Kidney diseases weighing on public healthcare expenditure

Kidney diseases weighing on public healthcare expenditure

This article is in conjunction with World Kidney Day 2021 which falls on March 11 every year.

KUALA LUMPUR: The burden of chronic and non-communicable diseases (NCDs) in the country continues to weigh heavily on the national healthcare system, with news reports highlighting the growing numbers of Malaysians impacted by often preventable diseases that lead to deteriorating quality of life and a growing cost to the healthcare budget.

Recent studies carried out by local health experts have shown that chronic kidney disease (CKD) has become one of the leading public health issues in Malaysia with increased prevalence and low awareness.

According to their findings, within less than a decade the prevalence of CKD increased from 9.1 percent in 2011 to 15.5 percent in 2018. The worrying part is, only five percent of people with CKD are aware they have the disease.

The rise in CKD numbers is driven by the increase in NCDs, particularly Type 2 diabetes, with nearly one in five Malaysian adults having diabetes. High blood pressure, obesity and cardiovascular disease are also risk factors that can lead to CKD.

Economic perspective

Malaysia also has one of the world’s highest proportions of patients with end-stage renal disease (ESRD) due to diabetes. It has been reported that almost 69 percent of the new ESRD cases recorded in the Malaysian Dialysis and Transplant Registry 2018 were caused by diabetes

(ESRD occurs when CKD – the gradual loss of kidney function – reaches an advanced state and the kidneys cease functioning on a permanent basis leading to the need for dialysis or a kidney transplant to maintain life.)

Malaysian Society of Nephrology (MSN) president and senior consultant nephrologist at Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia Prof Dr Abdul Halim Gafor said health experts have conducted several studies from the economic perspective to evaluate the cost and long-term sustainability of ESRD care, including dialysis treatment, in the country.

In 2010, the total ESRD expenditure in Malaysia was 2.95 percent of the total public sector health expenditure but it increased to 4.2 percent in 2016.

According to Dr Abdul Halim, the total health expenditure for the public sector dedicated to ESRD care is considered massive and disproportionate relative to the reported number of ESRD patients in the Malaysian Dialysis and Transplant Registry which stood at approximately 44,000 in 2018.

He told Bernama their studies have projected that – based on the current trend and if the situation remained unchecked – the number of ESRD patients would reach almost 51,000 in 2020 and 106,000 in 2040, which will cost the healthcare system an estimated RM1.5 billion and RM3.2 billion respectively.

Early Detection

Currently, the Ministry of Health is focused on addressing this health burden by using a multi-agency approach to reduce NCDs, including advocating the prevention and early treatment of CKD by conducting screenings for kidney diseases.

Dr Abdul Halim said if detected early and managed properly, the rate of deterioration of the kidney functions can be delayed significantly.

He said CKD is often symptom-free in its early stages and that individuals may not experience any notable symptoms until they reach advanced stages of the disease.

This may, in part, cause missed or late detection of CKD, hence contributing to the low percentage of individuals with CKD being aware of the disease, he added.

“Early screening of CKD among high-risk individuals such as those having diabetes or hypertension, therefore, is absolutely crucial. We encourage these groups to consult their doctors or healthcare providers for regular assessment of the risk of CKD.

“If detected early and managed appropriately, we can delay the rate of deterioration of kidney function significantly. Patients can also remain dialysis-free for many years with low risk of complications,” he said.

Dr Abdul Halim said MSN has been working closely with the Ministry of Health (MOH) and non-governmental organisations such as the National Kidney Foundation of Malaysia and MedTweetMy to elevate public awareness on CKD and educate patients and their caregivers by providing correct information on how to manage the disease.

Combating misinformation

Consultant nephrologist Dr Rafidah Abdullah, who is MedTweetMy vice-president and co-chair of MYBuahPinggang.com, said misinformation and the circulation of fake news have had a huge impact on CKD patients who frequently seek non-medical opinions via social media which would give them false hopes of a cure.

“They end up developing more complications and accelerating the progression of CKD. They may even end up having to commence dialysis much earlier than what would have been the case if they had followed the treatment delivered by healthcare professionals,” she said.

Meanwhile, MedTweetMy, with the support of MOH, National Kidney Foundation of Malaysia and AstraZeneca Malaysia, has developed a portal called MYBuahPinggang.com to provide easy access to comprehensive and accurate information on kidney diseases.

“The MYBuahPinggang.com website was developed to address misinformation. It acts as a one-stop centre for the public, patients and families to go to (for information on kidney diseases). This website will be expanded by providing more in-depth information on diabetes and modules on pre-dialysis education,” Dr Rafidah added.

The MYBuahPinggang website can be accessed via mybuahpinggang.com. -Bernama