Update on Space Crunch for Subsidised Dialysis for Kidney Failure Patients

Assoc Prof Daniel Goh Pei Siong asked the Minister for Health (a) how serious is the space crunch for subsidised dialysis for patients with kidney failure; (b) how is the Ministry planning ahead for the increasing number of dialysis patients; (c) what is the current percentage of patients opting for home hemodialysis and peritoneal dialysis; and (d) what programmes are there to subsidise and support home hemodialysis and peritoneal dialysis.

The number of end-stage renal disease (ESRD) patients requiring dialysis has risen from 5,200 in 2012 to 6,400 in 2016. This is likely to increase further, due to the burden of diabetes and ageing population. Currently, 92% of dialysis patients are on haemodialysis (HD) while 8% are on peritoneal dialysis (PD).

The Ministry of Health (MOH) provides subsidies for patients on PD as well as those receiving outpatient HD at 35 dialysis centres operated by the National Kidney Foundation (NKF), Kidney Dialysis Foundation (KDF) and People’s Dialysis Centre (PDC). At the national level, there are still available HD places, although there may be some geographical mismatch between demand and supply.

Compared to HD, PD offers greater convenience and independence to patients as it can be administered at home by the patients themselves. PD also offers greater flexibility for patients as they are not restricted by the HD centres’ schedules4. Hence, MOH has embarked on initiatives to promote PD as an alternative dialysis modality to patients who are medically suitable.

This is done in a few ways. First, MOH subsidises PD at higher levels to keep PD costs affordable for lower-income patients. Second, MOH is strengthening education programmes in public hospitals to raise patient awareness and acceptance of PD. Third, MOH has worked with NKF and public hospitals to develop and expand home support programmes for PD patients, where PD nurses will visit the patients to guide and assist them in carrying out PD at home.

At the same time, HD capacity will be increased to serve an additional 1,300 subsidised patients by 2020. Four new HD centres will be opened later this year to serve an additional 500 subsidised patients.

Besides promoting PD and expanding subsidised HD capacity, it is important that we strengthen upstream prevention of ESRD. MOH has recently announced new screening, detection and early intervention as well as more effective treatment efforts as part of the War on Diabetes.