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‘New normal’ transplants give hope to kidney disease patients
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ith chronic kidney disease remaining a threat globally and at home, Cipto Mangunkusumo General Hospital (RSCM) is committed to continuing to provide kidney transplants for people with end-stage renal disease. As the nation is preoccupied with the COVID-19 pandemic, kidney transplants are performed in accordance with strict health protocols.
A report in The Lancet medical journal shows that globally, chronic kidney disease directly resulted in an estimated 1.23 million deaths in 2017, with an additional 1.36 million deaths attributable to cardiovascular disease resulting from impaired kidney function. Chronic kidney disease was the 12th leading cause of death globally in 2017, up from 17th in 1990.
There were 697.5 million cases of chronic kidney disease in 2017. Nearly one-third of those patients lived in two countries – China, with about 132 million cases, and India, with about 115 million. Further, 10 other nations – the United States, Indonesia, Russia, Japan, Brazil, Pakistan, Mexico, Nigeria, Bangladesh and Vietnam – each had more than 10 million cases in 2017.
Meanwhile, data from the Internal Disease Department of the School of Medicine of the University of Indonesia (FKUI)-RSCM reveals that 12.5 percent of the country’s population, some 30 million Indonesians, live with chronic kidney disease.
Urologist Nur Rasyid from the Urology Department at the FKUI-RSCM said kidney transplants could improve quality of life and increase the survival rate of patients with chronic kidney disease. Kidney transplantation is one of two therapies, the other being hemodialysis, available to treat patients with end-stage kidney disease.
“With healthy kidneys from donors, the function of patients’ kidneys of removing waste products and excess fluid from the body can return to normal. Their quality of life can increase and they can conduct their daily routines normally just like before they had kidney disease,” he said during a virtual media briefing to mark the relaunch of the RSCM’s kidney transplant services in Jakarta on Friday.
Citing studies, patients with end-stage renal disease who get a kidney transplant have an average life expectancy longer than patients who undergo dialysis.
“In the long term, kidney transplants are more cost-effective than dialysis. Financial burdens for both patients and insurers can be lighter,” said Nur Rasyid.
Internist Maruhum Bonar H. Marbun of the RSCM kidney transplant working group at the FKUI-RSCM said end-stage renal disease was mostly caused by chronic diseases, such as hypertension and diabetes mellitus, as well as glomerulonephritis (bladder inflammation), kidney cysts and bladder outlet obstruction. Based on 2018 Indonesian Renal Registry data, 92 percent of 65,947 new patients who need hemodialysis were in the category of end-stage renal disease.
Maruhum said maintaining blood pressure and blood sugar levels; adopting healthy lifestyles, including a healthy diet, routine physical exercise, weight control and enough rest and sleep; and quitting smoking cigarettes and alcohol consumption were needed to prevent chronic diseases, such as hypertension and diabetes mellitus. Meanwhile, for patients with chronic renal disease, a kidney transplant offers some advantages.
“Life expectancy will increase and the quality of life will improve,” said Maruhum. “They can freely consume foods and travel long distances. Overall, they will feel a lot healthier”.
In Indonesia, kidney transplants were initiated in 1977 and have since then continued to improve. As of June, the number of kidney transplants in kidney transplant centers in 12 cities across Indonesia amounted to 913.
Of the total, 284 kidney transplants were conducted in the last three years, evidence that kidney transplantation has become widely accepted by the Indonesian people as an end-stage renal disease therapy. One of leading factors of the wider public acceptance is the successful rate of kidney transplants in Indonesia, which is akin to those of several developed countries.
A 2016 study by Jeffrey H Wang, Melissa A Skeans and Ajay K Israni showed that the one-year-survival rate of allograft (donor organ) in patients with a living-donor kidney transplant in the United States, Canada, New Zealand and European countries stood at above 95 percent. Meanwhile in Indonesia, based on research conducted by the RSCM, the survival rate of donor organs within one year after transplantation stood at 92 percent, and 90.6 percent three years after the procedure.
Kidney transplantation was one of the RSCM’s prime programs significantly affected by the COVID-19 pandemic, following the issuance of the Health Ministry’s call for a reduction in outpatient care services to avoid virus transmission. From January to March, the RSCM performed 14 kidney transplants. The procedure was halted from April to June as the COVID-19 pandemic got worse.
During the pandemic, the RSCM kidney transplant working group performed 28 kidney transplants, of which 16 were conducted in the RSCM, Nur Rasyid said.
RSCM president director Lies Dina Liastuti said the hospital had applied a tight zoning system that was aimed at reducing potential virus transmission risks among patients, health workers and employees.
“With the new health protocols, the RSCM can hopefully minimize the potential risks of COVID-19 transmission to patients without reducing the quality of its services. People who need to undergo kidney transplant procedures can now go back to the RSCM without having to feel insecure or concerned,” said Lies.
