Better dialysis therapy

NST: The Automated Peritoneal Dialysis or APD is a convenient solution to young patients suffering from renal failure. RUSLINA YUSOFF finds out why it’s a better course of treatment.
To date, there are 12,000 kidney patients on dialysis. Datuk Dr Zaki Morad Mohd Zaher, first vice-chairman for the National Kidney Foundation says that one-tenth of these patients are below the age of 20.
There are 100 to 120 new adult cases per year per million whilst for children it is between 10 and 15 new cases per million, which is almost the same as the rest of the world.
Saying that the figures are still manageable, Dr Zaki, who also the head of the Nephrologist Department and senior consultant, Hospital Kuala Lumpur, attributes the fairly stable figures to the increased accessibility to the services as well as greater public awareness.
“Kidney failure is a serious condition and when it occurs in children, it can be devastating for some parents,” he says. “This is certainly sad because being young, the ailment deprives them the chance of being productive.”
Although there are several dialysis therapies available, Dr Zaki says they are pushing for the APD (Automated Peritoneal Dialysis) to replace the CAPD (Continuous Ambulatory Peritoneal Dialysis) as the better choice for children. In APD or Automated Peritoneal Dialysis, the dialysis exchanges are performed by the machine during the night in contrast to CAPD where about four exchanges are done manually by the child or his parent during the course of the day, which can be intrusive.
The APD allows children to attend school full time and reduce the impact of the dialysis treatment on the child as well as his family. This helps the child and his family attain the highest level of psychological and social rehabilitation, says Dr Lim Yam Ngo ,a consultant paediatric nephrologist and a board member of the National Kidney Foundation. In short this could only mean a better quality of life.
To date 10 young patients are on the APD, with the youngest about 1 1/2 years old and the oldest 17. However, the main obstacle is the higher cost of the APD compared to CAPD which include the cost of fluid, tubing and cartridge as well as the additional monthly rental for the machine. The machine costs RM38,000, which is definitely not within the reach of many.
Neither is haemodialysis a good option for children as haemodialysis also requires them to be on the machine for about four hours three times a week in a hospital-based hemodialysis centre. Children are afraid of needles and haemodialysis requires two needles to be inserted at each dialysis.
The Children Dialysis Programme set up by the Kidney National Foundation provides financial assistance to enable more children to have access to APD, says Dr Zaki. To receive the APD treatment, children registered under the programme are only required to pay for difference in cost between APD and CAPD.
However, for the low-income group who still cannot afford to pay the balance, the NKF has introduced the child adoption scheme where organisations or individuals can “adopt a patient”. The dialysis programme, which will soon be extended throughout the country, is only a short-term measure until the children get a kidney transplant.