NKF to raise subsidies to encourage home-based peritoneal dialysis

Peritoneal dialysis is more convenient and healthier, but many patients still averse to it
By Janice Tai, The Sunday Times, 15 Feb 2015

It is more convenient and healthier to undergo dialysis at home - yet kidney patients in Singapore are reluctant to embrace this.

And that is why the National Kidney Foundation (NKF) intends to further raise subsidies to encourage patients to choose home-based peritoneal dialysis - commonly known as water dialysis. Of its 3,400 kidney patients now, just 328 - less than a 10th of the total - are on peritoneal dialysis.

In 2013, the NKF came up with a bag of goodies to encourage home dialysis. It offered vouchers, paid for home renovations and got nurses to do home visits. But only about 100 new peritoneal dialysis patients came on board last year.

At the Kidney Dialysis Foundation (KDF), peritoneal patients have dropped from 70 in 2010 to 38 last year.

NKF senior nurse clinician Tang Woon Hoe said the slow uptake is due to a "confidence issue".

In an NKF survey of 2,000 patients who receive treatment at its centres, the top reasons given for not wanting to make the switch to home treatment was the belief that they could not manage the procedure on their own, or had nobody to help them. There was also a fear of infection.

"But actually, infection rates are low and they can call our staff on standby if they need help," said Ms Tang.

The treatment patients get at centres is called haemodialysis. It involves being hooked up to a machine, which acts like an artificial kidney and filters the patient's blood. It takes up to four hours each time, and patients typically undergo the procedure three times a week.

Peritoneal dialysis involves filling and draining dialysis fluid into and out of the abdominal cavity either four times a day - 45 minutes each time - or overnight.

Not only can patients save the trouble and expense of travelling to a centre, they can also drink and eat more as their dialysis is done more regularly on a daily basis.

It is considered to be gentler on the body as waste materials do not build up but are discharged more frequently.

"It has proven to be as good as haemodialysis, but awareness of it in the community is not very high," said Ms Tang. "Patients should not feel alone in this journey and we want to be there to give them the confidence to help themselves."

Currently, both haemodialysis and peritoneal dialysis are subsidised by the NKF and the Government. Patients get an average of $600 in subsidies a month, depending on their financial situation.

Haemodialysis costs about $2,000 a month while peritoneal dialysis costs between $1,000 and $2,000, depending on whether patients opt for the day or night treatment.

More details of the increased subsidy for home dialysis will be released next month at the NKF's charity musical.

The NKF also intends to beef up its community support teams of nurses to include doctors, medical social workers and dieticians who will visit the homes of those on this form of treatment to monitor and advise them.

The push towards home dialysis is also based on the simple reality that building more dialysis centres is unsustainable in the long run because of space and monetary constraints, said the NKF.

Its 26 centres are currently running at near-full capacity.

It intends to open four more centres this year to cater to another 1,000 new patients expected to need dialysis in 2020, but they will not come cheap. It costs $2 million to set up a new centre and another $2 million to run it every year.

Places facing a space crunch, such as Hong Kong and Thailand, already have a "peritoneal dialysis first" policy. In Hong Kong, only one fifth of kidney patients are on haemodialysis.

Less tiring at home
By Janice Tai, The Sunday Times, 15 Feb 2015

Kidney patient Radhiah Rashid used to swallow the 15 tablets she needed daily to control her cholesterol levels and diabetes with barely a gulp of water.

"I went to the dialysis centre only three times a week so I could not take too much fluid or it builds up in my body," said the 49-year-old housewife.

The taxi fares home from a dialysis centre were also eating too much into the little income that her husband brings home as a petrol pump attendant. "I had to take a taxi back because I get cramps and feel giddy when I stand up after sitting for so long for dialysis," she explained.

After seven years of haemodialysis, she decided to give home dialysis a try late last year. Each time she does dialysis at home, she first cleans her hands with alcohol swabs. Next, she inserts a water tube into another tube permanently inserted into her stomach in a prior surgery. Fluids from her stomach then take about 20 minutes to drain into an empty water bag. When that is done, dialysis fluid from another bag gushes in to replace the fluids lost.

She does the dialysis four times a day, about 45 minutes each time.

Initially, Madam Radhiah was afraid of getting an infection. So her husband helped by making sure the house was spick and span, vacuuming and cleaning the tabletops every day.

Compared to being hooked up to a machine for four hours at a time at a dialysis centre, her current regime is far less tiring, she said. "Last time, it was so draining to sit there for hours at a go that I had to sleep after I came home. But now once I finish with it, I can go outside and jalan jalan (walk) or cook and do housework."

* Healthier dialysis to become cheaper
NKF to pump $1.63 million more into subsidies, education programmes to promote 'gentler' option
By Samantha Boh, The Sunday Times, 8 Mar 2015

They fear they cannot handle the procedure on their own, that they have no one to help them, or that they might contract an infection. This is why only 15 per cent of new kidney patients opt for the more convenient and healthier peritoneal dialysis treatment - commonly known as water dialysis.

To turn the tide, the National Kidney Foundation (NKF) is pumping in $1.63 million more over the next three years to not only make these treatments cheaper, but also help patients become more confident of administering the dialysis on their own.

From July, patients on peritoneal dialysis will pay $100 less each month, while new patients will have up to a month of free home visits from nurses, medical social workers and dietitians to ease them into peritoneal dialysis. At present, peritoneal dialysis costs between $1,000 and $2,000, depending on whether patients undergo day or night treatment. It is subsidised by the NKF and the Government to an average of $600 a month.

NKF chairman Koh Poh Tiong shared details of the Comprehensive Peritoneal Dialysis Home Support Programme last night at the NKF's charity musical. He said he hopes the scheme will make peritoneal dialysis a more viable and attractive option for patients.

The aim is to increase the number of patients on peritoneal dialysis from 10 per cent to 50 per cent of all NKF dialysis patients within the next five years.

Peritoneal dialysis is an alternative to haemodialysis, the treatment patients get at dialysis centres. It is gentler on the body as waste materials do not build up and are discharged more frequently.

It involves filling and draining dialysis fluid into and out of the abdominal cavity either four times a day - 45 minutes each time - or overnight.

Under the new programme, more than 60 per cent of these patients will be fully subsidised and will not have to pay a single cent for their treatments. In addition, volunteers from the NKF will help caregivers of patients starting dialysis by doing their grocery shopping and light housekeeping.

A Love Life Love Your Kidneys event will also be held next weekend at the National Library Building to raise awareness of peritoneal dialysis through a host of educational games.

Meanwhile, Mrs Josephine Teo, Senior Minister of State for Finance and Transport, participated in a Zumba party organised yesterday by the Kidney Dialysis Foundation (KDF) to raise funds for the KDF-NUS Research Fund. About 150 participants were also given free blood pressure and BMI tests at the event.