Kidney failure is on the rise in Singapore, and experts say all signs point to the numbers soaring further.
The latest report from the Renal Registry, which tracks kidney failure cases here, listed 913 new cases last year, up from 647 a decade ago.
The number on dialysis has risen too, with 5,237 needing it at the end of last year, up from 4,895 the previous year. More than half are men.
"What we are seeing is definitely the tip of the iceberg. The report only highlights patients who are on dialysis," said Dr Chionh Chang Yin, head of renal medicine at Changi General Hospital.
Associate Professor Muhammad Faishal Ibrahim, Parliamentary Secretary at the Ministry of Health, said the numbers are worrying and the ministry will be looking at what can be done to stem the rise.
Professor A. Vathsala, head of nephrology at the National University Hospital, said many of the more than 62,000 people already having kidney impairment will end up with kidney failure in the coming years.
Kidney failure occurs when the kidneys cannot clear toxins in blood, and the poisons then need to be removed artificially through dialysis.
The total number on dialysis rose from 3,408 in 2004 to 5,237 last year, comprising 3,553 Chinese, 1,260 Malays, 359 Indians and 65 of other races.
The main cause of kidney failure here is diabetes, which accounts for more than 60 per cent of cases. About 15 years ago, only 40 per cent of kidney failure patients were diabetic.
Prof Vathsala said the number of diabetics getting kidney failure has doubled from 246 cases in 1999 to 598 last year.
Dr Chionh expects kidney failure numbers to continue rising, as the incidence of diabetes has risen significantly, from 8.2 per cent of adults in 2004 to 11.3 per cent in 2010, the most recent year with available data.
The 2010 National Health Survey also found that almost half of those with diabetes were not aware of it, and were therefore not being treated.
Dr Cynthia Lim, an associate consultant in renal medicine at Singapore General Hospital, suggested early screening because there is medicine that can delay kidney failure. Without that, she too sees rising numbers needing dialysis.
Dr Tagore Rajat, director of renal medicine at Alexandra Hospital, said: "Lack of understanding, unhealthy lifestyles and obesity remain our major challenges and a concerted effort to educate the general population must continue, and perhaps increase."
Kidney failure and dialysis are known to reduce patients' lifespan. Both patients and society incur higher costs too.
Prof Vathsala said: "The consequence is an increase in health-care costs to the patient, loss of earnings for the patient, health-care costs for the nation and the need to build more dialysis centres."
The rising numbers mean the National Kidney Foundation (NKF) and the Kidney Dialysis Foundation have their work cut out for them. The NKF is already planning fund-raising to build four more dialysis centres.
Prof Vathsala said dialysis is not the best option, as kidney failure patients have the best chance of living a normal life with an organ transplant.
But the number getting transplants has fallen over the years from a peak of 124 in 2004 to 62 last year, due to an ongoing shortage of organs as well as a lack of willingness by family members to give up a kidney.