In Hong Kong, all patients with end stage kidney failure requiring renal replacement therapy (dialysis or kidney transplantation) can have the renal replacement therapy provided by the Renal Units of Hospital Authority.
Hospital Authority adopts a Peritoneal Dialysis (PD) First policy, that is, all patients will be offered Continuous Ambulatory Peritoneal Dialysis (CAPD), unless there is a contraindication.
CAPD is a good treatment option for patients, as it is a smooth continuous treatment which is performed by patient (with or without an assistant) at home. The patient performs the exchange of the dialysis fluid three to four times a day, 365 days per year. Each exchange takes about 45-60 minutes.
It may be somewhat inconvenient or may interfere those who are working full time.
There are other dialysis options which a patient may elect to choose as the treatment option.
(1) Haemodialysis at a charitable centre or private hospital.
(2) Nocturnal Haemodialysis (NHD) by the patient overnight at home.
(3) Automated Peritoneal dialysis (APD) by the patient with or without a helper overnight at home.
(Haemodialysis treatment at the Renal Unit of the Hospital Authority is only provide as a first option for a patient who is contraindicated for CAPD.)
Dialysis service and support for patients with end stage kidney failure.
(1) HKKF offers in-centre haemodialysis treatment at WoChe centre at a subsidized rate.
(2) HKKF supports patient on nocturnal home haemodialysis at home with a subsidy.
(3) HKKF supports patient on APD treatment by loaning an APD machine.
In-centre Haemodialysis at WoChe Centre
WoChe Haemodialysis Centre was set up in 1994 with a donation by Hong Kong Jockey Club
The centre has 15 haemodialysis stations to provide haemodialysis treatment for up to 78 patients.
(Kowloon City Haemodialysis Centre was set up in 1981 with a donation by Mr. Li Ka Shing. The centre is now closed due to the damage by two typhoons in 2017. All the patients at the KC centre were transferred to WoChe Haemodialysis centre).
Patients on haemodialysis treatment at WoChe Centre were referred by kidney specialist from the Hospital Authority or private sector.
Patient needs 2-3 sessions of haemodialysis treatments per week, each session lasting 4-5 hours.
With the subsidy provided by HKKF, the cost of treatment at HKKF is around HK$1100-1200 per session.
Haemodialysis treatment in process: insertion of 2 needles to take blood out from patient into the haemodialysis circuit on the machine. The blood is cleaned after going through the haemodialysis filter. The cleansed blood is returned to the patient. The process lasts 4-5 hours.
HKKF also supports the “Share Care program” by Hospital Authority, offering haemodialysis treatment for patients referred to the centre by the renal units of Hospital Authority.
The purpose is to allow patients to have the dialysis treatment in a local community setting.
Nocturnal Home Haemodialysis (NHD) is a self-care programme with the treatment being performed by the patient at home overnight on 3 to 4 nights per week.
The patient is trained to insert the needles and to operate the haemodialysis machine.
The patient can sleep safely overnight when the HD machine perform the treatment automatically.
First patient in Hong Kong to receive nocturnal home haemodialysis.
Hospital Authority provides the training and consumables.
HKKF provides a monthly subsidy of HK$3000 to support the patient.
The cost to the patient is about HK$3000/ month.
HKKF will support up to 60 patients on NHD program.
A look back at the haemodialysis service provided by HKKF
Over the past 40 years, HKKF has provided haemodialysis treatment for 600+ patients.
HKKF is accepting about 20-25 new patients every year.
Currently, HKKF is providing in-centre haemodialysis treatment for around 65 patients and is supporting 52 patients on home haemodialysis, amounting to 8500+ sessions of in-centre haemodialysis treatment and 10,000+ sessions of nocturnal haemodialysis every year
Free loaning APD machine Program
Automated Peritoneal Dialysis (APD) is a self-care treatment which can be performed by a patient (with or without a helper) at home.
Most patients cannot afford an APD machine (around HK$84,000).
HKKF will loan an APD machine to a patient free of charge (if the patient meets the criteria based on financial assessment and social situation).
The process of performing APD:
At the night time before going to bed. the patient sets up the dialysis circuit on the APD machine, connects himself to the dialysis circuit through the Tenckhoff catheter which is placed permanently through the skin inside his abdomen cavity. Overnight, the APD machine will run the dialysis fluid into his abdomen cavity, after a set period of dwelling, the dialysis fluid is drained out by the machine. The cycle is automatically repeated throughout the night while the patient is sleeping.
A look back at the Automated Peritoneal Dialysis Program
Since August 1997, HKKF has procured 727 APD machine through donation of cash or machine (equivalent of HK$60m) HKKF has supported 1,715 patients with free loaning of an APD machine, on average for 3-4 years, some to 10 years.
Currently, HKKF has 558 APD machines for free loaning to patients.
As at 30 June 2020
30 May 2019
HKKF received a donation of HK$16.8 million from Hong Kong Jockey Club to purchase 200 Automated Peritoneal Dialysis Machines over the next 3 years – 140 as replacement for 10 years old machines and 60 as new machines for patients.
1 Jan 2020
HKKF launched the Home Automated Peritoneal Dialysis Co-Funding Co-Use program on 1 January 2020 for patient opting for APD treatment.
Home Automated Peritoneal Dialysis machine
Co-Funding Co-Use program
On 1 Jan 2020, HKKF launched the Co-Funding Co-Use (CFCU) program. It was made possible with the donation of 10 APD machines (HK$840,000) by a donor and 5 APD machines by Baxter Healthcare Ltd Hong Kong. On 23 April 2020, the Estate of late Cheung Ching Lan donated HK$4.2 million for HKKF to procure another 50 APD machines for the program.
The CFCU is for a patient opting for APD treatment but does not meet the criteria for free loaning of an APD machine from HKKF. The patient can join the CFCU program – to be loaned an APD machine, with an understanding to contribute $2800 per month to the CFCU fund for a maximum of 30 months.
As contributing $2800 per month for 30 months will amount to $84,000 that will enable HKKF buy another APD machine for the program, the patient does not have to contribute more funding to the CFCU fund after 30 months. He can continue to use the machine till he does not need to be on the dialysis treatment.
CFCU is a self-sustaining program. It is projected with the initial donation of HK$5 million to procure 60 APD machines may generate up to HK$25 million for the CUCF Fund, enable HKKF to expand the program to a pool of 280+ APD machines, can serve 400+ patients over 6 years.
Drugs for kidney transplant, renal anaemia and renal bone disease are expensive. Some are self-paid drug by patients under treatment by Hospital Authority.
HKKF has various programs to support patient to purchase the self-paid drugs by providing a subsidy for 50% of the cost of the drug,
which is in the range of $6,000-$24,000 per year.
With the support by pharmaceutical companies, a cumulative donation of HK$10m has enabled HKKF to support the drug subsidy programs.