The burden of kidney disease in the Philippines

By Romina Angangco DanguilanThe cost of treatment is not limited to the cost of dialysis. Rather, the cost is multiplied a hundredfold, and becomes the burden of an entire family. Each year an estimated 120 Filipinos per million population (PMP) develop kidney failure. This means that about 10,000 Filipinos need to replace their kidney function each year.

Sadly, in 2007 only 7,267 patients started dialysis or received a kidney transplant directly. Only 73% received treatment because they were able to get to a hospital providing dialysis or could afford the therapy. The acceptance rate of treatment for kidney failure in the Philippines is only 86 PMP, compared to 100 PMP in South Korea, and 300 PMP in the United States (accessed from the International Federation of Renal Registries in 2000 Web site). A quarter of Filipino patients probably just died without receiving any treatment last year.

The leading cause of kidney failure in the Philippines is diabetes (41%), according to the Philippine Renal Disease Registry Annual Report in 2008, followed by an inflammation of the kidneys (24%) and high blood pressure (22%). Patients were predominantly male (57%) with a mean age of 53 years.

Thus, diabetic males in the most productive years of their lives comprise the population who received treatment for kidney failure in 2007. They require replacement of their kidney function to live. Without dialysis or kidney transplantation, patients with kidney failure die.

Options for treating kidney failure

Patients developing kidney failure can choose between dialysis and kidney transplantation as treatment for their illness. Dialysis comes in the form of hemodialysis (HD) where the patient’s blood is made to run through a series of tubes which removes poisons and excess fluid that have accumulated in the blood, and is then returned to the patient. A hemodialysis session lasts for four hours and needs to be done three times a week to adequately replace sufficient kidney function for the patient to live. The patient needs to travel to a dialysis unit each time for treatment.

Another option is peritoneal dialysis (PD), where a permanent tube is placed in the patient’s abdomen, and the patient’s own membrane acts as the artificial kidney. Special fluid enters the abdominal cavity and stays there for several hours, and the poisons and excess fluid transfer from the blood to the fluid, which is drained out of the body. This process is done daily, three to four times a day. Patients are trained to perform this type of therapy by themselves at home.

The best way to replace kidney function though is to transplant another kidney into the patient through a surgical procedure. Only another kidney can completely replace kidneys shrunken because of disease. Dialysis only provides about 15% of kidney function. It is enough to sustain life, but needs to be performed regularly, and for life.

Cost of treatment

Adequate dialysis costs from P25,000 to P46,000 per month or P300,000 to P552,000 annually. If one is able to afford this lifelong treatment then the patient will be well enough to return to his normal way of life, and just apportion time for dialysis treatment. However majority of Filipinos cannot afford this costly treatment for more than a year. A study at the National Kidney and Transplant Institute (NKTI), a tertiary government hospital providing services for kidney disease, showed that half the patients who start dialysis are dead within a year, presumably because they could not afford sufficient dialysis.

Most Filipinos pay for their treatments without any subsidy from insurance. Philhealth covers about 51% of the annual cost of treatment, if the maximum benefit is claimed. The patient therefore has to pay for half of the treatment or at least P150,000 per year. According to NKTI, only 15% of the partially-subsidized patients are Philhealth members. Thus they have to pay for most of the treatment, and are reliant on government assistance to afford any treatment.

This results to patients who can afford only partial therapy, which may be sufficient to exist, but not enough to live. Patients without sufficient dialysis are weak and display many of the symptoms that led to their diagnosis. They are malnourished and unable to work, existing only until the next dialysis treatment, whenever that may be.

In a survey conducted by five kidney specialists on patients with chronic kidney disease from Bacolod City, Negros Occidental, from May to July 2002, only 46% of 182 patients prescribed dialysis were able to start treatment. Among those who started dialysis, 96% had inadequate treatment because they could not afford it.

A family’s burden

Unfortunately, treating kidney failure is a burden borne not only by the patient, but by the entire family. A family member or caregiver is needed to care for the patient, attend to medications and meals, and assist in providing treatment, whether by performing dialysis itself with PD or accompanying the patient to an HD facility. Commonly, a family member has to stop working to care for the dialysis patient. The patient is too weak to provide self-care and loses independence.

Patients who cannot afford treatment rely on other family members to look for the needed funds. Children stop schooling, savings are used up, objects of value are sold, and all the earnings of those who work are used to pay for dialysis. This results to families that are impoverished because of a single patient with kidney failure who needs treatment. The cost of treatment therefore is not limited to the cost of dialysis. Rather, the cost is multiplied a hundredfold, and becomes the burden of an entire family.

Full Story

via abs-cbn newsonline

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  3. Hi there.. Thank you for sharing this informative contents that i can used or apply in my daily life.. I am looking forward to see more contents like this :)

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