The number of Filipinos with chronic kidney disease (CKD) requiring dialysis is on the rise, warns the Philippine Society of Nephrology (PSN). A meta-analysis published in 2022 in the peer-reviewed open access journal PLoS One showed that the prevalence of CKD in the Philippines is 35.9%, which is much higher than estimated global rates of 9.1% to 13.4%.
Data from the National Kidney and Transplant Institute (NKTI) reveal that approximately one Filipino develops chronic kidney failure every hour, translating to roughly 120 Filipinos per million population annually. Unfortunately, the problem is compounded by underdiagnosis, the PSN said.
As the country observes National Kidney Month, it is vital to reiterate the importance of CKD prevention through healthy lifestyle as well as early diagnosis to enable optimal treatment.
CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. As a result, excess fluid and waste from blood remain in the body and may cause health problems, including heart disease and stroke, according to the US Centers for Disease Control and Prevention (CDC). If left untreated, CKD can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or a kidney transplant is needed for survival. Kidney failure treated with dialysis or a kidney transplant is called end-stage renal disease (ESRD).
Individuals are at higher risk for CKD if they have diabetes, hypertension, heart disease, a family history of CKD, and obesity. People with CKD may not feel ill or notice any symptoms. The only way to find out for sure if you have CKD is through specific tests that measure the creatinine level in the blood and protein in the urine, the CDC said.
A healthy lifestyle is key to CKD prevention. The PSN recommends eating a diet that includes a variety of fruits, vegetables, lean meat, fish, and whole grains, while limiting the intake of added sugar, sodium, and fat; and engaging in regular physical activity that helps control blood pressure and blood sugar levels as well as maintain a healthy weight. Also important are staying hydrated by drinking adequate amounts of water, quitting smoking, taking pain relievers and supplements responsibly, and scheduling regular medical check-ups.
The high cost of CKD treatment imposes a heavy financial burden on Filipino patients and their families. A study by Pajimna et al published in The Lancet in August 2023 found that 94% of ESRD patients are undergoing center-based hemodialysis (HD), 4% are on peritoneal dialysis (PD), and only 2% had kidney transplantation (KT).
PhilHealth covers in varying degrees the cost of those procedures in line with the Universal Health Care Act. However, the study noted geographical discrepancies in PhilHealth-registered beneficiaries from 2018 to 2021, with a few remote provinces recording coverage rates of only 52% and lower. It acknowledged PhilHealth efforts to address gaps in the provision of financial assistance to beneficiaries, specifically when the agency expanded its dialysis benefit package in June 2023 to 156 HD sessions to fully cover the recommended thrice-weekly annual treatments.
The enhanced package is an improvement from the 45, 90, and 144 HD sessions previously amended in years 2013, 2015, and 2020, respectively, wherein patients had to resort to twice-weekly sessions or pay out-of-pocket, the study explained.
The study attributed ESRD patients’ overwhelming preference for center-based HD to supervised care provided in dialysis centers, patient burnout, the heavy burden imposed on the family by home-based dialysis, and a lack of confidence in self-treatment. It recommended increasing the use of home-based HD or PD as one strategy to minimize the healthcare workforce strain and to reduce the economic costs of ESRD.
Citing the concentration of HD centers in urban cities, the study contended that home-based dialysis would be ideal to address geographical barriers to healthcare access, especially in rural areas. Home-based dialysis lowers costs from manpower and infrastructure and reduces patient exposure to infection in the hospital; it is also correlated with improved cardiovascular, nutritional and quality of life parameters, as well as long-term survival advantages, the study added.
PhilHealth introduced a PD-First Z-Benefit Package in 2014 to promote PD as the first line modality for eligible ESRD patients, with coverage of up to 90-120 PD solutions per month or three to four PD solutions per day. Despite this policy, PD remains underutilized in the country, the study stated, noting that to date no local studies have been conducted to explore the reasons why more Filipinos opt for HD over PD.
Whether HD or PD, the biopharmaceutical industry is committed to support patients by providing treatment options that would help those impacted by kidney diseases.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
