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    Kidney disease is one of the most common chronic diseases in Hong Kong, ranking sixth among the top 10 fatal diseases in Hong Kong in 20201. Many people tend to ignore the early signs of kidney disease and the early symptoms are usually not obvious. By the time they realise that they have kidney disease, the disease may be so serious they are required to undergo dialysis. What are some treatments for kidney disease? What are the different ways kidney disease patients can choose for dialysis? We will share some comprehensive information on dialysis in this article.

    Do all kidney disease patients require dialysis?

    The kidney is said to be the regulator of our body. It is responsible for cleansing the blood of toxins and helps transform the waste into urine. The kidney also coordinates and balances the body's blood pressure, water, electrolytes, and so on. If the kidney function is damaged, it could lead to other diseases such as high blood pressure and hematuria. Kidney failure can be divided into acute and chronic kidney failure. Acute kidney failure can cause the kidney function to deteriorate suddenly in a short period of time, within hours to days. If the condition of the kidney is not improved after finding the cause, emergency dialysis will be needed. Chronic kidney failure occurs when the kidneys are damaged for more than three months.

    Patients suffering from early chronic kidney disease can turn to medication or dietary control to slow down the disease. However, if the condition worsens and the kidney function continues to decline, dialysis may be required. In general, if the kidney function drops to less than 15% and complications cannot be controlled by medication, dialysis may be required. The severity of chronic kidney failure is divided into the following four levels according to the kidney function index2.

    Degree of kidney failure

    Kidney function index

    Renal insufficiency

    51% - 80%

    Renal impairment

    25% - 50%

    Renal failure

    15% - 25%

    End-stage renal failure

    10-15%

    The symptoms of kidney disease are usually not obvious in the initial stages. Many patients with kidney failure often only discover their illness in the end stage when their kidney function index is less than 15%. At this stage, their kidneys are no longer able to effectively cleanse their blood from toxins properly. As kidneys are unable to recover after losing their function, a common treatment method for end-stage kidney failure patients is kidney transplant.

    Methods of kidney dialysis

    Kidney dialysis refers to the treatment of kidney failure, which is divided into: hemodialysis and peritoneal dialysis.

    Hemodialysis

    Hemodialysis, also known as "blood dialysis,” refers to the use of a dialysis machine to extract blood from the patient's body, guiding the blood to an artificial kidney on the hemodialysis machine. Toxins or waste in the blood that were unable to be removed due to kidney failure are filtered out using dialysis fluid. The blood will then be transported back into the body.

    Peritoneal dialysis

    Peritoneal dialysis, also called "belly wash", is a treatment that can be performed at home. A permanent peritoneal dialysis catheter can be surgically implanted into the abdominal cavity. By injecting dialysis fluid through the catheter, the peritoneum can be used as a replacement for the kidney to remove excess waste and water from the body. The peritoneum is a thin membrane that covers the organs in the abdominal and contains many small blood vessels.

    Is hemodialysis or peritoneal dialysis more commonly used?

    According to data from the Hong Kong government since 2014, the number of people receiving hemodialysis or home peritoneal dialysis in public hospitals has continued to rise. In 2019, the number of people receiving hemodialysis reached 1,570, while the number of people receiving peritoneal dialysis was 4,5433.

    Both kidney disease treatments have their own pros and cons. Below is a rough comparison on the pros and cons of the two treatments

    Haemodialysis

    Duration

    Patients will need to head down to the blood dialysis centre at least three times a week. Each dialysis runs for around 3 to 4 hours.

    Pros

    It may be quicker and more effective in removing water and toxins from the blood as compared to peritoneal dialysis.

    Cons

    • Haemodialysis is a more complicated process and requires professional nursing staff to operate. Patients will need to go down to the centre to receive treatment which could affect their daily life.
    • Additionally, blood must be drawn from the patient before each haemodialysis session, causing more pain for kidney disease patients.

    • If dehydration takes place too much and too quickly at once, it could cause complications such as headaches and muscle spasms during haemodialysis.

    Peritoneal dialysis

    Duration

    The dialysis will need to be performed 4 to 5 times a day, each time for about 30 minutes.

    Pros

    Patients and their family members can perform peritoneal dialysis at home by themselves after being trained by a nurse. They have the flexibility to choose the time for their dialysis, which can effectively reduce the physical and mental burden on patients and caregivers caused by frequent visits to hospitals or haemodialysis centres. Patients generally do not experience pain during this process.

    Cons

    • Performing peritoneal dialysis at home could run the risk of an infection if the environment at home is not clean. If bacteria were to enter the abdomen through the dialysis tube, complications such as peritonitis could arise.
    • If dehydration takes place too much and too quickly at once, it could cause complications such as headaches and muscle spasms during haemodialysis.

    How do you do kidney dialysis at home?

    Many kidney disease patients hope to be able to do dialysis at home to save some time travelling to the dialysis centre. Two types of peritoneal dialysis can be done at home2: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD).

    CAPD costs less, but more time and effort are needed to do the dialysis. The patient will need to manually inject approximately 2 litres of dialysis fluid into the abdomen and leave it in the abdomen for 6-8 hours before draining out the used fluid. The draining out of fluid would take about an hour and needs to be repeated 3-4 times a day.

    On the other hand, APD is more convenient. The patient can connect to the APD machine before going to bed, and the machine will automatically drain the dialysis fluid when the patient is sleeping. This allows the patient to perform dialysis while resting without disrupting their daily activities.

    How much does an APD machine cost?

    APD is the most convenient treatment for chronic kidney failure patients compared to other methods. The popularity of home dialysis has also increased in recent years. There was an increase of approximately 14% of kidney patients receiving APD at home3. However, the cost of an APD machine is not cheap. According to the Hong Kong Kidney Foundation, it can cost as much as HK$84,0004, which is likely to be unaffordable for most people. Although some hospitals have rental programs for dialysis machines, the quota available for rent is limited. The cost of renting from private dialysis centres is also not cheap and can cost up to tens of thousands of Hong Kong dollars per month. Therefore, purchasing or even renting a dialysis machine can be a long-term financial burden without purchasing medical insurance. Some medical insurance plans in the market cover the cost of renting a home dialysis machine, such as FWD vPrime Medical Plan5, which fully covers the kidney dialysis benefit and allows reimbursement for the rental cost of the home dialysis machine.

    FWD Editor

    FWD is dedicated to sharing with you related to health, lifestyle, wealth, and insurance. You can complete an application through FWD Online Insurance Platform in as quickly as 5 minutes.

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