PD) is considered to be the most cost-effective dialysis modality, its utilization has been declining in some regions. The first year after starting PD is thought to be a vulnerable period for techniq...

Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsing Dokdonella koreensis peritonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal e...

Background: One of the barriers for the elderly patients to choose peritoneal dialysis (PD) is a concern of risk of peritonitis and its complications. Objective: The study aimed to examine the outcomes of peritonitis in elderly PD patients compared with younger patients. Methods: It was a single centre, cross-sectional study including all adult...

Background: Obesity is increasingly prevalent worldwide, and a greater number of patients initiate renal replacement therapy with a high body mass index (BMI). This study aimed to evaluate the association between BMI and organism-specific peritonitis. Methods: All adult patients who initiated peritoneal dialysis (PD) in Australia between January...

Background: Acinetobacteris a rare but important cause of peritonitis in peritoneal dialysis (PD) patients. As the complication has not been comprehensively evaluated previously, the present study examined the outcomes of Acinetobacter peritonitis in a large, national cohort of PD patients. Methods: The study included all episodes of peritonitis...

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 cou...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of urgent-start PD compared with that of conventional-start PD in adults and children with CKD requiring long-term RRT. © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of urgent-start PD (defined as initiation of PD within 2 weeks of catheter insertion) compared to HD (defined as initiation of HD using a CVC) in adults and children with CKD requiring long-term RRT.

Background: Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center-level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. Study design: Retrospective cohort study. Setting & participants: Using Australia and New Zealand Dialysis and Transplant Registry...

Background: The clinical outcomes of peritonitis in the elderly peritoneal dialysis (PD) patients have not been well studied before. The study aimed to determine the outcomes of peritonitis in elderly patients. Methods: This was a single centre retrospective cohort study, including all peritonitis episodes between 2011 and 2014. The primary outcome...

Aim: Traditional apprenticeship model (AM) of teaching in invasive procedures such as temporary haemodialysis catheter (THDC) insertion can result in propagation of errors and complications. Simulation-based learning (SBL) offers standardization of skills and allows trainees to repeatedly practice invasive procedures prior to performing them on ac...

Background: Corynebacterium is a rare cause of peritonitis that is increasingly being recognized in peritoneal dialysis (PD) patients. The aims of this study were to compare Corynebacterium peritonitis outcomes with those of peritonitis caused by other organisms and to examine the effects of type and duration of antibiotic therapy on outcomes of C...

Background and objectives: Technique failure is a major limitation of peritoneal dialysis. Our study aimed to identify center- and patient-level predictors of peritoneal dialysis technique failure. Design, setting, participants, & measurements: All patients on incident peritoneal dialysis in Australia from 2004 to 2014 were included in the study...

Objective Prevention of exit-site infection (ESI) is of paramount importance to peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effectiveness of chlorhexidine in the prevention of ESI in incident PD patients compared with mupirocin. Methods This retrospective, pre-test/post-test observational study included all inciden...

Objective Preservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients. Methods The study included incident PD patients who were balANZ trial participants. The primary and secondary o...

Aim: To examine the microbiological characteristics and outcomes of peritoneal dialysis (PD) related peritonitis. Background: Peritonitis is the leading cause of technique failure in patients on PD. Methods: A single-centre cross-sectional study was performed at Singapore General Hospital. Data of patients diagnosed with PD related peritonitis fr...