ABOUT MDTR

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The Dialysis and Transplant Registry was established by the Department of Nephrology, Kuala Lumpur Hospital (HKL) in 1992 to collect data from patients on renal replacement therapy within the Ministry of Health (MOH). In order to expand coverage to include non-MOH patients so that the registry may truly claim to be a national one, the ownership was transferred to the Malaysian Society of Nephrology. It was subsequently named Malaysian Dialysis and Transplant Registry (MDTR). MDTR collects information on patients with end stage renal disease (ESRD) on renal replacement therapy (RRT) in Malaysia.

Objectives:

The objectives of the registry are as follows:

Describe the natural history of ESRD
The registry shall describe the characteristics of patients with ESRD, its management, and patient survival and quality of life outcomes with treatment; and shall describe variation thereof across different groups, healthcare sectors or geographic regions, and its secular trend over time in Malaysia.
Determine effectiveness of treatments for ESRD
The registry shall determine clinical effectiveness and cost effectiveness of treatments of ESRD in real-world clinical practices in Malaysia.
Monitor safety and harm of products and services used in the treatment of ESRD
The registry shall serve as an active surveillance system for the occurrence of unexpected or harmful events for products and services.
Evaluating access to and quality of treatment services for ESRD
The registry shall assess differences between providers or patient populations based on  performance measures that compare treatments provided or outcomes achieved with "gold standards" (e.g., evidence-based guidelines) or comparative benchmarks for specific health outcomes (e.g., risk-adjusted survival rates). Such programs may be used to identify disparities in access to care, demonstrate opportunities for improvement, establish differentials for payment by third parties, or provide transparency through public reporting.
  To maintain the national renal transplant waiting list electronically - the  eMOSS  or electronic Malaysian Organ Sharing System
The dialysis registry shall maintain and update patients on dialysis who do not have contraindications to kidney transplantation onto the national renal transplant waiting list according to published agreed criteria. This list is available on the web for ready access by the transplant physicians any time a deceased kidney becomes available.

Registry design

This is a multi-center, observational cohort study designed to evaluate the health outcomes of patients with ESRD undergoing treatment at participating clinical centres.  Patient inclusion criterion is deliberately broad and shall include any patient with a confirmed diagnosis of ESRD.

There is no prescribed study visits. Patient shall attend the clinical site as and when required per the standard of care at the site. Required data shall be collected as they become available.

  A clinical site shall notify all new patients to the registry, and shall continue to do so until the termination of the registry. Patients shall be follow-up for life.
Participation. Site shall notify the patients' treatment to the registry in a calendar year of its participation. A site shall similarly notify patients during each year of its participation in the registry.

Registry study population:

The registry study population consists of male or female patients with ESRD to be recruited from participating sites in Malaysia. Participation in this study is voluntary. However, in accordance with the Private Health-care Facilities Act 1998 (AKTA 586), all dialysis health facility are required to submit data to the Malaysian Dialysis and Transplant Registry (MDTR).

All clinical centres or sites that satisfy the following selection criteria will be invited to participate:

This registry is opened to all clinical sites that provide RRT services for patients with ESRD in Malaysia.
Each site shall have a Principal Investigator who is also a licensed physician / Surgeon and a qualified professional experienced with ESRD management.
Each site shall appoint a Site Coordinator (SC). The SC is the person at the participating clinical site who is responsible for all aspects of registry management and data collection at site, and who will liaise with the Clinical Registry Manager (CRM) and Clinical Registry Assistant (CRA) at the Registry Coordinating Centre (RCC).
 Each site shall accept responsibility for data collection, as well as for ensuring proper record keeping and registry document filing.
  Each site shall agree to comply with the registry procedures and shall be willing to be subjected to ongoing review of data by CRM or CRA or other representative of MDTR. This may include one or more site visits by prior arrangement

Patient eligibility criteria:

  All new patients with ESRD undergoing treatment at a participating clinical site are eligible for entry into the registry.
In addition, a site may opt to enter existing patients on follow-up at the site into the registry. 

Registry data

The data elements to be collected by the registry shall be relevant and reliable with modest burden to sites, shall comply with existing data standard where this exists,  shall be compatible with established data set used by other existing registries, and shall employ standard terminology (dictionary) where available.

Two datasets are defined:

  Core dataset:
These are data elements that are needed to address the key questions for which the registry was created.
Non-core dataset:
these are speculative data elements included to provide an opportunity to generate hypotheses or to explore other subsidiary questions not of primary interest to the registry.

The data domains and related specific data elements to be collected by this registry is tabulated below:

A. Identifier Name, NRIC number, Other identifying document numbers, Address, Contact numbers
B. Demographics Age, Sex, Ethnicity, Educational attainment, Occupation, Household Income group, Weight & Height, Use of tobacco, Funding for Treatment
C. Medical history Medical history/ comorbidities, Family history
D. ESRD diagnosis Date of first diagnosis, Date re-entering each RRT
E. Laboratory investigations Date & time of tests, Blood chemistry, Hematology, Serology
F. Treatment Modalities of RRT- haemodialysis, peritoneal dialysis; treatment of other uraemic complications;  kidney transplantation
G. Outcomes Patient survival; death, date of death, cause of death Quality of Life/ Work rehabilitation status
H. Economics Source of funding for dialysis treatment,  and immunosuppressive drug treatment for transplantation
I. Healthcare provider characteristics Sector providing dialysis treatment, (private, public or NGO),