Professor Edwina Brown, President-Elect, International Society for Peritoneal Dialysis (ISPD)
Associate Professor Lina Choong, President, 19th ISPD Congress 2022
Associate Professor Adrian Liew and Associate Professor Marjorie Foo, Co-Chairs of the Local Organising Committee, ISPD 2022
Associate Professor Jason Choo, President, Singapore Society of Nephrology
Distinguished guests
Ladies and gentlemen
1. I am delighted to be here with you at the 19th Congress of the International Society for Peritoneal Dialysis (ISPD) 2022. To our foreign guests, welcome to Singapore!
2. A key objective of the ISPD is to increase the utilisation of peritoneal dialysis (PD) around the world and improve the health outcomes of these patients. This Congress, a flagship event for ISPD, allows the meeting of expert minds to further this important mission.
3. This year, the Singapore Society of Nephrology (SSN) is also celebrating its 50th anniversary. The SSN’s collaboration with ISPD will bring much needed improvement to the care of patients suffering from kidney failure.
End Stage Kidney Disease in Singapore
4. Kidney failure is a major health challenge across the world, with Asia-Pacific registering one of the highest rates of kidney failure in the world. Three of the Southeast Asian nations – Thailand, Indonesia, Singapore – are amongst the ten countries with the highest incidences of treated end-stage kidney failure.
5. Kidney failure brings a significant burden to the patients, their family, and society. By the time they need dialysis, it is too late. Our work as healthcare authorities and providers must weigh heavily on prevention, especially for diabetes, which is a leading cause of kidney failure.
6. Further, we need to improve disease management, which should include adopting a PD preferred approach. This is supported by innovation and research and will help us advance treatment and care. Let me talk about both aspects of prevention and disease management today.
Diabetes Prevention
7. First, disease prevention.
8. In 2011, about four new patients were diagnosed with kidney failure in Singapore every day. This has now gone up to six per day. The number of kidney failure patients is driven mainly by two factors – age and disease prevalence. On age, we are an ageing society, and that is a key factor driving up patient numbers. Fortunately, the prevalence of diabetes has stayed quite consistent over the past several years, probably due to the various initiatives we have implemented under our War on Diabetes effort.
9. The long-term, sustainable, and most sensible course of action is early detection and preventive care against diabetes, to reduce chronic kidney disease and complications. Hence the Ministry of Health (MOH) has been working with partners, such as the Health Promotion Board (HPB), to support Singaporeans in leading healthier lives.
10. One key risk factor for diabetes is obesity, a result of excessive energy intake from an unhealthy diet. Obesity prevalence is going up in Singapore. The World Health Organization (WHO) has called on countries to take action to reduce individuals' intake of sugar to as low as possible, stating that "nutritionally, people do not need any sugar in their diet".
11. Nevertheless, the 2018/2019 National Nutrition Survey showed that Singaporeans consume on average, 12 teaspoons of sugar daily. We do not have to cut to zero, but we can certainly do more to moderate our intake of sugar.
12. We are making some progress. Today, more than half of Singaporeans’ daily sugar intake comes from beverages, of which prepacked beverages, i.e. can and packet drinks, contribute nearly two-thirds. To address this, MOH has introduced mandatory nutrition labelling and advertising prohibition measures for prepacked beverages.
13. From 30 December this year, prepacked beverages with higher sugar and saturated fat must be labelled with a Nutri-Grade mark. It is a neutral or even nice name, but the message to consumers is to avoid those with Nutri-Grade mark that indicates a high level of sugar. Those with the highest level of sugar and saturated fat are also prohibited from advertising.
14. Our measures have brought about a positive response from the demand and supply sides of the market. Producers have significantly reformulated their beverages ahead of the effective date of implementation. Preliminary data shows that the median sugar level of prepacked beverages has been reduced from 7.1% in 2017 to 4.7% in 2021. This is quite a significant reduction.
15. As for demand, sales of pre-packaged beverages with higher sugar content (Grade C and D) have fallen from 63% in 2017 to 40% in 2021. Conversely, sales of beverages with less than 5% sugar content have gone up from 37% to 60% over the same period.
