Speech by Mr Chan Heng Kee, Permanent Secretary, Ministry of Health, at the 3rd Kidney Care Conference 2019, 25 May 2019

Mr Arthur Lang, Executive Committee Member and Board Director, National Kidney Foundation

Mr Tim Oei, Chief Executive Officer, National Kidney Foundation

Professor Tan Chorh Chuan, Executive Director, Office for Healthcare Transformation, Ministry of Health

Distinguished Guests

Ladies and Gentlemen

            Good morning.  I am delighted to be here with you today.  Let me start by congratulating the National Kidney Foundation (NKF) on its 50thanniversary.  In five decades, NKF has grown from humble origins to become the largest provider of dialysis care in Singapore.

2.          I believe one of the reasons why NKF has thrived is its continuing effort to advance its services – through acquiring new knowledge, adapting to new needs and collaborating with partners. This NKF Kidney Care Conference, now into its third edition, is a good example.  I am happy to note that this year’s event has been extended to healthcare professionals in the Asia Pacific region so that we can widen the sharing and learning.

3.          End stage renal disease is a growing problem in Singapore.  Each day, 4 new patients are diagnosed with kidney failure. The number of kidney failure patients is expected to rise due to our ageing population and the increasing prevalence of chronic diseases such as diabetes.  To address this, we will need to do more across the whole spectrum – from prevention to treatment and management, as well as in research and innovation. Let me touch briefly on each of these areas.

Prevention, Early Intervention and Management of Kidney Diseases

4.         We estimate that 1 in 3 patients with diabetes has poor control of their condition, which raises their risk of developing complications. To reduce kidney failure incidence, it is critical that we strengthen upstream prevention, such as lowering the risk of diabetes.  This is part of the reason why the Ministry of Health declared War on Diabetes, and is working hard to create an environment that supports Singaporeans in leading healthier lives - through healthy eating and daily habits, increased physical activities and regular disease screening and follow-up.

5.          Once a person has chronic kidney disease, we must work to stop the progression to kidney failure. In 2017, MOH rolled out what is known as the HALT-CKD programme, which stands for Holistic Approach in Lowering and Tracking Chronic Kidney Disease.  This programme systematically identifies and tracks patients with chronic kidney disease and helps them control their risk factors at the primary care level. HALT-CKD has been implemented at all 20 polyclinics. As of March 2019, over 49,000 patients have benefited from the programme.  90% of these patients have been placed on kidney protective medications. More than one-third of patients with poorly controlled diabetes achieved their blood glucose targets within a year since joining the programme.

Supporting Kidney Failure Patients

6.          Notwithstanding our prevention efforts, the number of patients who require renal replacement treatment remains high. Transplant is the preferred option for end stage renal disease patients as it provides better quality of life and survival outcomes for patients in a cost-effective way.

7.         However, kidney transplant rate has remained relatively unchanged over the past ten years. In 2018, 81 kidney transplants were performed, out of about 300 patients on the national kidney transplant wait list.  We need to do better by working more closely together to raise awareness of and encourage more living kidney donations. I note that NKF is keen to contribute in this area. In fact, it has already been active. Its establishment of the Kidney Live Donor Support Fund in 2009 is a testament of its commitment to this cause.  The Fund supports kidney donors who find it challenging to meet the costs of hospitalisation and medical follow-ups.

8.          Not every patient is suitable for transplant.  Many end stage renal disease patients will require dialysis. Today, NKF has 36 haemodialysis centres island-wide, supporting some 3,700 HD patients.  By 2021, NKF will add another 3 such centres to cope with the rising demand for dialysis. These will serve another 400 more patients. This will help in meeting new demand.

9.       Yet, while MOH has worked with providers like NKF to expand haemodialysis services in the community, we cannot solely rely on more of such centres to address the rising demand of dialysis.  MOH has thus adopted a Peritoneal Dialysis preferred strategy for more sustainable dialysis care for patients with kidney failure. We hope to encourage more patients to opt for Peritoneal Dialysis (or PD for short).  It is more cost-effective and produces clinical outcomes comparable to HD, with more convenience and other lifestyle benefits for patients. To encourage further uptake of PD, MOH has worked with our healthcare institutions and NKF to develop a set of pre-dialysis counselling and PD training materials. These include educational materials which help patients make informed decisions on treatment options, and equip those who chose PD to perform PD independently at home.

10.        To support patients who lack confidence in performing PD at home, NKF has also launched a PD Community Support Programme.  Its nurses conduct home visits to guide patients when they start PD treatment and boost their confidence in performing PD independently at home. MOH and the Agency for Integrated Care are working to refine this programme so that it can be expanded to support more PD patients.

Closing

11.          To do all these well, we must continue to review our needs and approaches and advance our strategies and practices.  Research and knowledge sharing play an important part in this. Which is why a conference such as this is important. I encourage our healthcare institutions and dialysis providers such as NKF to continue pursuing and sharing knowledge in the area of kidney disease care.  I urge you to work hand in hand towards achieving a seamless, integrated system for the betterment of renal care.

12.       Let me close by once again congratulating NKF in reaching a significant milestone in its history.  I wish you many more good years ahead.

13.          And I also wish all of you a fruitful conference. Thank you.