THE GOVERNMENT has allocated RM40mil, the largest amount yet, to encourage the establishment of more private haemodialysis centres in Budget 2017.
But, a nephrology expert says the funds should be focused on promoting organ donation and health awareness programmes instead.
This is because organ transplants cost half the medical expenses of dialysis and carries longer-lasting benefits in terms of wellbeing compared to the blood-cleansing procedure.
Malaysian Society of Transplantation President Datuk Dr Ghazali Ahmad said studies have proven that almost 4,000 renal kidney patients failed to be saved each year.
“In recent years, we are starting to record as many as 7,000 new patients with kidney failure in the country annually, and with this mortality rate of 4,000 deaths per year, this means there is a increase of 3,000 kidney patients every year.
“As of December 2014, we recorded 35,580 patients living on dialysis. Although data for last year is still being analysed, this figure can be expected to rise to at least 38,000,” he said.
Dr Ghazali said, according to the National Renal Registry in 2005, there were 504 patients per million living with kidney failure on dialysis.
“Ten years later in 2015, this figure has doubled to 1,155 per million population.
“This could mean that more patients are receiving the treatment they need, with more facilities with dialysis equipment being built,” he said.
However, he added that “good” is relative, as he questions how much money is actually being spent for the treatment of every patient.
He said, in 2003, the Nephrology Department of the Health Ministry conducted a study on the cost effectiveness of dialysis treatment and found that the cost needed to sustain one patient on dialysis was RM33,000 a year, including additional subsidies from the government.
“Bear in mind this was in 2003, and costs would have risen significantly since then. We don’t have a new study done on this yet.
“There was also a similar study done for organ transplants, evaluating all cost elements involving transplant patients who received organs from live and dead donors.
“We found that the costs needed to support and sustain a kidney transplant patient is almost cheaper by half compared to dialysis patients,” he said.
Although RM20,000 may seem like a hefty price to pay for transplant surgery, Dr Ghazali said costs are minimal after the first year when the patient’s condition has stabilised.
“Looking at the thousands of kidney patients we have in the country, it is only logical for us to channel funds towards treatment through organ transplants that is not only cost-effective but also ensures the wellbeing and longevity of patients,” he said.
However, the statistics for organ transplants in Malaysia are bleak Dr Ghazali noted.
The numbers for organ transplants remain almost static. In 2005, there were a total of 65 organ transplant patients per million population in the country.
“And 10 years later, this number has dropped to 61 per million population.
“So even though we can give ourselves a pat on the back and feel happy that our country is able to allocate a large sum of money for the provision of more dialysis to kidney patients, you can see that our progress on organ transplants is falling far behind,” he said.
Dr Ghazali said, as more government funds are being poured into dialysis, kidney disease treatment appears to be now be fully focused on haemodialysis.
He said despite the widespread belief that kidney patients can be sustained by dialysis, this is not the best kind of treatment.
“Analysis done by the renal registry shows that there is only a 50% survival rate over five years for patients undergoing dialysis.
“Whereas for transplant patients, more than 75% of them will still have a functional kidney and will be able to live up to 10 years and above after the transplant,” he said.
Dr Ghazali also pointed out the difference in the quality of life between a dialysis patient and a transplant patient. A dialysis patient has to undergo the procedure three times a week for four hours each time.
“Apart from those four hours in a day, time is also lost when you take into consideration the time taken to travel to and from the centre.
“There is a waiting process before treatment starts, and after treatment is done, the patient also needs to wait because there might be some side effects like bleeding and headaches,” he said.
Pointing out that a real, functional kidney works around the clock every day to filter waste products from the blood, Dr Ghazali said dialysis only does so 12 hours a week.
“It (dialysis) doesn’t produce the same blood-cleansing quality as a functional kidney.
“And there is also the issue of dialysis patients having to go on a strict diet to ensure that the toxins in their blood can be eliminated properly two days after every dialysis treatment.
“If patients aren’t disciplined enough in watching that they consume within the first 24 hours, they are highly susceptible to emergency situations and have to be warded immediately,” he said.
Dr Ghazali said the influx of kidney patients in the emergency wards of general hospitals is a testament to that.
He said there have been many cases where patients who receive dialysis treatment in both public and private medical facilities are admitted due to complications that arise after the treatment.
“These complications range from low blood pressure, muscle cramps, and infection to the formation of blood clots.
“The longer a patient undergoes dialysis the more likely it is long-term complications such as inadequate filtering of waste products, more severe blood clot formations and cardiovascular diseases will appear.
“Besides this, patients also need injections to help the kidney produce red blood cells, Vitamin D – things that can normally be produced by a healthy kidney on its own.
“For younger female patients who are fertile, they will never be able to conceive a child after undergoing dialysis too,” he said.
Quality of life for a dialysis patient is also affected in terms of work and family, said Dr Ghazali.
“From the productivity aspect, dialysis limits your work capabilities, and this in turn puts pressure on employers because they are still paying a full salary when work productivity decreases.
“Those who stop working to receive dialysis treatment face problems when they wish to join the workforce again.
“Families of kidney patients are also affected, because this heavily limits their chances of going on a holiday or change of work location as kidney patients are tied to the dialysis centre they go to,” he said.
However, once a kidney transplant is carried out, Dr Ghazali said, all these impediments and complications disappear.
“Sadly, in a survey of hospital staff during the national-level Organ Donation Awareness Week, 95% of the respondents said they were not willing to pledge themselves as organ donors though they were willing to receive an organ in the event of emergencies.
“This is what we call ‘free riding’, despite the reasons they give such as fear, worry and religious beliefs,” he said.
Citing statistics from two Health Ministry hospitals specialising in organ transplants, the Kuala Lumpur Hospital and the Selayang Hospital, Dr Ghazali added there only 56 people successfully donated their organs in 2014, and 30 in 2015.
“Meanwhile, there are thousands of kidney patients. There are at least 20,000 of them are being placed on the waiting list for a transplant and it could take 15 to 17 years.
“Once an organ is harvested, it will be given to the patients who have been on the list the longest, but they are the ones who also face a higher health risk because of the long-term complications of dialysis mentioned earlier.
“And we can’t give a harvested organ to newcomers on the list, otherwise there would be complaints,” he said.
FAced with high cost of dialysis treatments and the difficulty in supplying organs for patients in need of transplants, Dr Ghazali said it is better for the government to tackle this increasingly serious health problem by interacting with the community to raise awareness about organ donation.
“I think a special budget should be allocated for this very purpose, because it is obvious there is a pressing need to raise public awareness on preventing kidney diseases and kidney failure.
“Hopefully, we can stop the increase of kidney patients in the future. But until then, we hope to do what we can now to work on increasing awareness for the importance of organ donation.
“Otherwise, there will only be more people requesting dialysis, more parties providing the treatment, and even more who will apply to run dialysis centres, all of which propels the government to allocate more funds for this purpose,” he said.