16. These shifts are as significant as those recorded in the UK, which has implemented a sugar tax, and much more stringent regulation of the market. It shows that by providing the right information in the right way, our industry and consumers are sophisticated and health-conscious enough to respond positively.
17. Encouraged by these developments, MOH and HPB will step up our efforts to reduce sugar intake from freshly prepared beverages. This means freshly brewed beverages from coffee shops, freshly squeezed juices, and of course, bubble teas. These are growing source of sugar in Singaporeans’ diets.
18. Our latest measures will require the outlets selling these drinks to label on their hard and softcopy menus, beverages higher in sugar and saturated fat with the Nutri-Grade mark. Advertising prohibitions will also apply to these freshly prepared beverages with the highest level of sugar and saturated fat content. We are working towards publishing these measures in the middle of next year and have them come into effect by end of next year. It is not a heavy regulation but we provide the right information.
19. These measures aim to help consumers make more informed, healthier choices, reduce the influence of advertising on consumer preferences, and spur industry reformulation. We will share more details when ready.
20. While we cannot avoid the sugar in juices and sugar cane drink, we can enjoy coffee, tea, milo and bubble tea with less sugar content. I hope more Singaporeans will realise that less sugar will bring out the natural flavours of the drinks and we may well find them more enjoyable. More importantly, it keeps us healthy, and staves off a very scary disease in diabetes.
21. Beyond influencing diet and sugar intake, MOH is embarking a major healthcare transformation strategy, called Healthier SG, where we will place heavy emphasis on preventive care.
22. Private family doctors will be roped in to be an integral part of our public healthcare system, to deliver preventive care. Residents will progressively enrol with their chosen family doctor and work with them to maintain and improve their health. We will provide stronger support for recommended health screenings, vaccinations and also adoption of healthier lifestyles such as smoking cessation, better diet and exercising.
Effective Management of Kidney Diseases
23. Next, let me talk about disease management.
24. To achieve better disease management, the “Holistic Approach in Lowering and Tracking Chronic Kidney Disease” programme has been implemented across all public healthcare institutions in Singapore. It aims to prevent and slow down the progression of chronic kidney disease to kidney failure.
25. This programme optimises kidney protective medication for suitable patients. It also addresses risk factors that contribute to deterioration in kidney function, such as high blood pressure, diabetes, and overweight. By 2021, about 87,000 patients have been recruited under the programme, with 90% of eligible patients started on kidney protective medications.
26. We should also adopt a PD-preferred approach to disease management. Currently, in Singapore, haemodialysis remains the main method of kidney dialysis. However, PD which can be done at the patient’s home, offers greater convenience, self-empowerment, normalcy in life, while maintaining good outcomes.
27. MOH has been working with public hospitals and social service organisations to recommend PD as the preferred dialysis option for patients with kidney failure, unless they are medically unsuitable. We aim for 30% PD uptake amongst new dialysis patients by 2025.
28. To achieve this, we are developing with our stakeholders a set of pre-dialysis counselling, training and educational materials to help patients to perform PD independently at home. In April this year, we launched the National PD Home Support Programme. Through home visits and more specific counselling and support, it enables more patients and their loved ones to gain confidence to perform PD at home.
29. With a lot of hard work, the PD utilisation rate among new dialysis patients rose steadily from 18% in 2015 to around 21% in 2019. However, the progress hit a snag after that due to COVID-19. Catheter insertions were delayed, training and home support services were also disrupted. PD utilisation rate has therefore stagnated at around 20%.
30. Now, with the pandemic situation stabilised and normal operations resuming, we are again asking more patients to consider PD as their preferred treatment option. We will continue to deploy new tools to guide the treatment and care of our patients with kidney failure. One of them is the Artificial Wearable Automated Kidney Peritoneal Dialysis Device developed by researchers and scientists in Singapore. It allows for PD to be done on the go, further improving the patients’ quality of life.
Closing
31. This Congress brings together crucial knowledge sharing amongst international professionals in this field, to enhance our understanding on improving care for our kidney patients. Singapore is privileged to host this event, and I wish all of you a fruitful learning and sharing. Thank you.