Number of end-stage renal disease patients on the rise: report

AUDREY VIJAINDREN

KUALA LUMPUR: AS obesity becomes the No. 1 preventable risk factor for chronic kidney disease, new dialysis patients have risen from 3,167 in 2005 to 7,055 in 2014.

Most of the new cases involved those between age 55 and 64, according to the 22nd Report of the Malaysian Dialysis and Transplant Registry.

Based on the report, the dialysis treatment rate had exceeded 100 per million population (pmp) for all states in Malaysia in 2014 (except Sabah), with the lowest rates in Perlis, Kelantan and Sabah.

The states with dialysis treatment rate of more than 300pmp were mostly from economically-advantaged states in the west coast of the peninsula.

Chronic kidney disease (CKD) is recognised as a major non-communicable disease of epidemic proportions worldwide.

The prevalence of end-stage renal disease (ESRD), the most advanced stage of kidney disease, where dialysis or transplantation is required to sustain life, has been increasing.

Globally, 2.6 million ESRD patients needed dialysis in 2010 and this is projected to almost double to 5.4 million by 2030.

Senior consultant nephrologist and Hospital Serdang Nephrology Department head Professor Dr Goh Bak Leong said new dialysis patients in Malaysia were estimated to rise from 10,208 cases in 2020, to 19,418 cases in 2040.

To reduce the risks of kidney disease, he said people should exercise regularly, control their body weight, eat a balanced diet, quit smoking, monitor their cholesterol level and keep blood-sugar level under control.

Besides those, they should also reduce salt intake, avoid taking non-steroidal anti-inflammatory drugs (a type of painkiller) and consume a moderate amount of protein.

“Today, conventional treatment for kidney failure consists of various medications for symptoms like high blood pressure, proteinuria, swelling and anaemia.

“When kidney failure becomes end-stage or life-threatening, dialysis or a kidney transplant is needed. Dialysis is still the most commonly used treatment for end-stage kidney failure.

“However, it should be noted that it’s required not because it can cure kidney failure, but because it replaces the function of failed kidneys in cleansing blood.

“Since kidneys do not heal after dialysis, patients have to undergo treatment regularly.

“Kidney transplant is the best way to treat kidney failure because dialysis involves considerable cost and inconvenience.

“For example, to maintain one’s health and activities, one needs a minimum of 13 dialysis sessions and each requires no less than four hours of being hooked up to a machine.

“And all of that achieves about 25 per cent only of the normal kidney function,” said Dr Goh.

He said a transplant was constantly hampered by a lack of donors as well as exposure to lifelong medication, which increased the risk of getting cancer and an infection, besides chronic rejection of the donor’s organ.

“In 2015, 92 per cent of the patients on Renal Replacement Therapy (RRT) in Malaysia were on dialysis — only eight per cent received a kidney transplant.

“This is despite transplantation being available in Malaysia for more than four decades. The first living-donor kidney transplant (LKT) was performed in 1975, followed a year later by the first deceased-donor kidney transplant.

“Over the ensuing years, in comparison with dialysis expansion, the transplant rate has remained low with an average of 60 to 90 transplants annually. In 2015, the incidence rate of local transplant was only three per million population.”

The 22nd Report of the Malaysian Dialysis and Transplant registry also showed that there were 1,515 dialysis deaths in 2005, and the figure went up to 4,015 in 2014. Transplant deaths, however, went down from 49 to 45 for the same period.