Bandar Seri Begawan - Some 500 Bruneians are currently receiving dialysis treatment, a figure that is increasing by 40 patients a year, said Dr Jackson Tan, nephrologist at the Renal Service Department.

"The patients are mostly older people, but we do have at least three patients under 18 years old. The younger patients generally need dialysis because of genetic and hereditary diseases," he said.

Dr Tan added that diabetes was now a global health concern. "The whole world is experiencing major kidney problems, not just Brunei," he told The Bnmei Times. "The financial burden is substantial and it's the same story everywhere in the world - kidney disease is a big financial burden."

"We have launched health promotion campaigns, for instance World Kidney Day, which we do every year. We also have roadshows by health centres to promote awareness about kidney diseases and the type of conditions that can cause kidney diseases: generally diabetes and high blood pressure," Dr Tan said.

High blood pressure and diabetes comprised 70 per cent of kidney diseases, he explained. "We all know that diabetes and high blood pressure are both preventable if people have a healthy lifestyle. So by preventing diabetes and high blood pressure, you can in a way reduce incidence of kidney diseases in the future."

Asked whether the campaigns were effective, Dr Tan said: "It is very difficult to know whether it is effective. This is a very difficult thing to measure especially how people benefit from a healthy lifestyle. But we do hope that the constant health promotion that we do will have an impact on the people's lifestyle."

Public response to the campaigns has been positive, he said. "Over the past few years, the World Kidney Day campaign has had a lot of positive feedback from lots of people, saying that it helped them understand kidney disease, its symptoms and the problems it causes."

"Most of all, it helped them understand what they can do to prevent kidney disease," he added. Lifestyle is a very important factor because it can be changed, he said. "There are many other contributing factors, but these are likely to be beyond control, such as genetics and kidney problems that arise from other medical conditions such as heart disease," added Dr Tan.

Asked whether there has been a noticeable change in the public's lifestyle, he said: "This is a very difficult question to answer because we don't work in the public health arena."

"We do hope that our health promotions that we do will have some impact, but whether or not it leads to positive change in public lifestyle is very difficult to determine."

TRANSPLANTS

Dr Tan also talked about the possibility of kidney transplant as an alternative to dialysis treatment. "If there is a suitable donor, then kidney transplant is possible. Right now we have 30 patients who have undergone transplants," he said.

"A substantial number of patients (who have undergone transplants) have received organs donated by family members, but a few of them have received their organs from China and India," he said.

"That's obviously not something that we encourage because of the problems with ethical issues in getting kidneys abroad. You don't know where the kidneys are from or how the kidneys are procured," he said.

"If someone wants a transplant, we will be able to provide the support to go to Singapore for the operation, but it will very much depend on whether they have got a donor, the suitability of the donor's organ, and whether the donor and recipients are physically fit," he added.

But undergoing a transplant is not for the Faint hearted. They should be able to withstand the rigour of the operation, because it is a very demanding operation. Their heart and lungs have to be quite strong. If you go under general anaesthetics for 12 hours, and if your heart is weak, you might not wake up. Even if you do wake up, the kidney transplant is not going to do well," Dr Tan said.

EXPANSION

Dr Tan said that they're also looking into establishing their own kidney transplant operation facilities. Brunei currently has five dialysis centres, one each in Rimba, Kiarong, Raja Isteri Pengiran Anak Saleha (Ripas) Hospital, Belait District and Temburong District.

There are a total of 94 dialysis machines available, a number Dr Tan called "sufficient", but added that the establishment of another dialysis centre in Tutong was in the pipeline.
The problem with kidney disease is that the symptoms do not feature predominantly until it is at the late stage. The late stage is typically when the kidney is already down, functioning only 10 to 15 per cent of its capacity.

"For most people, when their kidneys are not functioning well, they still have a normal lifestyle, and so they don't know," he said.

He advised the public to have regular medical check-ups, even if they are fit. "Just have your blood test, blood pressure and urine checked on a regular basis. But if you have diabetes and high blood pressure, then it is more important to have more regular checks," he said.

"When you start noticing the symptoms, it is often too late. This is typically the cases with the patients in Brunei. Obviously, it's not applicable to all cases. Some people can start having symptoms at a much earlier stage," he added.

"It is important to remember that once you lose your kidney function, it doesn't regenerate. Once you've lost it, you've lost it. What we can do is preserve what we haven't lost and delay the kidneys from deteriorating," he said. -- Courtesy of The Brunei Times

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