Approaches to Curb the Chronic Kidney Disease Burden in Malaysia

March 19, 2024

By: Dr Rosnawati Yahya, Consultant Nephrologist & Kidney Transplantation, Sunway Medical Centre, Sunway City

Malaysia faces a silent but growing epidemic of Chronic Kidney Disease (CKD), a long-term condition that is described as a gradual loss of kidney function over time. Affecting a significant proportion of the population, CKD remains largely invisible until its advanced stages.

Studies have shown an increase in CKD among Malaysians from 9.07% in 2011 to 15.48% in 2018, with hypertension, diabetes mellitus, increasing BMI, and increasing age being significant risk factors.¹

“The challenge with CKD is that it’s a silent disease. There are no early signs or symptoms, and as a result, many don’t realise they have it until it’s too late. Once they are diagnosed, their kidneys are at the advanced stages, in which measures that are used to slow down the CKD progression are not as effective.”

Lifestyle as a factor

According to recent studies, almost 15% of the Malaysian adult population is affected by various stages of CKD. The most alarming factor is the direct correlation between CKD and lifestyle diseases such as diabetes, hypertension, obesity, and heart disease. A study highlighted that diabetic kidney disease accounts for 44.9% of CKD cases among adults, followed by hypertension (24.2%) and obstructive uropathy (9.2%). ²

Treating and managing CKD is classified into five stages. Stage 1 is the mildest, and stage 5 being kidney failure, requiring dialysis or kidney transplantation.

“Management often involves a multifaceted approach that will depend on the patient’s specific risk factors and causes of their kidney disease as well as its severity. This includes, but is not limited to lifestyle modifications, pharmacological agents to kidney transplantation or dialysis, as well as the management of complications of poorly functioning kidneys.”

Management of CKD

Managing CKD aims to slow the progression of kidney damage as well as manage cardiovascular risk factors, which include:

• Lifestyle changes – Achieving a healthy body weight, reducing salt intake, avoiding NSAIDs (nonsteroidal anti-inflammatory drugs), participating in physical activities, and quitting smoking. Studies have also shown that exercise improves physical function, cardiovascular outcomes, and quality of life among CKD patients. 3Physical activities need to be tailored to suit the individual’s capabilities and tolerance.

• Medication – Several groups of medications are also used to manage CKD, including, medications that can slow the progression of CKD such as those used to control blood pressure, blood sugar, and cholesterol levels, and reduce protein leakage in the urine. It is important to treat these parameters as recommended by guidelines. Some medications are used to manage symptoms, such as diuretics, to reduce fluid retention or swelling. Certain medications are prescribed to replace hormones when failing kidneys are no longer able to produce them. These include the management of anemia and bone diseases. Lastly, these medications are also prescribed based on the patients’ needs.

• Kidney transplantations – For advanced CKD (CKD stage 5), considerations for kidney transplantation or dialysis become necessary.

Kidney Transplantation offers a longer survival rate and a better quality of life compared to dialysis. However, the candidate is required to undergo a thorough evaluation. There are two sources of kidney donors: deceased donors and living donors.

In Malaysia, due to a low deceased donation rate, there is often a significant waiting period for a suitable donor organ. If a living donor is available, this can be performed as soon as the donor and recipient are ready to undergo the surgery.

• Dialysis treatment – this treatment removes waste products and excess fluid from the blood when the kidneys can no longer do so. There are two main types of dialysis: hemodialysis and peritoneal dialysis. Each has its own protocols, frequencies, and lifestyle implications.

Healthy diet, dose of exercise

“Diet and physical activities play a major part of managing CKD. A diet low in sodium can make a significant difference. Some diets, such as Dietary Approaches to Stop Hypertension (DASH) and a Mediterranean diet, have been shown to be helpful.

DASH is a healthy eating plan designed to help prevent or treat high blood pressure (hypertension) and may help lower cholesterol, which is often linked to heart disease.

Healthy diet include vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish, poultry, beans, and nuts, and foods that are rich in minerals such as potassium, calcium, and magnesium.

The diet also encourages limiting foods that are high in salt (sodium), additional sugar, and saturated fat, such as fatty meats and full-fat dairy products.

The life-changing impact of chronic kidney disease: early detection

Early detection of CKD plays an important role, as when it is detected during its early stages, the disease can be managed as the damage can be delayed compared to the later stages. Studies have also shown that early diagnosis through indicators such as proteinuria (high levels of protein in the patient’s urine), or a reduced estimated glomerular filtration rate (eGFR), is an indication of how well their kidneys are working.

This enables experts to implement strategies that decrease the risks associated with cardiovascular issues, kidney failure, and mortality [iv].

“Awareness, early detection, and lifestyle changes are our best weapons against CKD when it can be delayed and managed to ensure that patients have the best possible outcome. It is not just about adding years to life, but also adding life to years.”

Recognising the importance of kidney health, SMC organised the Nephrology Seminar 2024 earlier this month, where 700 healthcare practitioners from all over the country attended the seminar to shed light in raising awareness among primary health care physicians on CKD. The seminar also covered the importance of early detection through screening, prevention, as well as assisting healthcare practitioners to understand CKD and the most effective ways of managing it.

Sources:
1. Sainathan, T., Hooi, L., Yusoff, M., Ong, L., Bavanandan, S., Hasani, W., Tan, E., Wong, I., Rifin, H., Robert, T., Ismail, H., Wong, N., Ahmad, G., Ambak, R., Othman, F., Hamid, H., & Aris, T. (2020). Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study. BMC Nephrology, 21. https://doi.org/10.1186/s12882-020-01966-8.

2. Salman, M., Khan, A., Adnan, A., Sulaiman, S., Hussain, K., Shehzadi, N., &Jummaat, F. (2015). Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula. São Paulo Medical Journal, 133, 502 – 509. https://doi.org/10.1590/1516-3180.2015.005.

3. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review – PubMed (nih.gov) iv James, M., Hemmelgarn, B., & Tonelli, M. (2010). Early recognition and prevention of chronic kidney disease. The Lancet, 375, 1296-130

Health Care Asia
Home