SINGAPORE – In 2015, Mr Tam Hon Yuen was walking to a restaurant in Manchester, England, when he suddenly felt breathless and tired.
This was unusual for the then in-flight manager because he was physically active and would cycle 60km to 80km on his days off in Singapore.
On his flight back to Singapore, a few colleagues also told him he looked pale.
A week later, Mr Tam decided to go to a general practitioner for a check-up.
Blood tests showed that his kidney function was impaired.
He was referred to Changi General Hospital’s (CGH) Department of Renal Medicine, where he was diagnosed with stage three chronic kidney disease.
Chronic kidney disease is a gradual loss of the kidneys’ filtering ability, usually due to high blood pressure or diabetes.
Mr Tam, now 65, had both conditions, which led to him developing chronic kidney disease.
When kidney function is seriously impaired, dangerously high levels of fluid and waste can accumulate in the body. If left untreated, the kidneys gradually deteriorate and can stop working completely.
There are five stages of chronic kidney disease, and the last stage is known as kidney failure.
At stage one, there is normal kidney function, but a urine analysis or structural abnormalities may indicate kidney disease. At stage two, a patient’s kidney function is mildly reduced and may suggest kidney disease.
Mr Tam had stage three chronic kidney disease, which means the kidney function is moderately reduced.
Stage four indicates severely reduced kidney function. The final stage is known as very severe renal disease, or kidney failure.
To determine the stage of the disease, an estimated Glomerular Filtration Rate, derived from a blood test and urine test as well as factors such as age and gender, is used to measure the level of kidney function.
Mr Tam Hon Yuen had stage three chronic kidney disease, which means the kidney function is moderately reduced. ST PHOTO: HESTER TAN
As chronic kidney disease progresses, the rate declines and the patient will eventually need to undergo dialysis or a transplant to survive.
When Mr Tam, who is married and has two children, found out about his condition, he was disappointed and shocked.
“There was a flurry of thoughts going through my mind and I wondered about what was going to happen next,” he says.
Several months after his diagnosis, Mr Tam, who retired as an airline cabin crew in 2020, joined an international clinical trial for a new kidney medicine, which kept his condition stable for two years.
However, in 2022, his kidney condition worsened and he started peritoneal dialysis, which uses the lining of one’s abdomen, or belly, to filter the blood.
The latest Singapore Renal Registry Report in 2021 showed that the number of new patients diagnosed with kidney failure was 2,249 in 2020, compared with 1,587 in 2011.
A 2018 study published in the International Journal Of Nephrology forecasts that by 2035, almost a quarter of Singapore residents aged 21 and above could have chronic kidney disease, of which more than half will be undiagnosed.
To provide one-stop care based on patients’ physical and mental assessments, CGH’s Department of Renal Medicine set up a chronic kidney disease clinic for seniors in April.
Dr Yeon Wenxiang, consultant at CGH’s Department of Renal Medicine, says the team had observed that some senior patients find it difficult to accept their advanced chronic kidney disease diagnosis and choose not to follow medical advice to start dialysis in a planned fashion.
The new clinic, he adds, places significant emphasis on educating patients and their caregivers about chronic kidney disease management, lifestyle changes and the importance of following prescribed treatment plans.
Dr Yeon Wenxiang, consultant at Changi General Hospital's Department of Renal Medicine. PHOTO: CHANGI GENERAL HOSPITAL
It provides integrated care with the help of a multidisciplinary team of nephrologists, geriatricians, renal nurses, dietitians, pharmacists, physiotherapists and medical social workers.
About 200 patients are put on dialysis every year at CGH, notes Dr Yeon.
Dr Jason Choo, medical director at the National Kidney Foundation (NKF), says it is facing an “imminent kidney tsunami”. It receives 100 new applications for dialysis slots every month, which is twice the number compared with five years ago.
At Singapore General Hospital (SGH), the number of chronic kidney disease patients has also been increasing.
Dr Kwek Jia Liang, senior consultant at SGH’s Department of Renal Medicine, says more than 4,000 patients are referred to the department every year, but in 2022, it managed more than 18,000 chronic kidney disease patients in outpatient clinics.
On average, the number of patients with the disease at SGH’s renal department has increased by about 3.5 per cent annually for the past five years, adds Dr Kwek.
The rising rate of people with chronic kidney disease in Singapore is due to the increase in those with diabetes and high blood pressure in the population here – both of which are leading causes of chronic kidney disease, say doctors.
Diabetes and high blood pressure can damage the blood vessels in the kidneys and impair their function over time.
According to the United States Renal Data System Annual Data Report 2022, Singapore ranks first in the world for diabetes-induced kidney failure.
Dr Kwek says: “The cause of chronic kidney disease in Singapore is attributed to diabetes in two out of three patients with stage five, or last stage, chronic kidney disease.”
Singapore also faces the looming challenge of increasing chronic kidney disease numbers due to an ageing population, says Dr Choo.
