Kidney disease on the rise

Hakim Hayat

Brunei Darussalam has a high prevalence and incidence of end-stage kidney disease, where figures from the 2019 Brunei Dialysis and Transplant Registry indicate that the national prevalence in 2019 was 1,708 per million population, corresponding to 786 patients in the country.

The national incidence of end -stage kidney disease was 382 per million population, resulting from 176 new dialysis patients in the same time period. The figures show that its predominant cause in our population is diabetes mellitus (58 per cent).

By the end of 2020, the total number of patients in the country had rose to 881, of which 85 per cent (752 patients) were on haemodialysis, and this number is expected to rise. The other renal replacement therapy options available are transplantation (six per cent) and peritoneal dialysis (nine per cent).

This was were shared by Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar recently during the signing of a memorandum of understanding (MoU) between the Ministry of Health (MoH) and Jerudong Park Medical Centre (JPMC) to outsource haemodialysis services.

The minister said that as evident in the figures, Brunei is facing a significant number of people requiring renal replacement therapy and the treatment is complex and costly – approximately BND25,000 to BND35,000 per year per patient, just for dialysis alone.

“Given the increasing demand and the significant cost, it is easy to see that kidney disease presents a significant challenge for the MoH. The sort of challenge that we need planning for the future to ensure that existing health infrastructure and capacity do not get overwhelmed by the growing demand, and that current and future needs are met.”

Acting Director General of Medical and Health Services Pengiran Dr Haji Mohd Khalifah bin Pengiran Haji Ismail and JPMC Medical Director Dr Meera Sahib Kabeer during the signing ceremony as Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar looks on. PHOTOS: HAKIM HAYAT
Dato Seri Setia Dr Haji Mohd Isham and Minister at the Prime Minister’s Office and Minister of Finance and Economy II Dato Seri Setia Dr Awang Haji Mohd Amin Liew bin Abdullah visiting a patient

According to Head of Nephrology Division, Associate Specialist Dr Lim Chiao Yen in an interview, the outsourcing of the haemodialysis centre is timely to accommodate the increasing number of patients with end-stage kidney disease needing dialysis, to relieve the burden at the six existing haemodialysis centres in the country.

Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Dialysis Unit; Kiarong Dialysis Centre; Rimba Dialysis Centre; Temburong Dialysis Unit; Kuala Belait Dialysis Centre and Tutong Dialysis Centre.

The opening of the JPMC Renal Dialysis Unit symbolises an important milestone in the provision of renal dialysis, being the 7th dialysis centre and first ever public-private partnership of its kind in the country.

Dr Lim shared that the new centre at JPMC features 17 dialysis stations. In concrete terms it means that this new renal dialysis unit with 17 dialysis points (stations), operating three shifts per day, six days a week, to offer comprehensive thrice weekly treatment will be able to accommodate up to 102 patients per week on an ongoing basis via over 15,000 dialysis treatments per year.

On the significance of the new centre, he said that the opening was also held in concurrence with World Kidney Day 2021 which is commemorated every March 11 and themed ‘Living Well with Kidney Disease’.

He said, “In a way, we want to empower patients and their family members to look after their own kidney health, and kidney disease patients to collaborate and involve in more shared decision making to make the right treatment for themselves.”

Dato Seri Setia Dr Haji Mohd Isham said JPMC was chosen in view of its existing infrastructure and recognised benefits of a hospital-based dialysis centre. The benefits of privatisation were also highlighted by the minister, where he said that with the signing of the MoU, the burden of building and maintaining a new dialysis centre and its associated procurement of medical machinery and supplies as well as the recruitment of trained staff is removed.

“The benefits of a public-private partnership are numerous. It including boosting the economy and providing a benchmark for the government when it comes to setting healthcare standards,” he said.

The opening of JPMC Renal Dialysis Unit is the result of the Department of Renal Services’ foresight of a high growth in demand for dialysis and to ensure that there are sufficient (dialysis machines and trained renal staff) to uphold quality healthcare, in particular sufficient hours of treatment per week, for the ever growing number of patients.

With the Renal Dialysis Unit located within JPMC, it would be convenient for doctors to refer patients with dialysis needs to receive treatment within the premises. Currently, in-patients at Gleneagles JPMC and Pantai Jerudong Specialist Centre have to go to RIPAS Hospital for dialysis and return to their parent hospitals after treatment. Thus, the new arrangement would not only minimise unnecessary patient movement but also maximise treatment efficiency and improve patient care and safety.

In addition, there are existing chronic dialysis patients at RIPAS Hospital Dialysis Unit that require dialysis in a hospital-based setting which JPMC Renal Dialysis Unit will now offer.

The move of these chronic dialysis patients to JPMC Renal Dialysis Unit will allow RIPAS Hospital Dialysis Unit to focus on acutely-ill and warded patients additions.

The Minister of Health said that there is also the potential for medical tourism with the private facility being able to attract patients from overseas who are in the country, either for short-term holidays or longer stays.

“Chronic dialysis patients living in the vicinity of JPMC can also take advantage of the proximity of the centre to save valuable travelling time to and from the centre and thus have more time to spend with their loved ones and doing other activities they would enjoy, which is in line with the theme of World Kidney Day this year,” he said.

The minister believed the opening of the new JPMC Renal Dialysis Unit exemplifies the thoughtful and committed approach of the MoH and the Government of Brunei Darussalam towards the value of healthcare.

“It demonstrates foresight in planning and a desire to cross traditional boundaries in healthcare with collaboration in the private sector and most of all, it demonstrates a commitment to quality patient services for the people of Brunei Darussalam,” he said. “The MoH will continue to strive for excellence in providing easily accessible care to all, not just in the area of kidney diseases, but in all non-communicable diseases, which is in line with Brunei Vision 2035.”