Kidney Failure and Dialysis: What You Need to Know

According to The Galen Centre, Malaysia is on the brink of a kidney disease crisis. SOCSO spent RM1.22 million on dialysis for its contributors in 1999¹. This increased a whopping 274 times in 23 years to RM334.67 million in 2022¹. Over 51,000 people in Malaysia currently live with ESRD, needing kidney replacement therapy¹. The dramatic increase in the number of patients is largely driven by poor dietary habits and uncontrolled diabetes².

The kidneys are vital organs in the human body that play a crucial role in maintaining overall health. As part of the excretory system, the kidneys are responsible for filtering waste and toxins from the blood, which are then excreted as urine. They also help regulate fluid balance, blood pressure, and electrolytes, and are essential for overall metabolic homeostasis. However, when the kidneys fail to perform these tasks adequately, it can lead to kidney failure, also known as end-stage kidney disease (ESKD).

Kidney failure occurs when the kidneys are functioning at less than 15% of their normal capacity. At this stage, the kidneys can no longer filter waste products effectively, leading to the accumulation of harmful substances and excess fluid in the body. This condition can be life-threatening and requires medical intervention to manage. Dialysis is a treatment option that helps to compensate for the loss of kidney function by cleansing the blood, a task typically performed by healthy kidneys.

While dialysis can perform some of the functions of the kidneys, it is not a cure for kidney failure. It is used as a life-sustaining treatment either until a kidney transplant is available or for the rest of the patient’s life if a transplant is not an option. Dialysis works by removing waste, toxins, and excess fluids from the blood, but it cannot fully replicate all of the kidneys' other vital functions, such as hormone regulation.

There are two primary types of dialysis: haemodialysis and peritoneal dialysis. Both methods aim to replace kidney function, but they do so in different ways.

Haemodialysis: This method involves using a machine to filter the blood outside the body. A patient’s blood is drawn through needles inserted into a fistula, graft, or tube placed in a vein. The blood then passes through a dialyser, often referred to as an artificial kidney, where it is cleaned before being returned to the body. Haemodialysis is typically performed three times a week and can take several hours each session. Patients often feel fatigued after treatment, but the intervals between sessions allow for normal daily activities.

Peritoneal Dialysis: This method uses the lining of the abdomen (the peritoneum) as a filter. A special fluid is introduced into the abdominal cavity, where it absorbs waste products from the blood vessels in the abdominal lining. After a set period, the fluid, along with the waste, is drained out and replaced with fresh fluid. This type of dialysis can often be done at home and may be done daily.

For patients undergoing haemodialysis, dietary modifications are crucial to managing their condition. Foods high in potassium, phosphate, and sodium are typically restricted to prevent complications such as high blood pressure, electrolyte imbalances, and other health issues. A dietitian will work with the patient to create a meal plan that suits their specific needs, ensuring adequate nutrition while avoiding harmful foods.

While haemodialysis is an effective treatment, there are potential complications that can arise. Blockages in the dialysis access site, such as blood clots or poor blood flow due to narrowed blood vessels, can disrupt the process. Other common side effects include muscle cramps, low blood pressure, dizziness, and nausea. However, medical teams are trained to address these issues promptly to ensure that treatment continues safely.

Dialysis is an essential treatment for individuals suffering from kidney failure, helping them manage their condition and maintain their health. Though it does not fully replace all of the kidneys' functions, it can extend life and improve quality of life for those with end-stage renal disease. Regular medical care, lifestyle adjustments, and a supportive healthcare team are key to navigating life with dialysis and managing its associated challenges.

Source:
¹The Galen Centre for Health and Social Policy.
² 31st Report of the Malaysian Dialysis and Transplant Registry 2023.

Dr. Nirmala Devi Baskaran
Neprologist
Gleneagles Hospital Kuala Lumpur