More kidney failures expected - The Borneo Post - Monday, 11 March, 2002

KUALA LUMPUR: The number of Malaysians suffering from end-stage kidney failure is likely to increase due to an expected rise in the incidence of diabetes, which is the leading cause of end-stage renal disease (ESRD), according to two kidney specialists.

Consultant nephrologist Datuk Dr Zaki Morad Mohd Zaher said 40 percent of the end-stage kidney failure cases recorded in the past few years in the country were due to diabetes, chiefly Type 2 diabetes which occurs later in life and affects more than 90 percent of the patients.

Dr Zaki Morad, head of Hospital Kuala Lumpur's (HKL) Department of Nephrology, said the rest of the kidney failure cases were caused by the spread of other diseases, including hypertension which was found in 24 percent of Malaysian adults surveyed in 1998.

There were an estimated 2,200 Malaysians suffering from end-stage kidney failure yearly, requiring dialysis or transplantation for survival, Dr Zaki Morad was quoted as saying in a statement released by Meridian Communications yesterday.

He said the estimate at 100 new cases per one million population per year totalling 2,200 in the Malaysian population of 22 million was derived from a number of local studies.

"However, not all kidney patients in Malaysia are reported to the authorities, Some seek traditional treatment, from bomohs, for example," he said.

Dr Zaki Morad was commenting on the findings of a landmark study called RENAAL which has determined that a hypertensive drug, "losartan", is effective in delaying the progression of kidney disease in hypertensive Type 2 diabetes patients.

Malaysia was among 28 countries that took part in the four-year study from 1997.  The local participating clinical trial centres were HKL and Universiti Malaya Medical Centre (UMMC), which was headed by consultant nephrologist Professor Dr Chua Chin Teong.

Prof Dr Chua, who is UMMC deputy director, said diabetes has been the most common cause of endstage kidney disease in Malaysia since 1997, setting off alarm bells in health circles because of the very high prevalence of diabetes occurring in eight to 15 percent of the general population.

Quoting World Health Organisation (WHO) statistics, he said Southeast Asia was projected to see the highest rate of increase in diabetes cases worldwide over the next quarter century, rising from 30 million in 1995 to 35 million in 2000 and surging to an estimated 80 million cases by 2025.

He said the sharp rise was associated with the increasing affluence in Asean countries, changing dietary habits and leading to a more sedentary lifestyle.

As comparison, the WHO figures projected the number of cases in other regions to increase to about 10 million in Africa, 50 million in Europe and 65 million in the Americas over the same period.

"As a direct result, in absolute numbers, we will see more and more patients getting end-stage kidney failure.

"This trend will create a serious public health and socio-economic problem because it is very expensive to sustain these patients by dialysis and transplantation," he said.

He said the worrying trend also indicated that Type 2 diabetes was increasing among the younger age groups, as shown in Japan and some other Asian countries, unlike previously when it mostly occurred in people in their 40s and 50s.

He added that delaying the development of ESRD, which essentially is death of the kidney, was an enormously important goal due to the limited and costly treatment options, such as dialysis or transplant.-Bernama