Singapore's rising kidney failure rates raise concerns over crowded dialysis centres

20170321100000, Brenda Lau
In the long term, the MOH spokesman said "it will not be sustainable to keep building HD centres."
As of last Tuesday, Singapore's three charity dialysis organisations only had space for 100 new dialysis patients, said the Ministry of Health (MOH). This is worrying as the number of Singaporeans with kidney failure has been increasing.

An MOH spokesman said that this should be enough to last till June or July and that there is sufficient haemodialysis capacity to cater to renal patients in Singapore, despite the high occupancy rate.

In July, a new dialysis centre that caters to poorer patients will be open and should add 90 spaces for new patients. MOH has also said that three more centres will open later this year, adding another 390 spaces for patients.

Two of them, by the National Kidney Foundation (NKF), which can each take 108 patients, will open in September and December.

The MOH has not said who will run the other two centres, but none are under the three existing voluntary welfare organisations (VWOs) that provide subsidised dialysis.

The MOH spokesman said that if the centres run out of places for new patients, VWOs are allowed "the flexibility to place subsidised patients with private providers until a place becomes available."

Vacancies in private dialysis centres charge up to S$2,500 to S$3,500 per month.

Charity organisations facing problems to cater for increasing demand

The number of patients who undergo dialysis has been increasing over the years, reaching 6,200 in 2015, the latest available figure. 1,000 patients were new that year.

While there are different forms of dialysis, nine in 10 choose haemodialysis (HD) and three in four patients undergo HD at centres run by the three charity organisations as these are highly subsidised. Currently, the NKF is the biggest and supports more than 4,000 dialysis patients but has space for 10 more only at its 31 HD centres.

Spaces are only available when existing patients pass away. Each month, the NKF looses on average, 20 patients, but accepts 50 new patients, reflecting the rising number of people who need dialysis. However the NKF did say that it will not be able to take on all the new patients seeking treatment, until a new facility is ready in September. Next year, the NKF will open three more dialysis centres to add 378 more spaces, but there is still more demand over supply. 

As an interim solution, the charity has said that it will pay for new patients to undergo dialysis at private centres, said Mrs Eunice Tay, NKF's chief executive officer. It assured that patients approaching NKF will not be turned away.

The People's Dialysis Centre can take in 13 more patients. The Kidney Dialysis Foundation has 78 spaces, but these spaces have to account for hepatitis patients. A chair used by a hepatitis patient cannot be shared with patients who are not suffering from hepatitis, limiting the space available.

Preventive measures and alternatives to HD need to be promoted

The MOH reassures that there will be sufficient subsidised HD capacity in the coming years to meet the nation's needs, but in the long term, the MOH spokesman said "it will not be sustainable to keep building HD centres."

NKF spokesman also said that it is getting increasingly difficult to find sites for new centres, which cost approximately S$2 million to build and S$2million per year to run. There is also a staff shortage that it faces, therefore it urged preventive measures to be implemented to and alternatives to HD such as kidney transplants and peritoneal dialysis (PD) need to be promoted.

"PD provides more convenience and independence to patients as it can be self-administered, and can be done at home," she said.

The MOH has been working with public hospitals and VWOS providers to develop a national 'PD-preferred' strategy to improve PD uptake. It has also been reducing the number of kidney failures with better care for diabetes patients, who account for more than three in five kidney failure cases.

But with one in nine adults suffering from diabetes, the number of kidney failures is set to rise. MIMS

Read more:
Kidney failure: A Singapore journey
Kidney failure in Malaysia on the rise due to unhealthy lifestyle
Singapore's MOH lauds efforts towards efficient and improved patient care

Sources:
http://www.straitstimes.com/singapore/health/nkf-cant-keep-up-with-rising-number-of-new-kidney-patients
http://www.tnp.sg/news/singapore/high-occupancy-dialysis-centres
http://www.straitstimes.com/singapore/health/only-100-spaces-for-new-dialysis-patients-at-3-charity-bodies