A solution to ESKD via a kidney transplant

Patients with end-stage kidney disease (ESKD) are unable to remove waste products and excess liquid from the body due to poorly-functioning kidneys. While dialysis, whether it be haemodialysis or peritoneal dialysis, is prescribed to perform this duty artificially, a more effective treatment for ESKD is a kidney transplant.

According to Dr. Wong Hin Seng, a Senior Consultant Nephrologist, Head of the Renal Transplant Unit, Head of Department of Nephrology, and Head of the Clinical Research Centre at Hospital Selayang, Selangor, a kidney transplant improves a patient’s chances of survival and quality of life, as well as helping to cut down on their medical expenses in the long term.

While dialysis is indeed a life-saving treatment, it cannot fully substitute for even one functional kidney. This leaves patients vulnerable to health complications that can arise from both ESKD and the dialysis itself. These include conditions such as fatigue, muscle cramps, anaemia, renal bone disease, and heart disease, among others.

In fact, only 52% of Malaysian patients on dialysis are still alive five years after they start the treatment. In contrast, the five-year survival rate for those who undergo a kidney transplant is 90%. 

There is also a vastly improved quality of life for patients who go from being on dialysis to receiving a donated kidney to replace their non-functioning ones, as the patient (and their families) no longer need to plan their lives around the patient’s dialysis schedule.

Patients on haemodialysis usually have to spend around four hours at a haemodialysis centre, up to three times a week. For those on continuous ambulatory peritoneal dialysis, they would have to undergo the dialysis process four times a day for a period of 30 to 40 minutes each time. And even for those on automated peritoneal dialysis, which probably offers the most flexibility among the dialysis options, the patient has to undergo the procedure for 8 to 10 hours daily, usually while asleep at night.

Kidney transplantation removes the need for this huge time commitment. Instead, those who have received a donated kidney mainly need to commit to taking immunosuppressant medications for the rest of their lives to ensure that their body does not reject the donated kidney – and of course, live an overall healthy lifestyle.

Dialysis is a lifelong treatment, and the expenses can certainly accumulate to large amounts over time. The reported annual cost for a haemodialysis patient, in Malaysia, is approximately RM40,000 (USD8,800). While just over two-thirds (67.1%) of dialysis patients are sponsored by the Malaysian government, 14.9% are self-funded, with the rest paid for by charities (13.2%), employers (1.3%), insurance (0.5%), and other sources.

In contrast, the transplant services provided by Ministry of Health (MOH) hospitals – namely, Hospital Kuala Lumpur and Hospital Selayang, Selangor – are heavily subsidised. Transplant recipients pay only RM1,000 (USD220) for the entire procedure, and are also provided the expensive, lifelong immunosuppressant medications for free.

The kidney donors also do not have to pay for the transplant surgery and will receive free medical care at MOH hospitals for the rest of their life.

Organ donation in Malaysia is strictly voluntary and cannot be done in exchange for any kind of reward or compensation (cash, property, career advancement, etc). While the majority of organs can only be harvested from a deceased donor, kidneys are one of the two organs that can be donated by a living donor (with the other being part of the liver). This is very important for ESKD patients as deceased donors are very rare in Malaysia. Based on the MyKAS (Malaysia Kidney Allocation System) database, there are currently about 10,270 ESKD patients awaiting a kidney transplant. However, only 20-40 kidney transplants involving deceased donors are performed annually, accounting for approximately 1 per million population (pmp).      

Regrettably, kidneys from deceased donors might also develop acute kidney injury prior to organ procurement, and generally have poorer graft survival as compared to a kidney from a living donor.

Dr. Wong has highlighted that a living donor can only give a kidney to their spouse, first- or second-degree relative. A first-degree relative is one’s parent, child or full sibling. A second-degree relative is one’s grandparent, grandchild, aunt, uncle, nephew, niece or half-sibling. It is also possible for a living donor to donate to a more distant relative, or even a non-family member after permission is obtained from MOH’s Unrelated Transplant Approval Committee (UTAC).

Dr. Wong has advised an EKSD patient receive an organ from a living donor, who would have been evaluated for their suitability and health before the procedure – regardless, a patient who has received a donated and transplanted kidney will have a better chance of living longer and better, compared to someone who remains on dialysis.

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