Chronic Kidney Disease (CKD) affects approximately one-tenth of the world's adult population and causes millions of premature deaths worldwide[6]. Studies show that the prevalence of CKD in Malaysia is 15.48%, and the incidence of end-stage kidney disease requiring dialysis is increasing, with 216 cases per million population in 2016, compared to 96 cases per million population in 2002[6].

This article discusses dialysis, including what it is, when it's necessary, the causes of dialysis, and how much it costs. Additionally, we look at how long dialysis can help, if it can be avoided, and whether dialysis is a one-way street.

Table of Contents

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What is dialysis?

The kidneys are two bean-shaped organs located in the lower back that play an important role in maintaining life. They remove waste and excess fluid from the body, regulate body fluid, eliminate harmful substances such as uric acid, and metabolize harmful substances in the body[1].

When is dialysis necessary?

When kidney function is impaired due to diseases such as diabetes and kidney stones, chronic kidney disease can occur, which can lead to kidney damage. When chronic kidney disease progresses to end-stage, where the glomerular filtration rate (GFR) is less than 15 ml/min/1.73 m2, and kidney function is less than 15%, dialysis is necessary.

If dialysis is not performed, the kidneys cannot handle their normal workload, and waste will accumulate in the body, potentially leading to a coma.

Causes of dialysis

Dialysis patients typically have end-stage (stage five) chronic kidney failure. There are many causes of chronic kidney failure, including:

• Diabetes
• Glomerulonephritis
• Hypertension or chronic heart failure
• Drug abuse
• Smoking and alcohol habits
• Family history

Can dialysis be avoided?

For patients with chronic kidney disease and kidney failure, dialysis is a life-extending treatment method. Besides waiting for a chance to undergo kidney transplantation, dialysis is the only necessary treatment method. However, dialysis is not a treatment for organ damage. In the event that the patient has no choice, dialysis is necessary to replace some of the kidney's functions and can affect the patient's quality of life and financial burden. However, dialysis can help renal failure patients maintain normal body function and survive. In other words, choosing dialysis is equivalent to choosing a lifetime of dialysis!

Of course, there is a type of acute kidney failure that may only require short-term dialysis, and once the kidney recovers normal function, dialysis may no longer be necessary. However, in the case of chronic kidney failure, kidney function cannot be restored, and patients may require dialysis for life.

Cost of dialysis in Malaysia

The cost of dialysis in Malaysia varies depending on the type of dialysis and the location. In general, hemodialysis is more expensive than peritoneal dialysis. In Malaysia, the cost of hemodialysis ranges from RM182 to RM241 per session, which is an average of RM206[2]. And lets say a patient need to do dialysis 3 times a week, the cost of dialysis will be RM2,678 per month, and it will sum up to RM32135 per annum! The cost of dialysis can be a significant burden for patients and their families.

Dialysis subsidy in Malaysia

In Malaysia, the cost of dialysis can be high, requiring patients to undergo treatment 3-4 times a week. To help mitigate this cost, non-governmental organizations and the government offer subsidies for each dialysis treatment based on individual living conditions. Patients can apply for this subsidy by filling out an application form and submitting it with their medical reports to the National Kidney Foundation (NKF) Dialysis Program. The NKF will arrange for home visits to review the patient's living environment and conduct interviews to determine eligibility. Click here to know more.

Upon admission, successful applicants are required to pay RM90 per dialysis treatment. The NKF can assist eligible patients in applying for a subsidy of RM100 per dialysis treatment from the Ministry of Health (MOH)[3]. At NKF, the cost of each dialysis treatment is approximately RM170, and NKF will fundraise to cover the remaining balance of RM80 per treatment for each NKF patient.

If the application is approved, the cost per treatment is RM90, and the cost of dialysis for one year will be approximately RM14,040. This reduces the cost by 56% compared to the original cost of RM32,136. Therefore, patients facing financial difficulties should apply for dialysis subsidies.

How long can dialysis help?

It is important to note that dialysis is a temporary solution for kidney failure, and the life expectancy of dialysis patients depends on each person's physical condition and adherence to the treatment plan. The average life expectancy of dialysis patients is 5-10 years, but some patients can live for up to 20 or 30 years after dialysis[4].

Conclusion

Given the increasing number of people undergoing dialysis in Malaysia, particularly those with type 2 diabetes, it is crucial for high-risk groups to seek treatment as soon as possible. Regular health check-ups are essential to detect suspicious symptoms and receive timely treatment. Pre-diabetes patients can exercise more to lose weight and prevent the onset of diabetes. Studies from Diabetes Prevention Programme show that reducing body weight by 5% to 7% can reduce the risk of high-risk adults developing type 2 diabetes by 58%.

Kidney disease is a costly and irreversible illness. Prevention is better than cure, so it is important to focus on prevention and undergo regular health check-ups to maintain good kidney health and avoid the need for dialysis.

References

1. U.S. Department of Health and Human Services. (n.d.). Your kidneys & how they work. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved December 8, 2022, from https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work
2. Surendra, N. K. et. al. (2018). The cost of dialysis in Malaysia: Hemodialysis and continuous ambulatory peritoneal dialysis. Malaysian Journal of Public Health Medicine, 18(2): 70-81.
3. Dialysis treatment costs in Malaysia at NKF. National Kidney Foundation Malaysia. (2021, April 6). Retrieved December 8, 2022, from https://nkf.org.my/patient-welfare/
4. What is dialysis? National Kidney Foundation. (2022, November 16). Retrieved December 8, 2022, from https://www.kidney.org/atoz/content/dialysisinfo#:~:text=Life expectancy on dialysis can,20 or even 30 years
5. 69% of new patients on dialysis are diabetics - the Malaysian Reserve. (n.d.). Retrieved December 8, 2022, from https://themalaysianreserve.com/2021/11/15/69-of-new-patients-on-dialysis-are-diabetics/
6. Saminathan, T. A. et. al. (2020). Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study. BMC Nephrology, 21(1). https://doi.org/10.1186/s12882-020-01966-8