Kidney failure, also known as end-stage renal disease, is the last stage of chronic kidney disease when the kidneys stop working well enough for the patient to survive without dialysis or a kidney transplant. Approximately five people are diagnosed with kidney failure in Singapore daily, up from four a day six years ago.
There are various causes of kidney failure, and the leading cause is diabetic nephropathy or diabetic kidney disease, which is damage to the kidneys arising from diabetes mellitus. The condition leads to a loss of kidney function, which can eventually result in kidney failure over time, according to Dr Kwek Jia Liang, a consultant from the Department of Renal Medicine at the Singapore General Hospital (SGH) and an alumnus of NUS Medicine.
“It can result in end-stage kidney disease with complications such as fluid overload, electrolytes imbalances and build-up of metabolic toxins, which can affect the functions of multiple organs such as the heart and brain,” said Dr Kwek.
Although dialysis is a viable option to prolong and sustain the lives of patients with kidney failure, Dr Kwek explains that kidney transplants result in far more ideal outcomes. A kidney transplant is the process of surgically removing a kidney from a living or dead donor and implanting it into another person. The patient may receive a kidney from a family member, a spouse or even a stranger, though the most compatible match is usually a sibling due to similarities in genetic make-up, according to the National Kidney Foundation. Patients can also receive a kidney from a person who has recently died, and is known as a cadaver renal transplant.
“In Singapore, five-year survival in living kidney transplantation is 96.6 per cent compared to 34.6 per cent to 59.5 per cent in dialysis populations. Kidney transplantation also improves patient quality of life,” Dr Kwek added. Dialysis also does only 10 per cent of the work that a functioning kidney does, and can cause other health problems.
Kidney transplants may be the best means of treating end-stage kidney or renal disease as the transplanted kidney can substitute almost fully the lost functions of the failed kidney, but the number of patients on the waiting list for kidney donations in Singapore, albeit falling, still remains significant at 247 last year. The average waiting time for a kidney transplant is nine years, and there are also patients who are unsuitable or ineligible for transplants due to medical conditions and age, who will need to rely on dialysis.
While life will be easier for patients who can get a kidney transplant than those who are on dialysis, the organ recipients need to take medications every day to ensure that their immune system does not reject the new kidney. Transplanted kidneys also do not last forever, with an average lifespan of 12 years if transplanted from a dead donor, and about 15 years from a living donor.