The moment Tanapol was diagnosed with end-stage kidney disease felt like the end of the world.
He lost everything -- his job, money, and friends -- because he needed to constantly be absent from work to get dialysis three times per week. He ended up selling personal property and even borrowed money from friends and relatives to foot the medical bills.
He developed kidney disease due to bad eating habits. Although haemodialysis and peritoneal dialysis for the terminally-ill costs 200,000-300,000 baht a year, the government has offered these treatments for free under the universal healthcare scheme since 2008. Unfortunately, kidney failure is incurable but lives can almost return to normal with a kidney transplant.
Tanapol Dokkaew is one of 8 million patients with kidney disease in Thailand. His personal story was shared at a forum held recently by the Nephrology Society of Thailand and its partners ahead of World Kidney Day on Thursday. The day is part of a global campaign that aims to raise awareness of the importance of kidney health. This non-communicable disease currently affects 850 million people worldwide. Due to this, doctors have warned the public to cut back on excess sodium intake in order to reduce the risk of developing kidney disease and other illnesses.
Exceeding safe threshold
Salt has long been part of our cuisine, hence the local expression "eat rice and salt". While ordinary people eat rice and seafood, the poor "gnaw lumps of salt". However, a paper recently revealed our daily sodium consumption is nearly double the recommended level.
The study was conducted by the Nephrology Society of Thailand, the Thai Low Salt Network, the Thai Health Promotion Foundation, and the World Health Organisation (WHO). It was published in the Journal Of Clinical Hypertension in January. The study analysed the urine of 2,388 participants nationwide and found that the daily amount of salt consumption was highest in the southern region (4,108mg/day), followed by the central region (3,760mg/day), the northern region (3,563 mg/day), Bangkok (3,496 mg/day), and the northeastern region (3,316 mg/day).
Assoc Prof Dr Surasak Kantachuvesiri, the president of the Nephrology Society of Thailand and chair of the Thai Low Salt Network, said the research showed that Thais eat 3,636mg of sodium per day, which is equivalent to 1.8 spoonfuls of salt, nearly two times more than the WHO's recommendation of less than 2,000mg per day.
"Excess salt consumption can cause non-communicable diseases such as kidney disease, heart disease, high blood pressure and stroke. The incidence of kidney disease has grown by 10% each year. The WHO has recommended reducing sodium intake by 30% over the next five years [2025]. In the UK, a reduction in salt consumption by 20% can lower the mortality rate associated with heart disease by 30% and help diminish medical costs and caseload," he said.
Gp Capt Dr Worawon Chailimpamontree, the president of the subcommittee on the prevention of chronic kidney disease for the Nephrology Society of Thailand, expressed concern that the prevalence of kidney disease has risen by 17.5% to almost two out of 10 people. It is estimated that the number of patients over 18 with kidney disease is now around 8 million.
"However, the disease is asymptomatic in its early stages. It only begins to show signs in the fourth or fifth stage when kidneys work less than 15% of their capacity. We can't slow down kidney failures but we can postpone renal replacement therapy by weeks or months. Moreover, proper screening can ensure early detection for at-risk groups, including patients with diabetes, high blood pressure, family history, kidney stones and the elderly. They should have a medical check-up every year," she said.
While renal replacement therapy is a treatment for the terminally ill -- including haemodialysis and peritoneal dialysis -- the remedy for early-stage patients involves slowing down kidney failure by planning diets carefully.
Dr Worawon drew attention to the fact that young children are at risk of kidney disease, warning that they should not eat seasoned fried foods at school because condiments are high in sodium. Cooking at home, using fresh food, and eating unprocessed products help to reduce high salt intake.
Doctors have also warned the public of exaggerated advertisements about herbal supplements because there is not enough evidence that they can treat kidney disease. They often get reports that people who eat caterpillar fungus or tang chao for several months also experience kidney failure.
Some herbs are also harmful to kidneys. For example, aristolochia can cause chronic kidney failure and bladder cancer while star fruit can cause acute kidney failure. Liquorice can also increase blood pressure and herbs can counteract prescription drugs.
Expanding early screening
Dr Jakkrit Ngowsiri, the deputy secretary-general of the National Health Security Office (NHSO), said the number of patients who have registered for end-stage kidney disease treatment this year under universal health coverage has risen to 64,639 at the cost of 9.7 billion baht, an increase from 44,807 at a cost of 7.1 billion baht last year.
"If we don't take care of ourselves, it will create a financial burden. The NHSO is working on the provision of automated peritoneal dialysis. Almost 300 patients have joined the programme this year. We will increase the number next year but this is treating the symptom and not the cause," he said.
Dr Jakkrit said the NHSO has taken preventive action by allowing patients with complications such as diabetes and high blood pressure to undergo early screening for kidney disease. It is also studying the scope of benefits in detail for people in general and at-risk groups.
"We must consider the capacity of our service. If the number of patients is higher than expected, the government will have to shoulder costs and invest in personnel and facilities," he said.
In the meantime, universal health coverage has provided full benefits to patients with end-stage kidney disease and those insured under Section 40 of the Social Security Office to prevent medical bankruptcy. It covers renal replacement therapy, including blood and peritoneal dialysis, and kidney transplant surgery.
Dr Jakkrit said the NHSO also offers free drugs and medical support to patients with kidney disease and other comorbidities. Its centralised management allows it to have negotiating power to buy drugs at a reasonable price and save 8 billion baht in its budget.
