Dr Chua Horng Ruey, an expert in kidney disease at NUH, with his patient, Madam Chow Yow Leng, who is benefitting from the newer treatment. ST PHOTO GAVIN FOO
SINGAPORE – There are new treatments that can significantly slow down the progression of kidney disease, giving hope to the hundreds of thousands of people in Singapore suffering from early-stage kidney disease.
This is especially since the class of drugs called sodium glucose co-transporter-2 (SGLT2) inhibitors was placed on the standard drug list in November 2023, meaning it has become subsidised. It had been on the Medication Assistance Fund for the past two years, but that provides subsidies only for patients who have been means-tested.
SGLT2 inhibitors can slow down the progression of kidney failure by 37 per cent, said Dr Chua Horng Ruey, an expert in kidney disease at the National University Hospital (NUH).
While such drugs had originally been marketed as medication for diabetes, they have since been proven effective in slowing down the deterioration of kidney function in both people with and without diabetes.
Dr Chua, who heads the division of nephrology, or kidney disease, at NUH, said there is now “a wealth of more advanced therapeutics to treat chronic kidney disease, and especially diabetic kidney disease”.
He said that if SGLT2 treatment is started in the early stage of kidney disease, when kidney function is still good, it might add 20 more years of kidney function versus without medication. If treatment is started later, when the disease is more advanced, it could still delay the need for dialysis by a couple more years.
How long it takes for someone to progress from stage 1 to 5 can vary significantly, from a few years to two decades or more.
Doctors say a healthier lifestyle and medication can help to slow the progression of kidney disease. The earlier it is diagnosed, the sooner interventions can start, and the better the outcome.
Dr Sheryl Gan, a senior consultant in renal medicine at Singapore General Hospital, said: “Optimal control of blood pressure and diabetes is paramount to slow down the progression of kidney disease.
“In particular, some medications to treat blood pressure and diabetes have been shown to be effective in slowing down the progression of chronic kidney disease and, more importantly, delaying the need for dialysis.”
She said that aside from SGLT2 inhibitors, blood pressure-lowering medications from the angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers classes have been shown to reduce the progression of kidney disease and need for dialysis by 15 per cent to 20 per cent.
Dr Gan stressed the importance of early detection, as treatment can be started “when there is any trace of protein leak in the urine or used to control blood pressure or diabetes before the onset of protein leak in the urine”.
Lifestyle changes such as lowering sodium intake, not smoking, weight control and exercising are just as important in slowing damage to kidneys.
Dr Yeo See Cheng, who heads renal medicine at Tan Tock Seng Hospital, said people with diabetes or high blood pressure, who are obese, have cardiovascular disease or a family history of kidney failure, should get screened for chronic kidney disease.
This is because while lifestyle interventions and kidney protective medications are still effective in stage 3 chronic kidney disease (moderate) and stage 4 chronic kidney disease (severe), they are more effective when they are started earlier, he said.
Dr Chua praised the Agency for Care Effectiveness for “rapidly reviewing evidence and cost-effectiveness of various drugs in consultation with healthcare leaders”.
The agency was set up by the Ministry of Health in 2015 to assess treatments and provide evidence-based recommendations to doctors to help them in treating patients.
“As a result, new efficacious drugs are rapidly reviewed and pushed for subsidies very early, and these steps have benefited our patients. Optimal therapeutic drug use will slow down kidney failure for many patients in need,” said Dr Chua.
He added that many hospital specialists have been engaging primary healthcare and community partners to raise the overall awareness of these medications, so they can prescribe them to their patients.
Looking ahead, he added: “I believe we will see a revolutionary change in the kidney disease management landscape.”
Madam Chow Yew Leng, 73, is one of Dr Chua’s patients who are benefiting from the newer treatments. She has diabetes, and her kidney function has been moderately impaired.
Madam Chow Yew Leng is benefitting from the newer treatment. She has diabetes, and her kidney function has been moderately impaired. ST PHOTO: GAVIN FOO
She is doing all she can to keep her kidneys working, as she is dead set against going on dialysis.
“I’m vain and I don’t want my skin damaged by the dialysis,” she said, referring to scarring on the arms that dialysis patients get when an artery and a vein are surgically joined to facilitate efficient blood flow during haemodialysis.
“I also don’t want to spend so much time on it, plus it is expensive,” she added. People on haemodialysis usually spend three half-days a week linked to a machine that cleans their blood.
So she is careful with her food, does one hour of exercise three times a week, and goes for walks with her husband, who is also diabetic but does not suffer from kidney disease.
Madam Chow said she prefers a good quality of life to just longer life. What she enjoys most is dinner with the families of her two sons every Saturday, as well as holidays with them. Their last trip was to Melbourne in December 2023.
