Once kidneys fail, the options are transplant and dialysis

When kidneys fail, patients need an alternative way to rid their bodies of waste, salt and excess liquid.

- Salma Khalik

The best option is to have a transplant, as that will give the patient the best quality of life and the longest survival rate.

According to the Singapore Renal Registry Annual Report 2022, 93.5 per cent of transplant patients survive more than five years, and 84.8 per cent are still alive 10 years after a transplant.

In comparison, 56.9 per cent of patients on dialysis live five years or more, and 29.6 per cent survive beyond 10 years.

For transplant, a kidney can come from either a live or dead donor. The wait for a dead kidney donor is slightly more than nine years. In 2023, 39 people received such kidneys. Another 49 people were given a kidney from a live donor.

As at end-2022, there were 7,745 people on haemodialysis (HD), 1,133 on peritoneal dialysis (PD) and 1,611 people living with a donated kidney.

Experts said that PD is often the better option.

Dr Chua Horng Ruey, who heads the division of nephrology (kidney care) at the National University Hospital, said PD puts less stress on the body as it provides a gradual and slower toxin clearance compared to HD.

"Patients on PD will do better if they retain some degree of residual kidney function. PD will complement what's left of the patient's own kidney function." But the majority of kidney failure patients in Singapore opt for HD, in spite of the pain of inserting needles every time they do dialysis, as they are more comfortable having someone else in charge of the procedure. They worry about doing PD on their own, although nursing support is given by hospitals and the National Kidney Foundation, among others.

In HD, fat needles are inserted into an artery and a vein, usually on the arm, so blood can be removed from the body, cleaned by the dialysis machine and returned. This takes about four hours. Patients usually do it three times a week at a dialysis centre.