Opening Address By A/Prof Benjamin Ong, Director Of Medical Services, Ministry Of Health At The 3rd Scientific Meeting Of The National Kidney Foundation, 9 April 2016

Mr Koh Poh Tiong, Chairman, National Kidney Foundation

Ladies and Gentlemen

1. It gives me great pleasure to join you here at the National Kidney Foundation’s 3rd Scientific Meeting.

2. Let me first congratulate NKF, which has just celebrated its 47th anniversary at the World Gourmet Summit two days ago.

Growing Burden of Renal Disease in Singapore

3. There is a growing burden of end-stage kidney failure. The statistics show that we have about four new cases of end-stage kidney failure added in Singapore daily. Diabetes and hypertension formed about 60% of the causes for end-stage kidney failure cases. While we are ramping up the renal replacement therapies to meet growing needs, more efforts are needed in risk factor prevention as well as effective chronic disease management.

Education, Prevention and Research

4. I thought I will start by talking about how we can play a part in this through leading a healthy lifestyle with a balanced diet, regular physical exercises, and not smoking. This will reduce the risk for chronic diseases such as diabetes and hypertension. Working on the population cohort of Chinese Adults enrolled in the Singapore Chinese Health Study, researchers from the Health Promotion Board (HPB), the Saw Swee Hock School of Public Health and Duke- NUS Graduate Medical School, showed that smoking and physical inactivity are associated with increased risk of kidney failure. The Community, Occupational and Family Medicine department in partnership with the department of Endocrinology at Singapore General Hospital, have also shown a positive correlation between high body mass index (BMI) and chronic kidney disease in Malay males, based on a cross section of Malay adults in Singapore. The Health Promotion Board has thus launched the Healthy Living Master Plan to encourage the adoption of a healthy lifestyle as a whole. This includes appropriate health screening. Early and regular screening for chronic diseases such as diabetes and hypertension enables early detection and timely treatment to prevent the development of downstream complications like kidney failure. The Screen for Life Programme, also launched by the Health Promotion Board, consolidates the recommended, population-based screening programmes, and covers screening for diabetes and hypertension. I am glad to know that NKF has also been working upstream through their programmes on screening for chronic conditions, raising public awareness on risk factors as well as educational outreach on disease management.

5. We also need robust research to better inform the efforts on prevention and disease management. The Singapore Buddhist Welfare Services has over the years contributed generously to the Venerable Yen Pei-NKF Research Fund. This fund has supported many research projects on topics related to kidney diseases, including prevention of kidney disease, renal physiology, and various complications of kidney failure, many of which will be showcased today. Some notable projects include looking at barriers to timely initiation of dialysis, which enables us to further improve in ensuring that patients get treatment when needed. Others look at how specific glycoproteins contribute to progression of albuminuria and renal insufficiency in type 2 diabetic patients, which might potentially help enhance the current understanding of how renal disease progresses.

6. The Ministry of Health (MOH) has also funded projects such as the Nephrology Evaluation, Management and Optimisation (or NEMO) programme. This programme was jointly developed by National University Health System (NUHS) and National Healthcare Group Polyclinics (NHGP). NEMO aims to retard the progression of diabetic nephropathy through the optimal use of an angiotensin converting enzyme inhibitor (ACE-i) or an angiotensin receptor blocker (ARB). Early results show that an increase in uptake of ACE-i/ARBs was effective in reducing albuminuria, a surrogate measure of renal disease progression in diabetic patients. Moving forward, MOH is looking to expand the NEMO programme.

Peritoneal Dialysis and Exploring Alternative Haemodialysis Modalities

7. MOH is also working with the public healthcare institutions and other partners such as NKF, to promote the uptake of Peritoneal Dialysis (PD). Literature shows that PD is more cost effective and, moreover, offers patients the convenience and time flexibility of conducting the treatment at home or at work. On its part, NKF is ramping up support for PD patients with the opening of a PD Wellness Centre in Whampoa as well as at its upcoming integrated renal care centre at 500 Corporation Road in Jurong. All these will contribute to improving PD uptake in Singapore.

8. MOH is also exploring alternative haemodialysis strategies to optimise haemodialysis capacity in land- and resource-scarce Singapore. One modality is Nocturnal Haemodialysis, which allows patients to dialyse overnight at the dialysis centre for eight hours from 10pm to 6am. Such nocturnal haemodialysis also brings convenience and can minimise disruption to patients’ lives. NKF has recently introduced this in its newly-opened dialysis centre at Jurong West. You will be able to learn about nocturnal haemodialysis from Dr Christopher Chan, a renowned expert in this field.

9. Another modality is self-administered haemodialysis at the dialysis centres, which will also help address the manpower and staffing at dialysis centres.

Closing

10. In closing, I would like to thank NKF for their tireless work in their care for needy kidney patients. I would also like to wish all participants a fruitful session of learning from each other in improving care for our patients. Thank you.