Studies forecast kidney failure patients in Malaysia to reach 106,000 by 2040, at RM3.2b cost to healthcare system

According to the chief executive officer of Galen Centre for Health and Social Policy, Azrul Mohd Khalib, almost 9,000 new kidney patients are registered annually, and they require dialysis treatment.

Research has forecasted that the number of kidney failure patients will reach 106,000 by 2040, double the current number, according to the National Kidney Foundation (NKF).

NKF chief executive officer Khor Xin Yun said high rates of kidney failure will lead to increasing burden and demand for medical services.

“It was estimated that this burden would cost the healthcare system RM 3.2 billion,” she told Malay Mail in an email interview recently.

The total dialysis patients in 2022 totalled 51,256 while the healthcare costs was reported at RM1.12 billion as at 2016.

According to the chief executive officer of Galen Centre for Health and Social Policy, Azrul Mohd Khalib, almost 9,000 new kidney patients are registered annually, and they require dialysis treatment.

“One in seven of the 33 million population, or 4.7 million adults, have various stages of chronic kidney disease in this country,” he said.

He said the prevalence of chronic kidney disease is dramatically on the rise.

“Findings from a nationwide study in 2020 reported the prevalence of chronic kidney disease (CKD) in Malaysia has increased by 6.41 per cent, from 9.07 per cent in 2011 to 15.48 per cent in 2018,” he said.

Khor said diabetes and hypertension were identified as the primary causes of kidney failure among dialysis patients, based on data from the Malaysian Dialysis and Transplant Registry of 2022.

Diabetes accounted for 52 per cent of the cases while hypertension accounted for 34.8 per cent, she added.

She said diabetes and hypertension are often linked to unhealthy lifestyle factors such as poor diet, lack of physical activity, and obesity.

She also said obesity is also associated with an increased risk of kidney damage.

Azrul concurred that diabetes is the cause of kidney failure in this country and that there are now an estimated 4.4 million people living with diabetes, both diagnosed and undiagnosed.

“When you map out the rise of diabetes against the rate of increase of kidney disease patients, they are similar,” he said.

He said this would mean there will be more patients with CKD needing dialysis which is now happening in Singapore.

Public health expert from International Islamic University Malaysia Dr Mohammad Farhan Rusli also attributed the increase in kidney failure patients to the rise of non-communicable diseases (NCD), mainly diabetes and hypertension.

“Usually, the majority of the at risk population are actually diabetic and have renal impairment but they are asymptomatic,” he said.

He said many patients are diagnosed at stage three or four, the end stage when the course of treatment is dialysis.

“This occurs as many do not go for early screening or routine health exams,” he said, using the poor uptake of the PekaB40 initiative as an example.

He said the initiative was free, but many still do not undergo screening.

“A mixture of unhealthy lifestyle choices, mixed with a heavy amount of poor dietary intake (high sugars, fats and others) bundled with a sedentary lifestyle is the perfect recipe for an NCD bomb,” he said.

He said the “bomb has already exploded” and the burden of disease to the country in the next 20 years will be exponentially higher.

He said this will have a massive impact on quality of life of the patients and family while causing deep economic losses for the country.

Khor said people with lower socioeconomic status often have lower health literacy, so they tend to encounter barriers when accessing healthcare facilities and services.

“These challenges can result in delays in diagnosis and suboptimal treatment and management of conditions like diabetes, hypertension, and chronic kidney disease,” she said.

She said ultimately, these factors will lead to kidney failure among affected individuals.

Dr Mohammad Farhan said the incidence of kidney failure among patients must be slowed down and stopped before the situation can be reversed.

“Now to slow this, we need to nip the issue at the bud,” he said.

This meant mandatory comprehensive screening for everyone, he said.

“To stop it, we need to ensure that the early detection screenings have a clinical pathway that is adhered to, to prevent or limit the progression of the disease to a severe stage,” he said.

Khor agreed that early screening for NCDs should be promoted as these are major risk factors for kidney diseases.

“Government initiatives like Program Saringan Kesihatan Perkeso, PeKa B40 health screening, and NGO-led initiatives by NGOs like the National Kidney Foundation Malaysia offer valuable health screening services,” she said.

She said there is a need for a comprehensive whole-of-society approach to effectively address the issue of rising kidney diseases among individuals.

She said it should involve collaboration among various stakeholders including the government, healthcare providers and non-governmental organisations (NGOs), among others.

Both she and Dr Mohammad Farhan said early health education and awareness programmes for children are important to instil lifelong healthy habits and to promote kidney health.

Education should also involve patients diagnosed with NCDs, Khor said.

She said patients diagnosed with diabetes, hypertension, and early-stage chronic kidney disease should be educated on disease management.

The disease management must emphasise on self-monitoring, lifestyle modifications, medication adherence, and regular follow-ups to delay or prevent kidney disease progression, she added.

They both also touched on the need for government policies that promote healthier environments and nutritious food choices.

“The government must also revise its policies on subsidising sugar — which is a main contributor to the problem,” said Dr Mohammad Farhan.

He said the government should also plan out healthy living policies under the ministry of health to better empower the future generation.

Azrul agreed with Dr Mohammad Farhan’s suggestion on the removal sugar subsidies and suggested the closure of late-night eateries too.

“We are the only country in the world which has subsidies for sugar,” he said.

He said if the country is not willing to make such unpopular decisions, the country will continue to have hundreds of thousands of people needing kidney dialysis in the future.

Khor said the implementation of the sugar tax was a good move.

“We can look at expanding policies promoting healthier environments and ensuring access to nutritious food choices,” Khor said.

She said these policies can encourage healthier dietary habits, promote healthier lifestyles and reduce the prevalence of risk factors.

Azrul said Malaysia will not be able to stop the rise in kidney disease patients if it is not serious about dealing with diabetes and unhealthy diets.