Between dialysis and a kidney transplant

WHEN your kidneys fail, treatment is required to replace the work your own kidney can no longer do. There are two types of treatment for kidney failure – dialysis or a transplant. But what are the difference and how long does it take?

Sunway Medical Centre Consultant Physician and Nephrologist Dr Ng Eng Khim emphasised that there are two ways to get an organ.

“One is called living related donation – which means one ofthe family members step forward and become the donor which can happen very fast. So, the moment it matches and is suitable, with medical advancement, we can make a transplant even across different bloodgroups.”

“However, if the donation is froma deceased donor such as an accidentvictim, those with intracranial bleedingand certified brain death but their heart is still pumping, the organ is still perfused and suitable for donation, then there is a waiting list in Malaysia.”

“The moment you require dialysis, and you’re already in the dialysis programme, automatically your name will be registered into the national registry. Nevertheless, after the age of 60, the name will be taken off due to the high risk of such a transplant, while prioritising those who are still young – to push them up the ladder of the waiting list.”

He then quoted news reports as at October 2017 where more than 21,000 chronic patients, as well as those suffering stage four organ failure were reported to be on the waiting list for organ transplants.
Of these, he said, only an estimated 20 to 30 patients get into the kidney donation programme.

Years before obtaining an organ transplant
An average waiting time, according to Ng, is between 14 to 16 years.

“That means, once you step into the dialysis programme, you have to ensure yourself to be in good health status for that period of time. Then your name will be in the top waiting list.”

“When there is an organ donated, then you’ll be called by the transplant centre. But often, these patience health deteriorate due to the long waiting time compare to the first time they entered into the programme.”

“Due to this, they may be disqualified due to health and heart related issues where they are deemed unsuitable with past history of multiple infections. After transplant, a patient may have to take amino suppressed medications and transplant doctors may think that they aren’t suitable candidate,” he said. –The HEALTH

Shifting through clouds of worry and fear

“DOCTOR, you mean both my kidneys are not functioning at all and I have to be on dialysis for three times a week with each time covering four hours for the rest of my life unless there is a possibility of me receiving a healthy donor kidney or advances in medical science?”

This was a question posed by a bewildered 21-year-old Vanitha Veeramugam to the nephrologist standing beside her ward bed in 2004 at the Universiti MalayaMedical Centre (UMMC) in Kuala Lumpur after the doctor had laid down the bare truth as to the cause of her illness.

She was earlier rushed to themedical centre upon an urgent referral by a medical group in Klang where her mother had brought her for treatment following a recurrence of continuous bouts of vomiting, diarrhoea and loss of appetite. Two weeks prior to the referral she was admitted to the Tengku Ampuan Rahimah Hospital in Klang for observation after she had similar signs of illness. The hospital in Klang after warding her for treatment and observation for a week discharged her.

Alas, she had recovered with dialysis which took much of her working time as an operator in a Japanese company in Shah Alam. Ultimately, after having been on medical leave for finding a diagnosis to her kidney failure and for her dialysis she had to quit her job.

In the search for a dialysis centre, she found a vacancy in Pusat Dialsis NKF – Bakti (Klang). She is now settled in her routine of dialysis and spends her additional time watching television programmes, cycling and cooking. –The HEALTH

The pitfalls of herbal supplements

IF you’re just starting to explore the many benefits of herbal supplements, may it be traditional, ayurvedic or even from direct selling products, think again.

Sunway Medical Centre Consultant Physician and Nephrologist Dr Ng Eng Khim reiterated that most patients would often say that such forms of supplements were recommended for better health.

“While it is not easy to proof the direct cause and effect of such products on the kidney, we advise consumers to do a blood test after three months of consuming the product to determine if it has any harmful effect or whether it is safe for continued consumption.”

“You can easily detect any abnormalities through blood test if these substance cause harmful effect on the health.”

“For someone with diabetes, heart failure and hypertension with an already existing kidney failure not serious enough to require dialysis, these types of supplements are not advisable.”

“Sometimes the basic ingredients may be harmless and may have some health benefits, but for that product to have a certain shelf life, the types of chemical process that the product has undergone is usually undisclosed.”

“These aren’t sold as a medicine, so it need not go through stringent clinical trials to proof their potential side effects. As long as it is not toxic and doesn’t cause death, it can be sold.”

