1. Dr. Ian Thomas
Mount St. John’s Medical Centre, Antigua
Caribbean Institute of Nephrology
5th Annual International Conference on
Nephrology and Hypertension
25th January 2013

6.  442 sq. km (171 sq. miles)
 Pop. 82,000
 GDP per capita - $13,552
 USA GDP per capita - $48,328
 Independent from UK November 1981
 Ethnicity – 91% Black, 4.4% Mixed, 1.7%
White
 Single government supported hospital
 Medical Benefits Scheme

7.  Districthealth centres
 185 bed public hospital
 4 small private medical facilities
 Private laboratories
 1 private radiology centre
 2 medical schools (basic sciences)
 1 haemodialysis unit

8.  7 Internists
 2 Nephrologists
 1 Infectious Disease Specialist
 1 Oncologist
 5 General Surgeons
 2 Orthopedic Surgeons
 1 resident and 1 visiting Urologist
 Visiting Plastic and Neurosurgeons
 4 Paediatricians
 5 Obstetricians
 2 Ophthalmologists

9.  Cardiology
 Emergency Medicine
 Critical Care Medicine
 Endocrinology
 Vascular Surgery

10.  Very limited data
 Pop. Est. 80,000
 Estimated 8000 – 10,000 with CKD
 Estimated 80 patients with kidney failure

11.  First haemodialysis unit started at Holberton
Hospital in 1997
 Prof. George Nicholson (Barbados/Guyana)
– technical advice and first consultant
 Dr. Leslie Roberts (Trinidad) visiting
nephrology consultant
 1st resident nephrologist in 2008
 3rd resident nephrologist in January 2013
 Dialysis services transferred to Mount St.
John’s Medical Centre in 2009

12. Year # of Patients
1997 2
2003 13
2004 15
2005 20
2006 24
2007 30
2008 33
2009 33
2010 43
2011 56
2012 61

13.  21% per year from 2008 – 2012
 30% per year from 2004 – 2008
 Growth may be more rapid if less
restrictive acceptance criteria

14. 7 in 2011
 56 patients on dialysis in 2011
 13% of total
7 in 2012
 59 patients on dialysis in 2012
 12% of total

15. Vascular Access
0%
Catheters
29%
AV Grafts
2%
AV Fistulae
69%

16. 20
18
16
14
12
10
8
6
4
2
0
< 30 30 - 44 45 - 59 60 - 74 > 74
Age

17. Age of Haemodialysis Patients
< 30 30 - 44 45 - 59 60 - 74 > 74
5% 10%
31% 22%
32%

18. Cause of Kidney Failure in Antigua and
Barbuda 2012
Unknown
Other Known
14% Diabetes
10%
49%
Lupus
3%
Glomerulonep
hritis
Hypertension
9%
15%

19.  St. John’s 60%
 St. George’s 9%
 St. Mary’s 9%
 St. Paul’s 10%
 St. Peter’s 6%
 St. Philip’s 4%
 Barbuda 2%

20. St. Paul's St. Phillip's
St. Peter's 7% 3%
St. George's 2%
2%
St. Mary's
17%
St. John's
Barbuda 67%
2%

25.  CKD patients identified in inpatient or outpatient
settings
 Referred for nephrology care – private or public
(as part of general internal medicine clinic)
 Dialysis services/ESAs/IV Iron provided without
patient fees
 Dialysis Committee charged with burden of
admitting patients to chronic dialysis programme
 Cost of dialysis session (consumables/EPO/Iron)
– U.S. $80.70
 Support by Antigua and Barbuda Renal Society

26.  Limited HD machines – Waiting List
 Physical space restrictions
 Nursing Staff limitations
 Cost of consumables
 Reliable access to medications (costs)
 Vascular access supplies and care
 Care for patients with Hepatitis B (and
HIV)

27.  Patient contributions to dialysis services
 Adoption of Kidney Disease under Medical
Benefits Scheme
 Institution of aggressive education and CKD
screening campaign
 Development of dedicated CKD clinics
 Opening of private dialysis facilities
 Reuse of dialyzers?
 Development of peritoneal dialysis service
 Development of formal pathway to
transplantation

28.  Dr. Leon Cox (nephrologist MSJMC)
 Sister
Patricia Thomas – Dialysis Unit
Manager MSJMC
 Developers of Caribbean Renal Registry