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April 26, 2007

Kidney failure: Call for diabetes checks for those 40 and above

By Salma Khalik, Health Correspondent

WITH kidney disease and failure reaching ‘pandemic proportions’ here, the fight against them should no longer just be the business of doctors and patients, a leading renal specialist has said.

Associate Professor S. Vathsala believes the national health-care system has to introduce a national screening programme for diabetes for those aged 40 and up.

She noted that in the past decade, diabetes has been responsible for 56 per cent of kidney-failure cases.

The renal specialist, who is also the director of Singapore General Hospital’s kidney transplant programme, predicts that by 2030, 14 to 15 per cent of the adults here will fall victim to diabetes.

The figure today stands at 8.2 per cent of adults.

She attributes the projected increase mainly to the population getting older, as older people are more likely to develop it.

Quoting foreign studies, Prof Vathsala said controlling the condition was key to cutting - by as much as two-thirds - the number of kidney-failure cases caused by diabetes.

But the last national health survey in 2004 found that half the diabetics did not even know they had the disease. With these individuals, diabetes is left untreated until the disease is at an advanced stage - which is when complications set in.

Prof Vathsala, who is also vice-president of Society of Transplantation, told The Straits Times that if each case of diabetes could be detected early, ‘we could potentially pick up kidney disease in at least 21 per cent of them at time of diagnosis’.

Left untreated, people with early symptoms of renal failure will lose the use of their kidneys in 10 to 20 years.

To make matters worse, Prof Vathsala added, chronic kidney disease is a known ‘disease multiplier’ - it increases a person’s risk of contracting other, often fatal, diseases such as heart attacks and strokes.

Diabetes is also linked to other conditions like non-healing ulcers and blindness.

In an article in the March edition of Annals, the newsletter of the Academy of Medicine, Prof Vathsala cited a list of facts to back her push for national screening for early detection.

They include:

· Diabetes is the eighth most common cause of death here; kidney disease is 10th.

· Diabetes accounted for 46 per cent of kidney failures in 1998. By 2003, the figure was 56 per cent.

· Patients on dialysis face a risk of death 22 times higher than the general population.

· The number of new dialysis patients has been going up. In 1998, there were 564 new cases, in 2003, 675.

The Health Promotion Board has no plans to introduce national screening; its stand is that diabetes can be staved off with a healthy lifestyle.

To this, Prof Vathsala argued that diabetic kidney failure peaked in people aged between 45 and 64, so a national screening programme for individuals starting at 40 would identify diabetics early; those at high risk of it should be screened even earlier.

She said a test comprising two separate fasting blood-glucose tests costs about $20.

Endocrinologists, the specialists who treat diabetics, have long called for early diagnosis as a way of preventing other serious diabetes-linked illnesses.

Dr Tan Chee Eng, an endocrinologist in private practice, recommends going a step further:

‘Screening is just the first step. There must be proper follow-up to ensure that patients keep the diabetes well controlled.’

Diabetes in its early stages presents no symptoms. Patients thus are likely to stop taking their medications, so they need to be under doctors’ supervision.

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