The potential side effects is evident from patients who are diabetes – upon consuming such products – the acceptable kidney function is straight away pushed into dialyses need, a diabetic consuming slimming products who present an acute critical stage requiring dialysis and patients consuming extracts from certain fruits; and certain phytochemicals sold in the form of juice also show rapid kidney deterioration after consumption. –The HEALTH

Herbal supplements that contain potassium

POTASSIUM is a mineral that may need to be limited in the diet of people with kidney disease especially for those on dialysis. Herbal supplements that have potassium include:

• Alfalfa
• American Ginseng
• Bai Zhi (root)
• Bitter Melon (fruit, leaf)
• Black Mustard (leaf)
• Blessed Thistle
• Chervit (leaf)
• Chicory (leaf)
• Chinese Boxthorn (leaf)
• Coriander (leaf)
• Dandelion (root, leaf)
• Dulse
• Evening Primrose
• Feverfew
• Garlic (leaf)
• Genipap (fruit)
• Goto Kola
• Japanese Honeysuckle (flower)
• Kelp
• Kudzu (shoot)
• Lemongrass
• Mugwort
• Noni
• Papaya (leaf, fruit)
• Purslane Sage (leaf)
• Safflower (flower)
• Sassafras
• Scullcap
• Shepherd’s Purse
• Stinging Nettle (leaf)
• Turmeric (rhizome)
• Water Lotus


Abdominal compartment syndrome

ABDOMINAL compartment syndrome (ACS) is organ dysfunction due to increased intra-abdominal tension.

“It is not a disease as it is uncommon, and only happens for a reason. Let’s say you have an abdominal injury and you bleed intra abdominally and because the abdomen space is quite limited, so pressure is built up. Then it compresses on the main blood flow, so you will not just compromise your kidney, it comprises other micro organs such as the liver and the gut system as well,” explained Sunway Medical Centre Consultant Physician and Nephrologist Dr Ng Eng Khim.

He, however, pointed out that it doesn’t happen without a reason.

“It always happens as a form of consequences of other things such as intra-abdominal bleeding, trauma caused by motor vehicle accidence, or a rapture – a vascular organ inside that is bleeding or lacerated or as a consequence of a medical procedure such as a biopsy of certain organs,” he said. –The HEALTH

Early screening to detect kidney disease

A LOT of people who present themselves with back pain are usually concerned of the kidney.

Sunway Medical Centre Consultant Physician and Nephrologist Dr Ng Eng Khim explained that in actual fact, kidney ailments don’t cause back pain – no pain at all.

“You only suffer pain if there are stones in the kidney or there’s an infection going into the kidney.”

“In slow deteriorating kidney function, there are no symptoms at all. By the time they get all the non-specific symptoms such as loss of appetite, lethargic and leg swelling – they would have only 20 per cent kidney function left.”

“In the early stage, kidney ailments are asymptomatic. For this reason, we advocate screening for those with diabetes, – get your kidney screened every six months to once a year, those with high blood pressure, those with past history of kidney stones disease, those aged 65 or older as elderly patients are prone to get kidney failure, those with unexplained family history of kidney impairment and those with long term pain relieve medications,” he said. –The HEALTH

Kidney donor today, a patient tomorrow

THERE is also a misunderstanding that if one becomes a donor, one fine day I would be a patient myself.

Sunway Medical Centre Consultant Physician and Nephrologist Dr Ng Eng Khim assured patience that they can take full trust in kidney donor programme in Malaysia.

“Someone would not be classified as a donor if there is some health related issues or if a donor has been found that they have below the expected kidney function. Even though the donor insist that he/she wants to be the donor, it will not be allowed as there is a very extensive and stringent selection criteria whereby their health will be assessed.”

Ng explained that after the donation, the donor will be under the care of a kidney specialist for the rest of their lives to monitor their kidney health over the years and that they don’t become a dialysis patient themselves one day.

“There is also a lot of misunderstanding that their health condition and fitness levels or a person’s fertility level will be half than what people of their same age.”

“No issue at all. For certain reason, we are created with two kidneys, but we just need one to function healthily at more than 80 per cent the expected function and we can live as normal,” he said. –The HEALTH