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Sunday, 9 April 2017

Don’t kid with kidney failure

The number of dialysis patients will more than double by 2040 if chronic kidney disease is not properly addressed. As part of the remedy, the Government plans to boost organ transplants in the country. 

THE signs aren’t obvious in the beginning. And that is why some call it a silent disease.

But it isn’t a time to keep quiet about chronic kidney disease (CKD), which strikes nine out of every 100 Malaysians.

The overall number of patients – from stage one to five – is currently between two and three million, but the numbers are expected to rise.

Most patients in stage five, known as end stage renal disease or kidney failure, depend on dialysis to carry on with life.

But while there are 40,000 dialysis patients now, the number is projected to more than double to a whopping 106,249 in 2040 if no effective remedies are in place, based on a recent study.

The large number of dialysis patients has made Malaysia the top seventh country with the highest dialysis treatment rate in the world, based on the study titled “Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040”.

However, many kidney patients in Malaysia are still hoping for the alternative solution – a kidney transplant.

In fact, most of the 20,000 people on the organ transplant waiting list are in need of kidneys.

The problem is that while organ pledges remain low, the number of medical professionals, including surgeons and supporting staff, that can conduct transplants are less than ideal.

Health Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai says there are plans to increase the capacity of medical staff to improve the level of transplants.

Calling it the ideal solution for kidney patients, he says transplants are also cheaper in the long run compared to dialysis.

“The main challenge when it comes to transplants is the need to increase the number of specialists, including transplant surgeons, pathologists and other supporting medical professionals.

“We are looking into roping in foreign and local experts to train more specialists in this area so that more transplants can be conducted and in a safe way too,” he told Sunday Star recently.

Dr Jeyaindran points out that while only 1% of the Malaysian population had pledged their organs after death, it was still the “greatest gift” a person can offer.

“As such, we need to strengthen the mechanism to support such a gift of life to another in need,” he adds.

One plan is to double the number of “organ retrieval” teams, or teams of medical staff in charge of retrieving organs from those who have pledged their organs upon death.

Currently, Malaysia only has two of such dedicated teams – one from Hospital Kuala Lumpur (HKL) and another from Selayang Hospital.

Dr Jeyaindran explains that increasing the number of teams would help make the process of transplantation more efficient.

He says the limited number of staff available to retrieve organs presents a challenge, especially when the deceased donor is located far away.

“Such teams have to go all the way there and the retrieval can be at odd hours.

“We want to double the number of such teams so that they can reach more locations quickly and cover wider areas like Sabah and Sarawak,” Dr Jeyaindran says.

Transplants can also be done involving living donors, who are often family members of the patient.

But for cases where the organ is from an unrelated deceased donor or cadaveric donor, there is also another hurdle – whether or not the organ is compatible with the patient.

“When the organ retrieval team gets an organ from Kuala Lumpur, it may not be suitable for a patient from the same place.

“But if it’s a match for someone in Alor Setar, then the necessary logistics have to be done to deliver the organ and this could take time,” he explains, adding that some organs may not last for long periods.

On dialysis treatment, Dr Jeyaindran says the ministry is focusing more on peritoneal dialysis, just like in Canada.

The treatment involves the lining of the body’s abdomen and a solution to clean the patient’s blood.

“Peritoneal dialysis can be done in the comfort of a patient’s own home. It is convenient and there is no need for patients to go to a hosp­ital or dialysis centre like in hemodialysis treatments,” he says.

In his Budget 2014 speech, Prime Minister Datuk Seri Najib Tun Razak had also announced the Government’s initiative in promoting peritoneal dialysis by providing free Continuous Ambulatory Peritoneal Dialysis (CAPD) kits costing RM19,000 per unit.

The initiative benefited over 1,000 patients who can use the kit at home.

Pointing out that Malaysia has room for improvement when it comes to transplants, Malaysian Society of Transplantation president Datuk Dr Ghazali Ahmad says the number of procedures done these days is a far cry from the past.

“In the 1990s, about 50 transplants were done in HKL itself.

“But last year, there were only 27 transplants from both living related donors and cadaveric donors in Malaysian public hospitals,” he says.

And only two Malaysian public hospitals performed such procedures last year, namely HKL and Selayang Hospital.

Although private hospitals only perform transplants involving living related donors, he notes that the total number of overall transplants is low and has been declining between 2009 and 2014.

“In 2009, a total of 141 transplants were conducted involving Malaysian patients in private, public and overseas hospitals.

“But this number steadily dipped over the years and in 2014, only 81 transplants were recorded,” says Dr Ghazali, who is a senior consultant nephrologist.

The dip is due to the overall drop in organ pledges, proliferation of dialysis centres and dwindling numbers of doctors qualified to carry out transplant procedures.

Dr Ghazali points out that Malaysia has a long way to go when it comes to organ pledges, compared to countries like Spain and Belgium.

In 2015, Spain recorded 39.7 actual deceased organ donors per one million population, compared to Malaysia which has about 0.6 per one million population.

Concurring that cases of CKD are on the rise, Malaysian Society of Nephrology council member Dr Lily Mushahar attributes the spike to the increase in elderly population in Malaysia.

“With better healthcare in Malaysia, the population now has a longer life expectancy. This leads to an increase in non-communicable diseases (NCDs) such as hypertension and diabetes that relate to long-term complications like kidney disease,” she says.

As such, the rise in NCDs over the last two decades, especially diabetes and hypertension, has led to the corresponding hike in kidney failure.

“Sixty per cent of end stage renal disease in Malaysia is caused by diabetes. Unhealthy lifestyle and diet among Malaysians also give rise to obesity and NCDs,” Dr Lily says.

Another factor is the lack of awareness among Malaysians, as many do not go for regular medical screening.

“They only do so when they become unwell and find out they have the disease,” she laments.

While Malaysia has enough nephrologists – about 120 for the country’s population of 30 million – Dr Lily finds it worrying that there are so few dedicated transplant surgeons.

“Most transplants are being done by general surgeons who are also involved in other daily duties.

“Malaysia needs a dedicated transplant team that comprises dedicated transplant surgeons, anaesthetists, nephrologists, nurses, psychiatrists and nutritionists that do not juggle their work with other non-transplant duties,” she says.

The National Kidney Foundation is also doing its part to help kidney patients by developing centres in underserved areas, especially in East Malaysia, to provide treatment for poor patients.

“We are also introducing another prog­ramme to help those with early kidney disease from progressing to advanced kidney failure.

“We hope to kick off this pilot project this year,” says its chairman Datuk Dr Zaki Morad.

Related stories:

Not enough donors, surgeons or teams for organ transplants

Successful transplants also a boon to families of patients

Carrying on beyond kidneys

Tags / Keywords: organ transplant , kidney , health ministry , organ donation , nephrology

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