Don't Kid Yourself

Your kidneys may be functioning at only 10 per cent of their capacity, and you may not even know it. That is why prevention and early diagnosis of chronic kidney disease is crucial.

​At 32, Anne (not her real name) was facing kidney failure, a condition she would never have associated with someone her age.

Previously diagnosed with hypertension — a leading cause of kidney disease — Anne had tried to manage her high blood pressure with a low-sodium diet, but did not consult healthcare professionals for medical treatment. 

Anne’s health took a turn for the worse in December last year. She had to be admitted to the emergency department of Khoo Teck Puat Hospital (KTPH) with ‘fluid overload’, a medical condition where her body was retaining too much fluid. A frequent issue for those with failing kidneys, fluid overload can cause serious health issues, like lung congestion and even heart failure.

Anne was unaware that her kidneys had stopped working properly. “She was in a critical condition, and was rushed to intensive care for lifesaving dialysis,” recounts Dr Allen Liu, Senior Consultant in General Medicine (Renal) at KTPH.

A Rising Concern

Our kidneys are vital organs that play several crucial roles, including that of filtering out waste and excess fluids, producing red blood cells, and maintaining an optimal balance of water, salts, and minerals in our blood. Chronic kidney disease occurs when kidneys are slowly damaged over time and lose their function. Any damage is irreversible. 

The disease is becoming increasingly common in Singapore, turning stories like Anne’s into a stark reality for many. Alarmingly, the rate has risen sharply, with the National Population Health Survey 2022 indicating a more than 50 per cent increase in cases — up from 7.3 per cent between 2019 and 2020 to 11.4 per cent in the following two years.

Chronic kidney disease occurs in older people, but it does not mean that younger adults are not also at risk.

The National Population Health Survey 2022 reveals a worrying trend: not only is the disease getting more common among older citizens, but younger groups are increasingly affected as well.

Lifestyle-related conditions such as diabetes and hypertension are also risk factors for chronic kidney disease. The number of people with hypertension has doubled over the past 10 years. Data from the National Population Health Survey 2022 indicates that hypertension is a growing concern, with more than a third (37 per cent) of Singaporeans diagnosed with the condition in 2021 and 2022 — a significant increase from 19.8 per cent in 2010.

Dr Liu highlights another stark reality: the incidence of chronic kidney disease among patients with diabetes has quadrupled. In fact, two-thirds of those requiring dialysis due to end-stage kidney disease are diabetics.​

Among patients with chronic kidney disease that he sees, many have pre-existing conditions such as diabetes, hypertension, cardiovascular disease and obesity. “As our population ages and people live longer, often with conditions like hypertension, the number of chronic kidney disease cases is unfortunately on the rise,” he says.

A Hidden Danger

​Chronic kidney disease quietly unfolds through five stages, often remaining asymptomatic in the early stages. This means that there are no clear symptoms and people may be unaware that their kidney function is declining. Dr Liu points out that it is possible for individuals to lose as much as 90 per cent of kidney function without any obvious symptoms.

As the condition worsens, signs like reduced appetite, foamy urine, swelling in the ankles, and a general sense of tiredness can emerge.

During the late stages, more severe symptoms appear, including breathing troubles, unconsciousness, confusion, loss of appetite, diarrhoea, nausea, and vomiting, as well as an ammonia-like smell on the breath.

“Without addressing underlying risk factors and making necessary lifestyle changes, kidney health can deteriorate to the point of kidney failure, necessitating dialysis or a transplant,” warns Dr Liu. He also notes that those with advanced chronic kidney disease have an increased risk of heart-related illnesses.

Proactive Steps To Lower Risk

Although chronic kidney disease is irreversible, detecting and managing it early can help to slow the damage.

Chronic kidney disease can be detected through a simple urine test or blood test. A urine test checks if there is any protein in the urine, while the blood test measures the level of creatinine in the blood. Healthy kidneys filter creatinine, a chemical compound, out of the blood. A large amount of protein in the urine suggests an issue with kidney function.

Given that the disease usually has no clear symptoms in the early stages, Dr Liu advises individuals with risk factors to go for regular screening tests, regardless of age. “Screening helps to diagnose early chronic kidney disease. Identifying and managing patients with early stages may slow or prevent the progression to end-stage kidney disease and reduce cardiovascular complications,” he explains.

In addition to regular screening, adopting a healthier lifestyle and diet is also beneficial. Staying active, embracing a diet rich in nutrients, staying hydrated, and avoiding smoking can all contribute to better kidney health.

Dr Liu references a comprehensive study from Singapore, which found a link between lower red meat consumption and decreased kidney failure risk. The research, which appeared in the Journal of the American Society of Nephrology in 2016, indicated that reducing red meat intake in favour of alternative proteins like chicken, fish, eggs, or plant-based options could reduce the risk of developing end-stage kidney disease by as much as 62 per cent.

At a national level, health authorities are addressing the high rates of hypertension by promoting a reduction in sodium consumption. Initiatives to increase the availability of lower sodium products in restaurants and markets are part of a strategy to make healthier options more accessible for everyone.

Dr Liu said that while research has shown salt intake to be associated with a 21 per cent increase in the risk of developing chronic kidney disease, relying solely on a lower salt intake has not been shown to prevent the disease or slow its progression.

“Managing your diet is crucial, but it’s just part of a bigger picture,” says Dr Liu. Those with existing health issues such as diabetes and high blood pressure need to vigilantly manage their conditions. Dr Liu stresses the significance of following medical guidance and sticking to prescribed treatments and medications.

“Individuals who consume over-the-counter medications such as pain medicine on a regular basis, or are on certain antibiotics, as well as those who take herbal medicine regularly, are also advised to seek medical advice as regular consumption of such medications increase their risk of kidney disease,” adds Dr Liu.

For those at a more advanced stage of kidney disease who need dialysis, Dr Liu offers a clear ​directive: adhere to your healthcare team’s advice to effectively prepare for dialysis and reduce further health risks associated with kidney disease.LW