Over the past couple of decades there have been great strides in combating heart disease and cancer thanks to greater public awareness and better treatments.
But there’s one big killer, which is still causing far more suffering and death than it needs to and it’s growing particularly rapidly in Asia in tandem with rising incomes. That’s kidney disease, or chronic kidney disease (CKD) to be more precise: a progressive decline in renal function that can end in complete kidney failure.
The problem is most acute in Taiwan, which has the world’s highest reported level of end stage renal disease according to the most recent United States Renal Data System (USRDS) report. The island state has a ratio of 525 per 100,000 people.
Indeed Asia now accounts for six of the world’s top seven countries and the rates are rising. Singapore is now second highest in Asia at 366, followed by South Korea (355), Thailand (339) Japan (307) and Indonesia (303). These levels are roughly three times higher than European countries such as Holland (107) and Sweden (110).
It’s therefore not very surprising that kidney disease was the sixth biggest killer in Hong Kong in 2021 and seventh in Singapore. Levels have been rising rather than falling over the past decade.
What’s more surprising is that the problem isn’t more well known even though a cursory glance at the newspaper headlines reveals plenty of famous figures who’ve recently succumbed to the disease. One such is the singer Melvis (Hong Kong’s famous Elvis impersonator) who died of kidney failure aged 68 in December 2020.
Another is Thailand’s former Health Minister, Chaiya Sasomsap. He also died of kidney failure the same month, aged 68 too.
The USRDS report reveals that Thailand has experienced the world’s fastest growth rate in end stage kidney disease since 2010, up 19.7% on average per year through to 2020. The figure is almost as bad in the second fastest riser South Korea, whose rate is up 18.8% per annum over the same period.
Indonesia does not break out kidney disease in its health data, but diabetes is now the country’s third biggest killer, up from sixth place in 2009. And therein lies ones of the main reasons about why Asia is experiencing such exponential growth.
CKD is one of the most common complications of type-1 and -2 diabetes. In turn, type-2 diabetes is a disease, which particularly afflicts countries rising up the income scale.
Declining nutrition typically accompanies urbanization and the rise of office-based jobs. Time-poor white-collar workers often substitute home cooking for processed foods and fail to replace the physical exertion they once undertook through manual labour with time in the gym.
Type-2 diabetes is often associated with obesity. However, Asians are genetically prone to develop it at a far lower body weight than Caucasians.
The charity, Kidney Research UK, also reports that Asian people with diabetes are 10 times more likely to suffer from kidney failure than white people with the disease.
Some clinical studies have also linked CKD with infectious diseases that are prevalent across Asia. For kidney damage is a side effect of dengue fever, hepatitis B and C, HIV, malaria and tuberculosis.
In 2016, for example, the Thai actor Tridsadee “Por” Sahawong died age 35 of dengue fever. The disease caused a cascade of complications including sudden kidney failure.
Heart disease and kidney problems are also interlinked. The high blood pressure that causes heart disease can also damage the small blood vessels in the kidneys, which then stop filtering blood as well as they should.
So why is kidney disease not being diagnosed sooner? One reason is because kidneys’ short-term strength can become a long-term weakness.
The bean-shaped organ, which sits below the rib cage, is the workhorse of the human body. It processes and cleans blood, sifting out toxins and waste products, while returning vitamins, amino acids, glucose and hormones into the bloodstream.
Workhorses are normally very adaptable. They’re good at taking the strain. Until one day, they can’t take anymore and collapse.
That’s the problem with kidney disease. The signs aren’t obvious until there’s already been considerable damage. As a result, CKD is often picked up when patients are being tested for something else.
This also feeds into a lack of awareness. The link between diabetes and kidney disease is not as well known as blood sugar issues and therefore many sufferers aren’t getting their kidney function tested.
In 2020, a Kidney Research UK survey discovered that half of doctors and nurses treating type 2 diabetes were not carrying out routine tests to identify kidney damage during their annual reviews. The cited reason was patients’ embarrassment about providing a urine sample.
The results further revealed that many patients were unaware that their diabetes put them at risk of developing kidney problems and how dangerous that could be. Technology may provide one solution to this.
In 2021, the UK’s National Health Service digitalisation project (NHSX) selected an Israeli start-up, healthy.io, to provide half a million people with a Smartphone-based home testing kit. Patients receive a collection tub and dipsticks for their urine, which is then scanned by an app that transmits the results to a GP.
The app tests a patient’s albumin-to-creatinine ratio (ACR), which detects protein levels in the urine. The other major test for kidney disease is through the blood, measuring the estimated glomerular filtration rate (eGFR) – how much blood the kidneys can clean per minute.
Visible signs of kidney disease range from tiredness, shortness of breath, blood in the urine and swollen hands and feet.
One of the best ways to minimise the risk is to stop smoking, increase exercise and eat a healthy diet. This includes reducing the amount of salt in food.
High salt diets can alter the sodium to potassium balance in the kidneys resulting in a loss of function. Asian food is often very salty.
The World Health Organization (WHO) recommends no more than five grams per day. A University of London study concluded that Chinese people consume some of the highest levels of salt in the world, averaging 10g per day.
Betel nuts are also not conducive to well-functioning kidneys, heightening the risk of CKD by 1.44 times according to research by China’s Huazhong University of Science and Technology in Wuhan. Diets rich with dark leafy greens, omega-three laden fish and berries are among the best kidney-supporting foods.
The kidneys are among the body’s most versatile and complex organs. Keeping them healthy, however, is far simpler. If we all adopt a healthier diet and test their function as part of routine health checks ups, we’ll transform kidney disease to prevention rather than cure.