SINGAPORE – Singapore’s biggest dialysis provider, the National Kidney Foundation (NKF), will open five new dialysis centres by 2025 to meet escalating demand as kidney failure cases rise.

Now, all 41 dialysis centres across Singapore are running at close to 90 per cent capacity, with slots set aside for emergency cases or patients who have to be isolated, such as those with hepatitis B virus infections, its chief executive Tim Oei told The Straits Times. 

Mr Oei said NKF receives more than 100 new applications for dialysis slots every month, which is about double the number from five years ago, when it had 36 dialysis centres. 

“It is worrying. The numbers are slowly but surely moving upwards,” he said.

This is happening as six new patients are diagnosed with kidney failure in Singapore every day.

Dialysis removes waste products and excess fluid from the blood when the kidneys stop working properly. Without dialysis or an organ transplant, these patients will ultimately die.

In January 2024, NKF will open a dialysis centre – long delayed by the Covid-19 pandemic – at the Sky Vista @ Bukit Batok Housing Board project. This will replace a small centre nearby.

By May 2024, another centre will open at Sengkang Community Hospital.

This will be the second dialysis centre co-located in a community hospital, following the one in Yishun Community Hospital. Patients at the hospital have found it very useful, as they need not travel to a dialysis centre by ambulance, Mr Oei said. 

The next three dialysis centres will open by 2025 in the HDB estates of Bidadari, Fernvale in Sengkang, and Punggol, taking the total number of NKF centres to 45.

On average, each dialysis centre has 22 stations and can serve up to 132 patients a week. 

New cases of kidney failure, also known as stage 5 chronic kidney disease, increased by a whopping 42 per cent over a decade, from 1,587 in 2011 to 2,249 in 2020. Diabetes and high blood pressure are the main causes.

The prevalence of chronic kidney disease has also risen significantly, from 8.7 per cent in the 2019 to 2020 period to 13.8 per cent in 2021 to 2022.

This means that about half a million Singapore residents now have the disease and are at higher risk of progressing towards kidney failure, Mr Oei said.

Opening new centres will not be enough to address the problem. NKF has previously said that it would also retrofit at least eight centres that are 20 years or older by 2030. This involves expanding floor size, which would allow them to cater to more patients, Mr Oei said.

At the same time, NKF is working on raising awareness about another type of dialysis known as peritoneal dialysis, which can be done at home. This is unlike haemodialysis, where patients need to be hooked up to a machine at a dialysis centre.

In 2021, 87 per cent of dialysis patients in Singapore were on haemodialysis and 13 per cent chose peritoneal dialysis.

Mr Oei said NKF counsellors are stationed at most public hospitals to talk to incoming patients about the pros and cons of both types of dialysis before they start the process.

The organisation needs more staff to cater to more patients, but it met with an exodus of nurses in the aftermath of Covid-19.

To prepare for new centre openings and replace the nurses it lost, NKF intensified its recruitment efforts in the past six to eight months and now has close to 900 nurses, up from more than 700 in 2020, Mr Oei said.

It also increased the number of dialysis care associates to 80. This role was introduced in mid-2020 to support nurses by taking over some of their non-clinical tasks, to help reduce the need for more nurses.

NKF now has about 150 patients from nursing homes and hopes to train nurses in the homes to help patients with their dialysis needs.

“If some of them can be right-sited in nursing homes, we can support them (there), rather than have them come to our centres,” Mr Oei said.

About 60 per cent of dialysis patients here – more than 9,000 – are served by NKF. Other patients are mostly treated at private dialysis centres. 

Half of NKF’s patients do not have to pay a cent, another quarter pay about $50 a month, and the rest pay a monthly fee that can range from a few hundred dollars to more than $1,000, Mr Oei said.

“Ensuring accessibility and availability of dialysis for patients with kidney failure is critical, otherwise, the consequences would be devastating,” he said.

Just two weeks ago, NKF said it would contribute $5.5 million to establish the Singapore General Hospital (SGH)-NKF Renal Research Partnership.​

NKF has held numerous activities over the years to raise awareness of the need to live healthily to prevent kidney disease, but this is the first time that it is investing in research​ to look for better ways to treat and prevent kidney failure.

Speaking at the 50th anniversary celebratory dinner of SGH’s department of renal medicine in mid-October, Health Minister Ong Ye Kung said that the rise in kidney failure cases is “driven by unhealthy lifestyle habits and the ageing of our population”.

Singapore’s plans to manage this problem start with preventive care, he said. 

For instance, family physicians will regularly monitor the kidney function of patients with high blood pressure and diabetes under the Healthier SG preventive care strategy. 

Mr Ong also reminded the audience that the Health Promotion Board will soon be launching a campaign to encourage industry and food and beverage operators to reduce the sodium content of their dishes by resetting recipes to what they were like in 2010, when the average dish contained 20 per cent less sodium than the same dish today.

“Preventive care starts with the individual. There is a lot of personal responsibility involved. The simple thing to do is to reduce our sugar and sodium intake, so as to reduce the risk of chronic kidney disease,” he said.

Mr Oei also advised maintaining a healthier lifestyle, staying active and going for regular kidney screening.