Don’t Kid with Your Kidneys

When faced with extreme adversity, we discover the ways to be happy. When we come face-to-face with death, we learn to truly live.

As part of work, I had the chance to interview 3 patients suffering from kidney failure (a.k.a. renal failure)over the last 2 weeks. One of them has received a kidney transplant, another has been on dialysis for more than 18 years, and the third is relatively new to dialysis treatments. All of them have a different life story, but they all share the same fate from this silent disease.

Repeated needling and futicila procedure causes severe scarring and hardened swells on the arm. All kidney patients undergoing dialysis will develop these unsightly scars.

Although this blog entry draw references to the Singapore National Kidney Foundation (NKF) and the work they do, this post is not sponsored or requested by them. But I have permission from NKF to write this personal account as a result of working with NKF for the exhibitory contents in their new gallery. I was just so moved by the will to not waste life in these kidney patients that I am compelled to record this personal experience lest I forget to count my blessings. Which I often do. I suffer from dementia of the good times.

The dialysis needles is no prick on the skin and hurts even the most seasoned patient. They come in different sizes with the thickest one being about the size of a Yakult straw.

Despite their dire health conditions, I couldn’t detect a drop of misery. I don’t know if they are feigning optimism, but one thing I know is that their zest for life is consistent throughout their individual interviews about coping with this deadly illness. Compared to what they have to go through, the problems I face in life suddenly don’t seem like troubles any more.

On top of the physical pain they have to endure, the patients have to deal with financial worries as well because it is almost impossible to work when you need to be hooked up to a machine all day. Each dialysis session lasts 4 to 6 hours depending on the amount of fluid retained in the patient’s body. Patients need to go for dialysis 3 times a week.

Diabetes and high blood pressure are the 2 major causes of kidney failure and treatment is a multi-prong approach to manage the aggravating illnesses and having kidney dialysis at the same time.

Causes of kidney failure :

– Illnesses – Diabetes and High Blood Pressure
– Infection of the bladder and urinary tract
– Family history / hereditary
– Alcohol and drug abuse
– Long term usage of certain prescription medications
– Damage caused by physical accidents

From what I understand, there are no real dietary means that could help prevent kidney failure so the best way is to minimise the aggravating conditions such as preventing diabetes and high blood pressure, moderating alcohol intake, staying away from harmful drugs and staggering medicinal therapies.

Once the kidneys fail, the body loses its ability to filter out and remove toxins and leads to a build of urea, phosphates and potassium in the body. These toxins literary melt your body from the inside by dissolving organs functions and bone mass. Without treatment, patients suffering from acute kidney failure typically don’t live past 3 weeks.

This is the artificial kidney that cleans the blood. Blood is pumped in from the top, cleaning solution from the side, and the filters in between remove the toxins before the blood is passed back into the patient's body at the bottom.

Symptoms of kidney failure

From what the interviewees shared with me about their first discovery of this invisible killer, it sounds like the most obvious and definitive symptoms are extreme tiredness and lethargy. They are followed by persistent dizziness and headaches.

Other tell-tale signs include blood and protein in the urine, and frequently waking up at night with a feeling to pee but there’s very little or no urine.

As the symptoms of kidney failure could present themselves as ailments of other organs, it is important to get a blood test done to ascertain kidney function. One of the interviwees told me that she saw a doctor who kept treating her for migraine for more than 1 year before realising that she has renal failure.

One of these dialysis machines cost about S$20,000. A dialysis session costs about S$130 each time and patients need 3 dialysis sessions each week. With support from NKF, more than half the patients pay less than S$50 for each session.

Cost of kidney dialysis in Singapore

The insurance agent in me can’t help but wonder about how the patients finance their treatments. And what I learnt made me feel how important my role is in providing medical and illness protection. One of them had insurance, the others have not. They wish they had. But it’s too late.

The cost of one dialysis session is S$130 and in a week, patients need 3 sessions. So that works out to be about S$1,690 a month. NKF subsidizes financially strapped patients and reduces their bill. More than 50% of dialysis patients pay S$50 or less for each dialysis session. That’s excluding the transport cost to the dialysis centres as some of these patients are immobile.

During dialysis, patients are hooked up to the artificial kidney to have their blood cleaned. A process that takes between 4 to 6 hours depending on the amount of fluid in the patient’s body. Because the failed kidneys cannot get rid of excess fluid in the body, it leads to water retention and patients constantly have this bloated or puffy look. Almost all kidney patients practice litre counting (as oppose to calorie counting) and have rather strict dietary restrictions especially salt intake because they don’t get enough water in their bodies to dilute it.

It costs S$1.5 million to set up a dialysis centre and approximately S$1 million to run it each year. Donations help patients and their families defray the high cost of dialysis and is their ray of hope.

The NKF is doing great work. But most Singaporeans would still remember the NKF scandal that broke out in 2005, leading to not just a massive reduction of donors to the charitable organisation, but also gave us an excuse to scorn charity donations as a whole. We don’t want to support nobody’s golden tap in the office or a S$600,000 paycheck. I am guilty of being that cynic.

But having spoken to the patients, the NKF debacle got slowly filtered away and I see that these are real people, with real problems needing financial help. With about 700 new kidney failure cases each year (up from an average of 500 cases previously), there’s going to be more people needing assistance. Currently, the NKF runs 24 dialysis centres islandwide at full capacity with plans to build 3 more.

Apart from monetary donations, help could also be given in the form of volunteerism to befriend kidney patients. Because of their disease, all the interviewees I spoke to are single. Many of the older patients live alone and need someone to help bring them for dialysis. In a way, the society is their family. One of them shared that the best thing about having his leg amputated is that he saw the kindness and helpfulness of strangers around him. We are a gracious city after all!

The other way to help, perhaps the most invaluable, is to pledge to be a kidney donor. A dialysis patient can be freed of the machines once he/she receives a kidney transplant. At the moment, the wait is 9 years to find a matching donor! But with a larger pool of donors, the waiting time can be shortened. Do visit NKF’s website if you would like to find out more.

When planning for the intereviews, I imagined that the patients would be miserable and pity-seekers. Instead, they were joyous, humourous and continue to have hopes and dreams despite what they have to go through. I won’t say that their cheerfulness is representative of all kidney dialysis patients. I bet many of them are grumpy and unhappy. But if they’re all going through the same path, how come these three can stay so positive and sanguine? (To find out what keeps them going and how they stay positive, do drop by the NKF public gallery at its Kim Keat Road headquarters. It is slated for completion at the end of 2010.)

And what does it make of the rest of us who have the freedom to drink as much as we want with the freedom to move? Let’s count our blessings… and share it too.

Please take care of your health and kidneys 🙂