In the last year, 20 percent of Filipinos were diagnosed with chronic kidney disease, based on the glomerular filtration rate (GFR) which measures kidney function. Presently, there are 70,000 patients on dialysis and even with thousands on the waiting list for a kidney transplant, only 400 are able to undergo transplantation annually.

Dr. Luis Limchiu, head of the Adult Nephrology Department at the National Kidney and Transplant Institute (NKTI), presented the latest numbers as the Philippines kicked off its celebration of World Kidney Month.

While not the top cause of mortality in the Philippines, chronic kidney disease (CKD) is among the top 10, he told the crowd gathered at the NKTI Atrium.

The kidney specialist said that chronic kidney disease (CKD) is a burden worldwide, with costs more than breast, colon and lung cancers combined.

CKDs include conditions which diminish the kidneys’ ability to function properly and optimally. Waste that is not filtered will build up and cause the organs to deteriorate.

Diabetes, high blood pressure and a family history of kidney failure can make a person vulnerable to the disease.

Kidney diseases almost always progresses to kidney failure, which will require either dialysis or transplantation to treat.

No longer a death sentence

The good news is kidney diseases are now treatable.

“Before, kidney failure was uniformly associated with death,” Dr. Limchiu said. “Now, we are able to extend life up to 20 years, and in transplant patients, making them [almost] normal.”

Moreover, the kidney specialist added, at least 75 percent of kidney diseases are preventable.

To prevent developing CKD, individuals must be aware of its two major causes: hypertension and diabetes.

“If you can control high blood pressure, control diabetes, then you can prevent up to 50 percent of kidney diseases,” Dr. Limchiu underscored.

High blood pressure contributes to disease development by causing the arteries within the kidneys to narrow, harden or weaken, and these affected arteries will no longer be able to deliver blood to the kidneys.

Around 30 percent of patients with Type 1 diabetes will be diagnosed with kidney disease, while between 10 and 40 percent of those with Type 2 diabetes will develop the condition.

Health Undersecretary Herminigildo Valle, a guest at the event, added that the best way is to address the issue through keeping one’s kidneys healthy.

Salt and sugar: the culprits

A person suffering from diabetes does not automatically develop kidney disease, Dr. Limchiu clarified. To explain, he said, “Most of the disease is chronic. They don’t develop kidney disease in 5 years, but in 10 to 15 years.”

This gives a patient with diabetes time to control and prevent kidney disease.

NKTI deputy executive director, Dr. Joselito Chavez added, that they key to preventing CKD is to avoid too much sugar and salt.

The US-based National Kidney Foundation noted that in one’s diet, sugars in soda – either natural or chemically manufactured – should be avoided as much as possible. Reach for water instead.

It is likewise better to opt for leaner meats like those of chicken and turkey, and to select low-sodium, low-nitrate meals. Consumption of processed deli meats should be minimal as these are sources of high sodium.

Frozen meals are likewise sources of sugar, sodium, and fats.

Dialysis only a bridge

The two common modes of kidney failure treatment are dialysis (hemo or peritoneal) and organ transplantation.

But NKTI Executive Director Dr Marie O. Rosete-Liquete emphasized that patients should not look at lifelong dialysis to manage or treat the disease.

“Let us think of dialysis as only a bridge for transplantation,” she stressed. “We encourage our patients while [undergoing] dialysis to do work-ups and find a donor,” the transplant surgeon said.

Dr. Rose Marie Liquete, NKTI  Executive Director: Dialysis is only a bridge

Dr. Rose Marie Liquete, NKTI Executive Director: Dialysis is only a bridge

The experts, along with Dr Sergio Simangan, Chair of the Organ Transplantation and Vascular Surgery department of the NKTI, agreed that while dialysis is being sustained well in the Philippines as treatment, the best option remains kidney transplantation.

Unfortunately, the number of kidney transplant operations has been declining over the years.

A clear disparity is that while there are 15,000 new dialysis patients annually, only 300 to 500 transplants are performed within the same period.

The lag is partly due to financial costs, and lot to do with availability of donors.

Maintenance a significant factor

Even though PhilHealth, the state-run health insurer, has benefits programme for dialysis under its Z-package which includes kidney transplantation, this does not include maintenance of medical treatment after the operation. And those that suffer most are indigent kidney patients, who are already hard-pressed to raise funds for transplantation, let alone maintenance post-op.

For private kidney failure patients, transplantation is estimated to cost from Php 1 to 1.5 million or even higher.

Maintenance costs Php 60,000 to 100,000 for the first 3 months, then goes down to Php 60,000 for the next three months. But it will cost Php 20,000 to 30,000 monthly for the rest of their lives to ensure survival.

Wanted: More kidney donors

The general consensus is that kidney transplantation is the best option for treatment and has been shown to enable the return to a normal life. Unfortunately, there are not many who undergo transplants annually.

The Philippine Network for Organ Sharing (Philnos) was created in June 2010 with the DOH as centre of coordination for all organ donation and transplantation activities in the country.

Currently, there are around 500 on the waiting list.

Nephrology experts frown on compensated forms of organ donation and that is the first block why organ donation is low.

But while they discourage this, most family members and relatives are also hesitant to donate their kidneys. The next option is the cadaver programme, rather than a live-donor transplantation.

Still, not many are willing to save a life in exchange for another being taken away.

Dr. Simangan pointed out it may be a cultural or attitudinal problem. “No matter how much we emphasize that their family member is dead, and they can help save a life” very few agree, he said.

“That is why we need help in advocating,” he stressed.

To further this advocacy, Dr. Liquete said they are now drafting an administrative order to strengthen the process of organ donation locally.

The theme for this year’s month-long celebration is “Wastong Pangangatawan… Sakit sa Bato Kayang Iwasan” (Good Health is Key Prevent Kidney Disease).

Among the activities lined up are those to advocate for organ donation, health teachings and CKD screening, and dialysis caravans, among others.

The observance of a national kidney month every June is mandated under Presidential Decree No. 184 signed in 1993. MIMS

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