PETALING JAYA: “Dialysis drains my energy and even causes me to faint easily.”
These are the words of a 62-year-old patient from Petaling Jaya, who only wanted to be known as Vijiya, as she undergoes treatment to manage her condition.
She said the weekly routine has taken a heavy toll on her physical well-being and daily life.
“I have to manage everything myself, including arranging transport to the hospital and the centre. I also go for eye check-ups at the government hospital, where I have to pay RM200.
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“Even when I come down from my flat on the 11th floor, I have to sit and rest before taking a cab,” said Vijiya, who started dialysis at 55 when she was working as a cleaner.
Although her medical costs are covered by the Social Security Organisation (PERKESO), she still has to bear travel and meal expenses.
Similarly, a 65-year-old food business owner from Petaling Jaya, who only wanted to be known as Jamilah, said dialysis has disrupted her livelihood.
Jamilah has been running her food business for 10 years, which helps pay for her house and car. But now, her health has left her too weak to keep it going.
“I can barely run my food business. I spend hours on dialysis and afterwards, I feel too tired to continue,” she said.
“The cost of my dialysis is about RM3,000 to RM4,000, but I am covered under my daughter’s insurance,” she said.
She began dialysis last July, immediately after suffering from influenza, when doctors discovered her kidneys were failing.
Meanwhile, IMU University Faculty of Medicine (clinical campus Seremban) senior consultant nephrologist Assoc Prof Datuk Dr Lily Mushahar said one haemodialysis therapy per patient per session (four hours) uses about 500 litres of water.
She said each patient requires about 12 to 13 sessions monthly.
“Dialysis is not very good for the carbon footprint, especially haemodialysis, because of the high utility (water, electricity) and disposables. But we cannot avoid this for haemodialysis therapy, but peritoneal dialysis is greener.
“Ultra-pure water uses more water, as it is more intensive and costly. Although ultra-pure water is more advanced in producing high-quality water, it does not reduce the volume of water used.
“The only thing moving towards green dialysis so far is recycling water, for example, by using reject water for other purposes,” said Dr Lily, who is also the USCI Hospital (Springhill, Lukut) internal medicine consultant nephrologist.
In a mini-review entitled “Water implications in dialysis therapy, threats and opportunities to reduce water consumption: a call for the planet”, published in Kidney International by Elsevier (Volume 104, Issue 1, July 2023), global annual water use for haemodialysis is approximately 265 million cubic metres per year.
The review said that, based on that estimate, two-thirds of the water from reverse osmosis reject water is discharged into the drain.
According to the Global Renal Replacement Therapy Annual Report 2022, haemodialysis is the most widely used treatment for end-stage kidney disease, chosen by approximately 90% of all dialysis patients – approximately 3.4 million patients.
With patient numbers on dialysis growing by at least 7% yearly, both the water used and the wastewater generated by dialysis units increase accordingly, the review said.
As such, the review proposed circular water management in line with the “3R” concept: reduce (reduce dialysis need, reduce dialysate flow, and optimise reverse osmosis performance), reuse (reuse wastewater as potable water) and recycle (use dialysis effluents for agriculture and aquaponics).
