OBJECTIVES: To evaluate differences in term of therapeutic achieved, clinical outcome and complications occur in both hemodialysis centers.

METHODS: Cohort observational study included hemodialysis patients who had followed up for 9 months and who died in last 5 years in both Hemodialysis (HD) centers (Jakarta, Indonesia and Penang, Malaysia).

RESULTS: Male and the third group of age (51-60 years), hypertensive of family history, married and non smoker patients were predominant. Most of patients in Indonesia had an experience in edema, anemia and hepatitis C. In Indonesia duration of hemodialysis was only 2 times in a week (4.5-5 hours per session) otherwise in Malaysia , it was 3 times in a week (5 hours per session). Besides that, in Indonesia, government insurance did not cover regularly laboratory check and Erythropoietin injection as an anti-anemia medication meanwhile, Malaysia government insurance cover all of those items. More than 50 % hemodialysis patients who died in last 5 years and 30% hemodialysed patients who had been followed up for 9 months in hemodialysis Jakarta, Indonesia had hepatitis C. In Indonesia, 35.33% hemodialysed patients died in 5 years but in Malaysia only 11.96% died in 5 years. From the study, it also found that cardiovascular disease caused mortality among hemodialysed patients in Indonesia and duration of cardiovascular disease influenced the probability of dying among these patients (P <0.005). During the study, few practice patterns revealed such as no parathyroid hormone level check among hemodialysed patients in Indonesia and it caused no thyroidectomy surgery among those patients. Besides that, no patients got calcimimetic agents and calcium value check was conducted irregularly, only when patients needed it.

CONCLUSIONS: The study found that health care system especially providing full insurance was the main contributing factor which influenced therapeutic outcomes such as; mortality rate and complications.