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Commentary: 'Kidney tsunami' looming large — why even the young should take action now

The National Kidney Foundation has warned of a “kidney tsunami” with the rising number of kidney failure cases in Singapore, according to a recent Channel NewsAsia report.

More public education is required to increase public awareness of the risks of chronic kidney disease and the need to screen and prevent the disease, says the author.

More public education is required to increase public awareness of the risks of chronic kidney disease and the need to screen and prevent the disease, says the author.

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The National Kidney Foundation has warned of a “kidney tsunami” with the rising number of kidney failure cases in Singapore, according to a recent Channel NewsAsia report.

Indeed, the number of new patients with stage 5 chronic kidney disease (CKD5) — also called end-stage kidney failure — and new patients on dialysis every year have been increasing as indicated in the latest Singapore Renal Registry Annual Report 2020.

And it’s not just the older folks who are at risk. Even though the majority of these patients were aged 60 years or older, 25 to 35 per cent were between the ages of 40 and 59 years.

Unsurprisingly, the numbers are driven up by the rise in patients with metabolic diseases, such as diabetes mellitus and high blood pressure.

Diabetes tops the list of causes of CKD5, with two out of every three new CKD5 patients attributable to it.

The upward trend will continue with the high prevalence of diabetes and high blood pressure in Singapore, unless immediate actions are taken to reverse the situation.

The strain from the increasing load of CKD patients is already keenly felt in primary healthcare clinics and hospital renal clinics.

The grim prospects explain why 2022 has been designated as the year of “Kidney Health for All” by the World Kidney Day Joint Steering Committee, representing the International Society of Nephrology and the International Federation of Kidney Foundations.

The drive includes calls to bridge the knowledge gaps to better kidney care by focusing on efforts to increase education and awareness about kidney health.

Locally, more public education is required to increase public awareness of the risks of CKD and the need to screen and prevent the disease.

PREVENTION BETTER THAN CURE

The age-old adage “prevention is better than cure” still holds true, and Singaporeans can do more to help themselves and their families and friends.

In order not to get kidney failure, we need to avoid getting diabetes and/or high blood pressure in the first place.

This is in line with the Ministry of Health’s (MOH) Healthier SG initiative, which seeks to focus efforts upstream to keep individuals healthy.

Prevention should start as early as possible with an emphasis on healthy diet and good exercise habits, coupled with age-appropriate health screening as diabetes is associated with obesity, poor dietary patterns (such as processed food products, sugar-sweetened beverages), physical inactivity, and smoking, apart from genetic risk.

A person with chronic diseases or obesity faces a higher risk of complications, such as heart attack, stroke or kidney failure when older.

Onset of any of these complications prevent the person from enjoying the quality of life and happiness he/she has envisaged, and cause burden for oneself and loved ones.

Timely screening for chronic diseases is important. “Screen for Life”, a national programme by the Health Promotion Board, encourages Singaporeans and Permanent Residents to go for regular screening and follow-up.

The programme covers screening for certain cancers and chronic diseases like diabetes, high blood pressure, obesity and high blood cholesterol, at a subsidised rate.

Early detection will allow early initiation of treatment and reduce the risk of complications from these chronic diseases later.

KIDNEY FAILURE STRIKES THE YOUNG TOO

The patients I encounter at the Singapore General Hospital’s renal clinic range from young adults to the very elderly.

While young adults are more likely to be troubled by diseases such as chronic glomerulonephritis (inflammation of the kidney’s tiny filters that remove excess fluid and waste from bloodstream), CKD in the middle-aged and elderly group are frequently caused by diabetes and/or high blood pressure.

Unlike many patients with heart disease or stroke, most of the patients with earlier stages of CKD do not have any symptoms.

Instead, they are diagnosed through regular health screening performed at primary healthcare level.

Oftentimes, when patients are first seen in the renal clinic, they are surprised or shocked to hear that they have CKD because they do not feel unwell.

They sometimes find it difficult to accept their diagnosis and their physicians’ advice on CKD treatment to reduce the risk of CKD progression and kidney failure.

The importance of regular screening of at-risk patients cannot be over-emphasised.

FIGHT OR FLIGHT?

The “fight-or-flight” response is our ingrained survival instinct in the face of threats.

However, when some patients choose “flight” and avoid engaging healthcare professionals or declining medical treatment for CKD, they will ultimately bring harm to themselves.

I have encountered patients, especially younger ones (less than 60 years old), who choose to avoid confronting their CKD condition and end up with kidney failure some years later.

Costs of regular tests and medications are sometimes cited by patients as the reason for avoiding treatment.

This may be true from the patients’ perspective in the short to mid-term, but in the long run, these costs will likely be lower and the quality of life will be better compared to being maintained on costly dialysis therapy.

Compared to more than 20 years ago, there are more medications now that have been proven to be useful in slowing down CKD progression and reducing the risk of kidney failure, if treatment is started early.

These medications, together with good control of diabetes and high blood pressure, as well as changes to dietary (including salt and sugar restrictions) and exercise patterns, may help us avert the ‘kidney tsunami’ which may hit us soon.

A person’s kidney function peaks at around 40 years old and after that, it declines very gradually as one ages. With CKD, the decline is much faster.

If one gets CKD at a younger age, the person will have a higher risk of kidney failure at a later stage of life.

Therefore, kidney protection needs to start young, way before acquiring CKD, diabetes and high blood pressure.

 

ABOUT THE AUTHOR:

Dr Kwek Jia Liang is a consultant in the Department of Renal Medicine at the Singapore General Hospital.

Related topics

kidney kidney disease renal Youth

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