The calm before the storm

There is an invisible kidney tsunami that people are not paying enough attention to in Singapore. Six people are diagnosed with kidney failure every day, and this is three times more patients than two decades ago. A recent documentary, produced by Channel NewsAsia in partnership with NKF, shares more about the rising number of people with chronic kidney disease (CKD) with many more undiagnosed, and the catastrophic consequences if nothing is done to stem the tide. We highlight some notable quotes from experts in the renal field that encapsulate the seriousness of this big wave that is looming and what needs to be done urgently.

The silent killer

“The ‘only way’ to catch the silent killer is through screening, which involves blood tests and urine tests. Most of the time, the routine screening people are aware of is... for cholesterol, for diabetes. But having a normal blood sugar level or normal cholesterol level doesn’t mean the kidney is healthy.”

Assoc Prof Tan Chieh Suai, Head and Senior Consultant, Department of Renal Medicine, Singapore General Hospital, who encourages people to go for kidney screening.

“About 9,000 people in Singapore have kidney failure and are on dialysis. This is merely the tip of the iceberg. You have more than 300,000 people who are under the water with chronic kidney disease. We can’t see them, but they need to be found so that we can screen them and institute appropriate treatments.”

Prof Thomas Coffman, Dean, Duke-NUS Medical School, who says that this big wave of the increasing number of people with CKD is going to crash on the health system and that raising awareness and carrying out nationwide kidney screening is critical.

Watch “Inside Singapore’s fight against kidney failure — A looming dialysis crisis?”

So what if more people have kidney failure?

“We’re at this brink of no return in terms of patient numbers. At the rate things are going, we’re going to have a problem with patients not having dialysis centres to go to … We need to build three or four centres every year just to cope with this demand.”

Assoc Prof Jason Choo, NKF’s Director of Medical Services, who says that across NKF’s 41 dialysis centres, about 100 new applications for a dialysis place are received every month, nearly double the figure from five years ago.

“I’ve been a kidney specialist for many years now, but each time when we still see a patient newly diagnosed with kidney failure, we know that the health burden and also the emotional support that the patient needs is tremendous.”

Adj Asst Prof Yeo See Cheng, Head and Senior Consultant, Department of Renal Medicine, Tan Tock Seng Hospital, who sees patients “crash land” at the hospital’s A&E department when they have developed severe symptoms of kidney failure. Some $300 million is spent on dialysis a year and that cost will only increase exponentially if nothing is done to stem the tide.

“I’m training new renal nurses like nobody’s business. It’s not easy to train renal nurses. It takes six months for a nurse to be competent to manage the dialysis machine and manage patients on dialysis. I lost a lot of nurses to overseas opportunities who are actually very well trained already. And I have got to start all over again. The question is, if we don’t have enough nurses, what’s going to happen to the patient?”

Ms Pauline Tan, NKF’s Deputy Director of Nursing, who is concerned about the shortage of nurses to run the dialysis centres, which was compounded by the exodus of nurses to other countries during the pandemic.

“During dialysis, there are a lot of complications that can happen. There can be hypotension, there can be chest pain, shortness of breath. We need to monitor (the patient for those) so that the patient doesn’t end up with severe complications.”

Ms Shanthini Durga, a nurse at NKF’s Integrated Renal Centre, Singapore’s biggest dialysis facility, shares about the struggles patients face having to undergo thrice weekly dialysis.