Tuesday, 9 April 2013

Peritoneal Dialysis: NKF steps up home-dialysis drive

It aims to get more patients to take up option as dialysis centres face crunch
By Melissa Pang, The Straits Times, 8 Apr 2013

THE National Kidney Foundation (NKF) is redoubling efforts to get kidney patients to opt for a home-based form of dialysis, as it struggles to meet the growing demand for treatment at its 25 dialysis centres across Singapore.

Speaking at the opening of the Wong Sui Ha Edna-NKF Dialysis Centre in Tampines yesterday, Mr Koh Poh Tiong, chairman of the non-profit group, said NKF is offering benefits such as grocery vouchers, free counselling services and blood tests.

It is even paying for simple renovations to improve hygiene conditions in the homes of patients who opt for the home-based peritoneal dialysis.

A community support programme, in which nurses visit the homes of those on this form of treatment, will also be expanded from the current team of five nurses to nine.

The new enhancements will cost NKF an estimated $750,000 for the 300 patients currently on peritoneal dialysis, commonly known as water dialysis.

NKF has always encouraged peritoneal dialysis but the need is now more urgent than ever as it is running out of money and space to build new centres.
Mr Koh said: "We are barely coping with our existing centres as they are running at near-full capacity with average utilisation rates of over 90 per cent."

The NKF currently looks after about 3,000 kidney failure patients, a group that is expected to grow by about 4 per cent each year. Building new centres to cope with the increase in demand - another 1,000 new patients are expected by 2020 - will be "unsustainable in the long run", he said.

Currently, only about 22 per cent of NKF's newly admitted kidney failure patients choose water dialysis. With the new measures, NKF hopes to push this up to 30 to 35 per cent. NKF's centres offer haemodialysis - blood is filtered through a machine that acts like an artificial kidney and returned to the body. This must be done in a dialysis centre thrice a week, up to four hours each time.

Peritoneal dialysis, which involves filling and draining dialysis fluid into and out of the abdominal cavity either four times a day, or overnight, can be done at home.

Despite the greater flexibility and independence that patients can have from this method, take-up remains low. Only about one in 10 NKF patients chooses water dialysis.

A lack of awareness about this alternative, and patients' fears over having to self-manage, are some reasons it is less popular.

"A lot of people feel that because they are doing it at home, they're on their own. The purpose of the home visits is to try and dispel some of the myths and misunderstanding about peritoneal dialysis, and to basically give them the confidence to help themselves," said Associate Professor Evan Lee, senior director of NKF's clinical services division.

In contrast, a "peritoneal dialysis first" policy in Hong Kong means only 20 per cent of the kidney failure patients there are on haemodialysis, also known as blood dialysis.

Peritoneal dialysis is recommended here for patients with more complex conditions as this form of dialysis is gentler on the body since it is done on a daily basis.

It is unsuitable for those who are very obese, said Dr Jason Choo, a renal medicine consultant at the Singapore General Hospital.

Retiree Mohammed Hashim Hassan, 63, is on peritoneal dialysis as blood dialysis, which causes fluctuations to blood pressure, is unsuitable for him because of some blockages in his heart.

"I don't have to travel three times a week to the dialysis centre and bother someone to accompany me there each time. It is easy to manage and I just have to be very careful about maintaining good hygiene levels," he said.

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