Forum: Water dialysis suits some patients better

Kidney failure requires most patients to choose a form of dialysis while waiting for a kidney transplant (NKF opens dialysis centre in Yishun Community Hospital, Nov 28).

Two types of dialysis are available in Singapore, namely haemodialysis (HD) or blood dialysis, and peritoneal dialysis (PD) or water dialysis.

Most patients in Singapore are on HD, compared with Hong Kong, where almost 80 per cent of patients are on PD. Medical literature shows that water dialysis can be more beneficial to certain patients in the first two years of undergoing dialysis as PD is a daily treatment and it works more like our kidneys. Hence, PD can better preserve a patient's residual kidney function.

Selection bias may lead to incorrect conclusions regarding which type of dialysis is better. Sicker patients who cannot tolerate blood dialysis have traditionally been placed on water dialysis, resulting in a misperception of the treatment.

In fact, water dialysis is suitable for younger and healthier adults who want minimal disruption to their lives. PD can be done at home using a machine while sleeping. Patients are free to go on with their usual routines during the day, with better quality of life.

For blood dialysis, patients need to attend treatment sessions at a dialysis centre three times a week for almost four hours each time. With transportation and recovery time, this can take up most of the day, for almost half of the week.

Blood dialysis patients also need frequent trips to the hospital for infections related to the HD catheter or procedures to keep their dialysis access working. Water dialysis patients usually need just one procedure to insert a PD catheter, with fewer infection risks of peritonitis, compared with blood infections with HD catheters.

This saves overall costs and inconvenience. PD catheter insertions are minimally invasive without the need for major surgery, with faster healing, decreased waiting time to start dialysis, lower infection risk and reduced bleeding risks.

The National Kidney Foundation (NKF) has noted that comorbidities, social influences, beliefs, limited health literacy and the need for autonomy are some of the barriers that affect patients' decision-making for treatment options.

We are, therefore, committed to journey alongside newly diagnosed kidney failure patients and their caregivers. They can call the NKF hotline on 1800-KIDNEYS (1800-5436397), or visit www.nkfs.org for additional assistance.

Behram Khan (Dr)

Medical Director

The National Kidney Foundation

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