In 2010, about one in 10 Singaporeans was aged 65 and above. In 2020, it rose to about one in six. By 2030, around one in four Singaporeans will be over 65.
“Ageing is a significant risk factor for chronic kidney disease, especially when coupled with other existing conditions, such as diabetes and high blood pressure,” says Dr Choo.
As at June 2023, about 70 per cent of haemodialysis patients at NKF are aged 61 and above, he adds.
Mr Tam Hon Yuen (right) sees Dr Ng Chee Yong, a consultant at Changi General Hospital’s Department of Renal Medicine, for his chronic kidney disease condition. ST PHOTO: HESTER TAN
Kidney function usually peaks at around 40 years old and subsequently undergoes a very gradual decline in a normal ageing adult, says Dr Kwek.
Chronic kidney disease can also affect people who are obese or have heart disease, or those with a family history of chronic kidney disease, diabetes or high blood pressure.
The disease, sometimes referred to as a silent killer, typically progresses slowly, without any noticeable symptoms, until the kidneys are severely damaged.
Dr Choo says: “Some patients find themselves in hospital emergencies when their severe symptoms emerge, having been well in the past. By this time, their kidneys are on the verge of failure, necessitating immediate dialysis treatment for survival.”
The signs and symptoms of advanced stage chronic kidney disease include fatigue, having no appetite, nausea and vomiting, having itchy skin and swollen feet or ankles. However, these symptoms are not specific to chronic kidney disease and can also be caused by other conditions, highlights Dr Choo, making the disease challenging to detect.
That is why it is important to go for screening tests, says Dr Kwek, adding that most cases are picked up during the screening tests at a primary healthcare clinic.
Patients with diabetes and/or hypertension are advised to screen for chronic kidney disease yearly by primary healthcare physicians.
Treatment for chronic kidney disease depends on the stage of the condition.
Medication and lifestyle changes can help manage kidney damage if the condition is detected in the earlier stages.
However, when patients reach stage five or kidney failure, they have to consult their nephrologist and make a joint decision on the best course of action, says Dr Choo.
In general, there are three main options available, depending on the patient’s eligibility and preference – kidney transplant, either peritoneal dialysis or haemodialysis, or conservative care for those who are frail or choose this option.
In Mr Tam’s case, he opted for peritoneal dialysis, in which a sterile fluid is introduced into the body through a permanent tube placed in the peritoneal cavity – a space within the abdomen that contains the intestines, stomach and liver.
The fluid then circulates through the abdomen to draw impurities from the surrounding blood vessels in the abdominal cavity and is drained from the body.
For this to be carried out, Mr Tam has to be hooked up to a machine for nine hours nightly. As he starts this process at about 8pm every night, he has had to give up his night-cycling hobby and turn down invitations to wedding dinners.
Although dialysis has affected his lifestyle, he is counting his blessings.
“There is no point feeling upset,” says Mr Tam, who has two grandchildren. “I just carry out the dialysis and continue living.”
He advises: “Go for check-ups, do the full set of blood work and find out what the issue is. It would be even better to start these check-ups when you are young, as prevention is better than treatment.”
How to keep your kidneys healthy
Maintaining good kidney health can help prevent kidney failure. Here are five tips to lower your risk of developing kidney disease.
1. Eat healthily
Keep leading causes of chronic kidney disease, such as diabetes and high blood pressure, at bay by opting for less sugar, salt, sodium and fat when eating out. Consider home-cooked meals as you can control the ingredients that you include.
Use the Health Promotion Board’s My Healthy Plate as a guide to exercise portion control and cultivate healthier eating habits.
The guide recommends that you fill a quarter of your plate with wholegrains, another quarter with good sources of protein, and half the plate with fruit and vegetables. Wholegrains include brown rice and wholemeal bread, while sources of protein include fish and tofu.
2. Engage in regular physical activity
Avoid leading a sedentary lifestyle as it puts you at a higher risk of developing chronic illnesses associated with kidney disease.
Adults are recommended to engage in at least 150 minutes of moderate- to vigorous-intensity physical activity a week. Meeting this recommendation is associated with a reduced risk of developing illnesses such as type 2 diabetes and high blood pressure.
3. Quit smoking
Smoking damages the blood vessels in the body and, as a result, slows the flow of blood to the kidneys and decreases their ability to function normally, according to the National Kidney Foundation website. It can also increase one’s risk of developing kidney cancer.
4. Lower alcohol intake
Drinking too much alcohol can raise one’s blood pressure, which is a common cause of kidney disease.
5. Get screened
The NKF’s chronic kidney disease intervention clinic provides complimentary kidney screening for those at higher risk of developing the condition. It includes tests to detect kidney disease, high blood pressure, high blood cholesterol and diabetes.
You can also have a consultation session with an NKF dietitian and exercise specialist on the day of the screening, where you will be given customised health tips and advice.