By June Cheong

Kidney failure can strike anyone.

The condition is not limited to the elderly, although a person may be more susceptible as he grows older.

Dr Gordon Ku, consultant nephrologist and physician at Ku Kidney Medical Centre, explained that this is because older people have a greater tendency to develop high blood pressure and diabetes.

Over 70 per cent of kidney failure cases in Singapore are due to diabetes, ageing and long-standing hypertension and chronic inflammation of the kidneys' glomeruli, or filters.

Kidney - or renal - failure can be acute, where kidney function fails within days or weeks; or chronic, where kidney function declines over months or years and leads to end-stage failure.

The former can occur in patients with very low blood pressure or severe infections and can be resolved by treating the cause of the failure rapidly and correctly.

In contrast, reversal of chronic kidney damage is usually difficult, though stabilisation is possible.

Once there is chronic damage to a kidney, the remaining functioning part has to work harder, leading to further damage.

Kidney disease should be treated as early as possible. Patients diagnosed early can be treated with medication to prevent reaching the stage where dialysis or a kidney transplant is needed.

An annual check-up, with a urine and blood pressure test, is sufficient for most people.

End-stage kidney failure is the total or near total loss of kidney function and such patients usually have less than 10 per cent of kidney function. A person with just one failed kidney, or 50 per cent of kidney function, does not require dialysis or a transplant.

In 2006, more than 1,000 people here were diagnosed with end-stage kidney failure.

Dialysis and kidney transplants are the two forms of treatment for end-stage failure.

Dr Titus Lau, senior consultant nephrologist in the department of medicine at National University Hospital, said that the better option is to have a kidney transplant although it is an imperfect treatment.

Dr Ku said of transplants: 'It's not a bed of roses like how people imagine it to be. It's the beginning of a different set of problems.'

While a kidney transplant can improve the patient's quality of life and halve the risk of death from 5 per cent to 2.5 per cent annually, the transplant may not be permanent and the anti-rejection drugs needed may cause patients to become prone to infection and cancer.

Also, the donated kidney only lasts 10 to 25 years on average due to chronic rejection by the body.

Dialysis mimics the function of the native kidney to a certain extent but is unable to fully replace the kidney. There are two main types of dialysis, namely haemodialysis and peritoneal dialysis.

The former involves filtering blood through a machine and needs to be performed for about four hours thrice a week. In the latter, blood is cleaned without being removed from the body and the abdomen lining acts as a natural filter. A solution of salts and sugars is injected into the abdomen to encourage filtration such that waste products are transferred from the blood to the solution. Peritoneal dialysis has to be done four times a day.

Patients can opt for either depending on their personal preference, the facilities available and their medical condition. For example, those with serious heart problems are advised to go for peritoneal dialysis.

A Ministry of Health Information Paper on kidney dialysis in 2006 stated that the outpatient charge for haemodialysis and peritoneal dialysis was from $2,002 to $3,484 and from $1,502 to $2,100, respectively.

In Singapore, 70 per cent of patients are on haemodialysis and the remaining 30 per cent are on peritoneal dialysis.

Asked if dialysis was a feasible long-term solution for patients with end-stage kidney failure, Dr Lau said: 'The longest surviving dialysis patients are still on it after 30 years. The most important factor determining survival on dialysis or transplant is the patient's health status before the dialysis or transplant.'

This article was first published in Mind Your Body, The Straits Times on July 23, 2008.