Dialysis – A Path back to Normalcy

It is a crucial lifeline for kidney patients, and it need not be costly.

Kidney disease is referred to as the “silent killer” because a person can lose up to 90% of his kidney function before experiencing any symptoms.

“It is always an advantage to have an annual comprehensive health screening as symptoms of kidney failure may not exist in the early stage,” says Dr Lim Hooi Leng, consultant nephrologist and physician at Penang Adventist Hospital. “By the time symptoms arise, kidney failure is usually already at an advanced stage. These are usually picked up through urine abnormalities, along with elevated blood pressure.”

Nurses at the Penang Caring Dialysis Society work to complete dialysis treatment for a kidney patient.

In Malaysia the number of dialysis patients increased from 14,657 in 2005 to 37,183 in 2015; this is attributed to the increase in new patients with end stage renal disease (ESRD) who are on dialysis, together with low kidney transplantation rates that are due to poor overall organ donation from live and deceased organ donors in the country. In Penang the number of patients grew from 2,081 in 2010 to 2,539 in 2015; with diabetes accounting for more than half of primary renal disease in new dialysis patients, followed by hypertension.1

Patients who develop ESRD have to undergo renal replacement therapy (RRT), which is either kidney transplantation or dialysis.

Kidney transplantation may be the best renal replacement therapy as it eliminates the need for dialysis and helps a patient to live longer, but it is not a procedure patients would want to rush into: “If there is underlying acute inflammation of the kidney, a kidney transplantation may see the primary inflammation being transferred to the transplanted kidney. I personally believe that patients ought to be stabilised by dialysis and have their general health carefully assessed before venturing into kidney transplantation,” says Lim.

What is Dialysis?

Dialysis is a treatment that replaces the processes originally done by healthy kidneys. When the kidneys fail, dialysis will keep the patient’s body in balance.

It is recommended that a dialysis session lasts at least four hours, and should be done three times a week.

But dialysis may not be as straightforward as it sounds: “Dialysis patients run the risk of hypotension, dialysis reactions and cross-infection, although it is most improbable in a proper setup. As for peritoneal dialysis, patients run the risk of peritonitis and tunnel infection of the peritoneal catheter, among other issues,” says Lim.

And dialysis does not come cheap: treatment and various medications can amount to RM3,000 a month – a steep price to pay.

According to Dr Kok Lai Sun, resident consultant nephrologist at Gleneagles Penang, financial constraints should not be a barrier for someone to seek treatment: “Many of my patients feel very bad because their families need to pay so much for them. Some even want to give up because of this. They are worried about keeping their jobs, too.

“What they do not realise is that without dialysis, salts and other waste products will accumulate in the blood of the kidney patient. The accumulation of these waste products will poison the body and lead to death.”

The question then arises: why don’t lower income patients seek treatment in public hospitals?

Kok explains that while the cost of treatment in general hospitals may be ideal for the lower income group, the machines are all occupied by existing patients and inpatients. “General hospitals in the country charge RM13 per dialysis. New patients can apply, but usually they have to wait for years before getting a placement.

“To make things clear, government hospitals aren’t the only option for cheaper treatment – even government servants are sent to private centres for dialysis because the government also funds private and NGO centres too,” says Kok.

As of 2015 the government provided 63.1% of total funding for dialysis. These funds are channelled not only to government dialysis centres, but also to NGO centres and public pensioners, civil servants and their dependents in private centres. In Penang there are nine public, 35 private and 23 NGO dialysis centres to cater to the rising number of dialysis patients.2

Nurses at the Penang Caring Dialysis Society work to complete dialysis treatment for a kidney patient.

“Arrangements can be made to ensure that the patient’s dialysis needs are seen to. We are fortunate to be living in Penang because the state has solid NGO support which collaborates with public and private hospitals to help the patients. I am in charge of patients in four different NGOs: Persatuan Kebajikan Haemodialisis St Anne Bukit Mertajam, Tzu-Chi Dialysis Centre, Penang Caring Dialysis Society (PCDS) and Pertubuhan Hemodialysis Seberang Perai Selatan. These centres and many more are helping patients who cannot afford dialysis; they get their funding from the Ministry of Health and also from public donations,” says Kok.

PCDS subsidises more than 30% of the cost of dialysis treatments, charging a fee of RM100 for each treatment. (Each patient requires medication, medical supplies, licensed and trained nurses to operate the dialysis machine, treated water, and other consumable items.)

“Dialysis patients with stronger financial support, such as those who have insurance and SOCSO, can seek dialysis treatment at private centres. SOCSO sponsors RM150 per treatment – that alone makes dialysis easier on the pockets of my patients,” says Kok.

Get Tested!

There are many medical options for the treatment of kidney failure, so an ESRD diagnosis is not the end of the road. “My message to kidney patients is not to be discouraged. Life can still go on as normal, albeit with a little more planning.

“Many of my patients live near-normal lives – one of them just returned from a holiday in Korea; three were pregnant while on dialysis. Today, there is even a dialysis machine that enables you to perform dialysis at home and in the office – it gives the patient more freedom and flexibility,” says Kok.

Even with sufficient funding and facilities to manage ESRD patients, the ever-increasing number of patients on dialysis therapy remains a concern for medical practitioners and the government. According to Kok, shifting the focus from managing kidney failure to its prevention could be key to decreasing the number of ESRD cases: “We must continue to encourage changes in behaviour and lifestyle choices, taking proactive steps to detect the early onset of kidney failure by encouraging people to go for yearly health screenings.

“Early detection and treatment can thwart the progression of kidney diseases. Prevention is better than cure.”

Emilia Ismail is a freelance writer who has a love-hate relationship with the weighing scale.
When she is not writing, Tho Mun Yi moonlights as a Tarot card reader and makes a living helping her clients live more in the present. During her sessions with her clients, she uses Tarot as a guide to gain a higher sense of mindfulness and enlightenment.

1Wong HS and BL Goh, eds. 23rd Report of the Malaysian Dialysis and Transplant 2015. Kuala Lumpur: The National Renal Registry, 2017. Web.

2Wong HS and BL Goh, eds. 23rd Report of the Malaysian Dialysis and Transplant 2015. Kuala Lumpur: The National Renal Registry, 2017. Web.

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