Rising trend of disease to push up treatment bill

NST: KUALA LUMPUR: The treatment and prevention of kidney diseases are proving to be a costly affair.
The government spends more than RM500 million annually, of which RM350 million is spent on 13,000 patients undergoing dialysis.
The total expenditure is expected to rise further as the number of patients with chronic kidney ailments increases by some 15 per cent yearly.
Alarmingly, for every patient that is registered, it is believed that there are at least 10 more unknown cases.
A total of 1,300 patients on dialysis die each year due to lack of donors, disease complications and old age.
There are currently 137 dialysis centres run by the Health Ministry, 99 by non-governmental organisations, 144 privately, eight by universities and eight by the armed forces.
Kuala Lumpur Hospital’s consultant nephrologist Datuk Dr Zaki Morad Mohamad Zaher said although the number of dialysis centres was sufficient for the time being, it would have to be expanded as the nation would experience an upward trend in chronic kidney disease due to the aging population.
"In fact, we have been seeing the trend since 2004," he said, adding that the occurrence of kidney failure in those aged 50 years and above was now between 500 and 600 per one million population as compared with only about 170 per one million population in 1996.
Dr Zaki said the number of kidney patients between 20 and 50 years had reached a plateau as other diseases such as diabetes and blood pressure were being effectively controlled. The occurrence of kidney diseases in this age group has remained at about 100 per one million population for the past five years.
Dr Zaki attributed the cases of chronic kidney diseases, especially in the older age group, to a high prevalence of diabetes and high blood pressure.
"One of the many complications they get due to years of suffering is chronic kidney disease. As for those in the younger age group, other types of kidney diseases are more prevalent such as inflammation of the kidney, kidney stones and infection in the kidney."
He said kidney diseases could be easily treated these days with better awareness and the availability of diagnostic and treatment facilities at almost all government and private hospitals.
"There are also effective drugs to control blood pressure and diabetes with less side effects. This delays the onset of kidney damage," he said.
Dr Zaki, who is also the vice-chairman of the National Kidney Foundation, said the foundation was encouraging the public to go for regular screening so as to detect kidney problems at an early stage.
"People with family members suffering from kidney problems and those in high-risk groups such as diabetics and those with high blood pressure should go for screening yearly, including doing blood and urine tests," he said.
"The mindset of doctors must also change. They only treat but they fail to talk to patients about their diets and drugs.
"It’s important for them to treat the diseases and refer to nephrologists for further management and treatment if necessary."
If these measures are taken, Dr Zaki is confident that the nation would see the number of Malaysians with chronic kidney disease reaching a plateau or decreasing in 15 years.
Dr Zaki , who is the president of the Malaysian Society of Transplantation, said shortage of kidney donors was another reason many patients on dialysis were dying.
"We have a supply and demand problem. Our resources are limited. We have opened up three kidney transplant centres — at Universiti Malaya Medical Centre, Selayang Hospital and KLH — but we only get to do an average of 30 transplants a year when the capacity at each hospital is for at least 150 transplants a year," he added.
There are currently 1,600 living transplant patients with some having done the procedure overseas, particularly in China and India.
Dr Zaki said many had resorted to undergoing transplants at these two countries and also in Pakistan and Latin America due to the lack of donors locally.
There is also a shortage of nephrologists. Currently, there are only 70 nephrologists, or three to a million population when ideally it should be 1:50,000.
Dr Zaki said there should be at least 500 nephrologists to handle the rising number of kidney cases.
To get a better picture of the kidney problem in Malaysia, the ministry’s Clinical Research Centre together with the KLH’s Department of Nephrology will conduct a survey beginning next year.
The results are expected to be ready by June 2007.