title: Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries.
abstract: OBJECTIVE
  Brunei Darussalam is a small South East Asian country with a high prevalence and incidence of end stage kidney disease (ESRD). This study aims to compare key performance indicators recorded in the Brunei Dialysis and Transplant Registry and department records against international practice. Registries from the USA (USRDS), UK (UK Renal Registry), Australasia (ANZDATA), Europe (ERA-EDTA Registry) and Malaysia (MDTR) were used for comparisons.
  
  
  RESULTS
  Haemodialysis (83%) and renal transplantation (6%) were the most and least favoured modality of renal replacement therapy in Brunei. Diabetes mellitus as a cause of ESRD (57%) was high in Brunei but on par with other South East Asian countries. Dialysis death rates (11%) and living-related transplant survival rates (5 year graft and patient survival 91% and 96% respectively) were favourable compared with other registries. Anaemia and mineral bone disease management were similar to Malaysia but slightly inferior to the others, but generally in keeping with KDOQI and KDIGO targets. Haemodialysis adequacy (48% achieving urea reduction ratio of >65%) was relatively poorer due to poor dialysis flow rates and low fistula usage (71%). Peritoneal dialysis peritonitis (24.5 patient-month/episode) and adequacy (78% achieving kt/v of 1.7) were in keeping with ISPD targets and international registries' results.
  
  
  CONCLUSIONS
  Brunei has achieved reasonable and commendable standards in many areas pertaining to the renal services. This report has identified several key areas for developments but this is to be expected for a service making its first foray into international benchmarked practice.
authors.affiliation: Rimba Dialysis Centre, Department of Renal Services, Bandar Seri Begawan, Brunei Darussalam.
authors.forename: Jackson
authors.initials: J
authors.lastname: Tan
mesh_terms: D000368:Aged; D019985:Benchmarking / Q000592:standards; D002010:Brunei / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000592:standards; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D015995:Prevalence; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries; D006435:Renal Dialysis / Q000592:standards; D017582:Renal Replacement Therapy / Q000401:mortality / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Brunei; dialysis; end stage renal disease; registry; transplant