As we mark World Kidney Day today, the fact remains that at least 15.5 per cent, or more than five million of the Malaysian population are living with chronic kidney disease (CKD). Only 5 per cent of them will be aware of it.
By the end of this day, 28 individuals in Malaysia would have been newly diagnosed as patients whose kidneys have permanently failed, needing dialysis to live.
Malaysia needs a reality check and a renewed commitment to implementing existing kidney health strategies and policies. The country is on the brink of a nationwide kidney disease crisis.
The incidence and prevalence of patients with end-stage renal disease (ESRD) has been on an upward trend for the past 20 years. More than 51,000 people in Malaysia currently live with ESRD, needing kidney replacement therapy.
Malaysia’s incidence rate for ESRD is among the highest in the world. The Ministry of Health (MOH) has projected that more than 106,000 Malaysians could be on dialysis by 2040 if the rising rates of kidney failure do not change. This is just 16 years away.
Each year, more than 10,000 people are newly diagnosed as needing dialysis, and this annual number is steadily increasing. More than half had diabetes.
The prevalence of chronic kidney disease is rising in tandem with the rate of diabetes. By next year, seven million adult Malaysians are estimated to live with Type 2 diabetes.
It is already the highest in the Western Pacific region. Diabetics are 3.5 times more likely to develop CKD. We need to address the diabetes epidemic in Malaysia to respond effectively to chronic kidney disease.
Every Parliament sitting during parliamentary questions, we hear calls for more haemodialysis (HD) centres to be built in constituencies. For more treatment subsidies or coverage to be provided to more people. The government is already bearing at least half of the expenditure used to treat chronic kidney disease. It is not sustainable.
In 2010, the government spent RM572 million to treat ESRD. Today, Malaysia spends about RM3.3 billion on CKD and ESRD care annually.
The Social Security Organisation (SOCSO) spent RM334.67 million on dialysis treatments for its contributors in 2022, and receives up to 3,000 new treatment applications annually. In 1999, it spent RM 1.22 million.
There is a reason why more and more private haemodialysis centres are being set up. It is a booming business, as more people are becoming ill, needing to access dialysis care to survive.
Prevention and early detection continue to be sound and effective strategies. We need to do better to reduce Type 2 diabetes and increase awareness of kidney health. Individuals who are living with hypertension and diabetes are at high risk of CKD and should be screened to increase the possibility of treating kidney disease much earlier.
Unfortunately, almost half of all people with diabetes in Malaysia remain undiagnosed. By the time patients are diagnosed, it is often when their diabetes has gone uncontrolled for many years, leading to permanent damage to kidneys.
In the case of dialysis care, the MOH’s National Action Plan for Healthy Kidneys (ACT-KID) 2018-2025 has already identified what needs to be done.
One of its key recommendations is to increase home-based dialysis therapy, namely peritoneal dialysis (PD). PD, compared to HD, provides many advantages, including fewer dietary restrictions, taking between 30 and 40 minutes (HD takes four hours), opportunities to return to employment, preserving residual kidney function, being less costly, and presents better patient survival rates.
However, in 2022, the number of patients on peritoneal dialysis was only 5,784, compared to 43,663 patients on HD. This must change. Clinicians must do their part to recommend to patients needing dialysis to take up peritoneal as the first option, while reserving HD as a second choice.
Ultimately, prolonging the quality and quantity of life for people living with CKD should be the key objectives to any kidney health strategy.
Equitable access to kidney disease screening, emphasis on early diagnosis, and sustainable access to quality treatment should be implemented to prevent chronic kidney disease or its progression.
Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
