SINGAPORE — The National Kidney Foundation (NKF) will expand its overnight dialysis capacity from 36 slots in two centres to 250 slots in five centres by 2027 to meet the evolving needs of its patients, as well as to keep pace with fast-rising demand from a rapidly ageing population.
This was announced at NKF's 55th anniversary event, held at its headquarters in Kim Keat Road on April 25.
With 41 dialysis centres, NKF is the biggest dialysis provider in Singapore, caring for around 5,500 of the roughly 9,000 people here who are on dialysis. Other patients are treated mostly at private dialysis centres.
The fight against kidney failure continues as, each day, six new patients are diagnosed with kidney failure in Singapore.
"The total number of kidney failure patients is rising: 10 years ago it was 5,500, today it is 8,800," said Health Minister Ong Ye Kung at the event.
The major culprits are diabetes and hypertension, which are precursors to kidney failure, he added.
To further support kidney failure patients, the Ministry of Health (MOH) wants to expand the enrolment of a two-year-old national programme for peritoneal dialysis, a type of dialysis that can be done at home. To date, about 300 patients are enrolled in it.
As demand and costs rise, it will also be doing more to help pay for kidney dialysis, which currently costs around $30,000 a year at NKF. The majority of NKF patients paid no more than $50 a month in 2023, and four in 10 do not pay.
Mr Ong said that MOH is reviewing MediSave limits for medical treatments like dialysis, as well as working with the MediShield Life Council to review and increase MediShield Life claim limits for dialysis treatments.
These changes will help dialysis patients offset the rise in treatment costs and relieve the immense pressure for organisations like NKF to raise more charity donations, he said. However, higher claims will push up MediShield Life premiums, he added.
Ong also announced that MOH will, from May 1, 2024, extend subsidies to Continuous Glucose Monitoring (CGM) for eligible adults and children with Type 1 diabetes mellitus who are receiving care in public healthcare institutions.
CGM is a wearable technology, usually a patch, that helps monitor glucose levels throughout the day, with readings transmitted wirelessly to a smartphone or reader device.
NKF first introduced overnight dialysis, the first of its kind in Singapore, in 2016.
This haemodialysis service - where patients are hooked up to a machine that cleans their blood for six or seven hours a night, versus four hours for conventional dialysis at the centre — is currently available at its Hougang and Clementi centres.
The longer hours allow for gentler removal of toxic waste and fluids, reducing stress on the heart and enhancing patient outcomes. The overnight treatment also allows patients to undergo dialysis while asleep.
The plan now is to increase slots at the existing centres as demand rises as well as make it available, by 2027, at other centres — in Woodlands, Serangoon and Simei — which are easily accessible via public transport, NKF chief executive Tim Oei told The Straits Times.
Tuginam Amin, 70, started undergoing overnight treatment, from 10.30pm to 4.30am three times a week, four years ago — a year after her husband died. Before that, she had been on the conventional day-time dialysis treatment for 11 years.
Being on overnight treatment has helped free up her time during the day, allowing her to do housework, cook and go for taiji classes.
"Some people will snore during the treatment, but for me, I will take naps, check my phone or think about what to cook the next day for my family," said the mother of three.
Oei said that dialysis patient profiles are changing, and the care NKF provides is therefore evolving as well.
"The care that we provide cannot be one-size-fits-all... three days a week, four hours each time, and non-negotiable," he said.
"Nocturnal dialysis is one form that will allow people to have better control of their life... For example, they may want to spend more time with family members; and with gig economy jobs like driving Grab, it is becoming easier for people to stay at work."
This same recognition of patients' needs also spurred NKF to pilot a palliative care programme earlier in 2024.
This allows older and frail patients, and those with serious medical conditions such as advanced dementia or multiple comorbidities, for whom undergoing dialysis may not be ideal due to health risks and reduced quality of life, to have a choice on whether they want to discontinue dialysis.
Calling it the Kidney Supportive Care programme, NKF is collaborating with palliative care providers and public health institutions to provide end-of-life care, with the aim of enabling patients to live their final days with comfort and dignity.
"It's supportive because the decision is with the family and the patient," said Oei.
"If they make that choice, we feel we should be supporting them in the medical and psychosocial side of it... The care is evolving from the hospital to the community to home."
NKF has so far spoken to four patients and their family members about the programme, and will be following up with them. It will speak to another five patients in May.
"If they want the dialysis, we will still walk with them," said Oei. "If they think enough is enough, we will respect them. In the past, if this is the case, we will discharge them and send them back to the hospital because they still have medical needs."
NKF is still facing high occupancy of around 90 per cent at its dialysis centres, and is expanding and retrofitting older centres to fit more chairs. It opened a dialysis centre in Bukit Batok in January, and will open another one at Sengkang Community Hospital in May.
The next three dialysis centres will open by 2025 in the HDB estates of Bidadari, Fernvale in Sengkang, and Punggol.
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This article was first published in The Straits Times. Permission required for reproduction.