Non-dialysis care may be preferable for some older kidney patients: Docs
Published on
10 Sep 2022
Published by
The Straits Times
Eight years after he was diagnosed with the penultimate stage of chronic kidney disease, Mr Jimmy Tan, 96, still exercises six times a week and makes weekly trips to Clementi Mall to meet a friend for coffee.
He is among at least 5,000 patients in Singapore aged above 75 who have opted not to have dialysis and instead manage their condition through conservative care - the use of medication and other regimens - or palliative care.
Giving these figures on Thursday, kidney doctors told the media that more older and frailer patients can consider conservative kidney care, which allows them to enjoy a better quality of life and lowers costs of treatment.
Their call comes amid a worrying increase in end-stage kidney disease patients as Singapore's population ages. Such cases rose by more than 30 per cent from 2011 to 2019, according to the Singapore Renal Registry Annual Report 2020 published in February.
In 2019, seven in 10 of such patients were aged 60 and above.
For Mr Tan, whose kidney disease has progressed to the last stage, conservative care was a straightforward choice as he is scared of needles.
"I chose medication because it is not painful at all," said the retired materials assistant, who has other health conditions and has undergone multiple procedures, including open-heart surgery.
When patients reach 85, more than half are less likely to have healthy longevity even with dialysis, said Associate Professor Jimmy Teo, a senior consultant at the division of nephrology in National University Hospital's department of medicine.
Conservative care is much cheaper than dialysis and would be preferable if a patient has low life expectancy, among other factors, Prof Teo added, estimating that dialysis can cost from hundreds to thousands of dollars a month when hospitalisation and ambulance transport are added.
In contrast, conservative care costs about $100 a month with subsidies and insurance, he said.
On average, between 10 and 20 per cent of patients above 75 near end-stage chronic kidney disease are unlikely to benefit from dialysis as they have a life expectancy of less than five years, he noted.
Still, dialysis will become essential when patients suffer from a build-up of toxins in their blood as a result of kidney failure, and would die without dialysis in at most two months, said Prof Teo.
While only 5 to 10 per cent of conservative and palliative care patients here are co-managed with primary care physicians, it would be ideal to have all of them managed with general practitioners and clinics to avoid unnecessary hospital visits, he added.
To combat the risk of kidney failure, a new drug for people with diabetic kidney disease - the top contributor of chronic kidney disease - has also been rolled out, said Dr Kwek Jia Liang, a consultant in renal medicine at Singapore General Hospital.
The non-steroidal drug known as finerenone reduces inflammation in kidneys, but may raise levels of potassium to adverse effect.
Finerenone was approved for patients with diabetic kidney disease by the Health Sciences Authority last November. It has been available at private medical institutions since July and is pending approval from public hospitals.
Together with other drugs, a clinical study involving hospitals here and abroad found that finerenone can further lower the risk of major cardiovascular events, including a heart attack and stroke, and kidney failure.
Trials are under way to test its effectiveness in non-diabetic patients, said Dr Kwek.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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