Senior Consultant Nephrologist, Dr Jason Choo, explains the devastating impact of chronic kidney disease and how timely intervention can prevent dialysis and kidney failure.

Chronic kidney disease or CKD is an irreversible condition characterised by the progressive loss of kidney function in effectively filtering waste and fluids from the body.

Unfortunately, CKD in Singapore is on the rise. According to the National Kidney Foundation, some 500,000 Singaporeans suffer from kidney disease and are at higher risk of progressing towards kidney failure. Singapore also has one of the highest rates of diabetes-induced kidney failure in the world, and ranks second and fifth globally for existing and new cases of kidney failure, respectively.

Consultant Nephrologist, Dr Jason Choo, from the Singapore General Hospital

Consultant Nephrologist, Dr Jason Choo, from the Singapore General Hospital

In this article, we speak to Consultant Nephrologist, Dr Jason Choo, from the Singapore General Hospital about the primary causes of CKD, particularly diabetes, and its deadly complications if not managed or treated early.

For Life (FL): What are the most common risk factors of CKD? How prevalent is the condition in Singapore?

Dr Jason Choo (JC): There are various risk factors for CKD, primarily diabetes and hypertension, which account for almost 80% of all cases. Other factors include advanced age (those above 65 years are at higher risk), a family history of CKD or kidney disease, prior kidney damage, obesity, and heart disease, as well as prolonged use of certain painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) that are often prescribed for joint pain or gout.

An estimated one in nine adults in Singapore are diabetic. Unfortunately, having diabetes increases the risk of CKD because high blood sugar damages the blood vessels in the kidneys that filter waste in the blood, consequently leading to kidney damage and hypertension.

In fact, approximately 25% to 40% of diabetic patients will develop diabetic kidney disease (DKD), with diabetes contributing to 67% of all end-stage kidney failure cases in Singapore.

FL: Why is it important to manage kidney disease early?

JC:  CKD is an irreversible condition characterised by a gradual loss of kidney function over time. It includes conditions that damage your kidneys and decrease their ability to keep you healthy by filtering waste product from your blood. If kidney disease worsens, waste product can build to high levels in your blood and make you feel sick. When CKD progresses, it can lead to end-stage kidney disease or kidney failure where the kidneys lose up to 85% to 90% of their function, thereby necessitating dialysis treatment or a kidney transplant for survival.

As diabetes is one of the primary causes CKD, managing diabetes is crucial in preserving the kidneys. Kidney disease progresses much faster in diabetic patients than non-diabetics, with the former experiencing higher rates of mortality and morbidity. Patients with diabetic kidney disease (DKD) are also more likely to experience complications associated with kidney disease, such as hypervolemia, which is characterised by fluid overload in the body, resulting in swelling, hypertension, and cardiac problems due to impaired fluid removal by the kidneys.

FL: How does dialysis help patients with kidney failure?

JC: The kidneys are vital for survival because they filter blood and remove waste from the body by excreting them through urine. Between them, the two kidneys filter 200 litres of fluid every 24 hours to maintain the chemical balance of the blood, in addition to maintaining electrolyte balance and keeping the water level in the body constant, while secreting several essential hormones.

When the kidney’s filtration function deteriorates, excess fluid, waste and electrolytes build up in the body. Dialysis is usually recommended to take over some of the kidney’s function in patients with CKD. There are two types of dialysis: haemodialysis and peritoneal dialysis, but the former is most common. In haemodialysis, a machine is used to extract blood from the body, filter it through a dialyser to eliminate waste and excess minerals, and then return the cleaned blood to the body.

Patients with kidney failure must attend regular haemodialysis sessions, up to three times a week, which typically take four hours per session. Apart from being physically and emotionally taxing, dialysis imposes a substantial financial burden on patients. Dialysis also burdens the country’s healthcare system, with the government spending $300 million per year on dialysis.

Featured photo by Dreamstime.
Dr Jason Choo photo courtesy of Dr Jason Choo.