Cutting-edge technologies revolutionize early intervention in kidney diseaseOctober 18, 2025
While xenotransplantation offers hope to thousands awaiting kidney transplants, significant regulatory hurdles and cultural considerations must be navigated before the technology can be widely implemented in clinical settings.
The reality of Malaysia's healthcare landscape is stark, with demand significantly outstripping supply in an increasingly challenging operating environment. Non-governmental organizations are finding it progressively more difficult to operate effectively due to multiple compounding factors. The most concerning projection reveals that by 2040, the number of patients with end-stage renal disease requiring dialysis will exceed 105,000—nearly double the current figures. This surge will inevitably lead to critical shortages in dialysis centers, dialysis chairs, nephrologists, nurses, and overall healthcare system capacity. Simultaneously, rising operating costs are further complicating the delivery of essential care services.
Speaking at the National Kidney Foundation's 18th Annual Dialysis Conference - Innovate, Elevate, Transform, Choo Kok Ming, Chief Executive Officer of the National Kidney Foundation of Malaysia, emphasized that this crisis translates into medical litigation affecting every patient today and in the future. This health burden will inevitably evolve into an economic burden as patients lose employment, welfare demands increase, and the taxpayer base diminishes. "Therefore, it is not unfair to say that this is an urgent cry for intervention," Choo stated. Global recognition paves way for improved treatment pathways Amid these challenges, there is positive news on the international front. At the World Health Assembly WHA 78 in May, a significant milestone was achieved with the formal recognition of kidney health in non-communicable diseases. This marks the first time kidney health has received such recognition at this level, setting the tone for developing more effective treatment pathways globally. Addressing the concept of preventive medicine or preventive healthcare, Choo explained that all patients suffer a double blow: first at the point of diagnosis—a health shock—and second, financially. "The consideration of treatment has gone beyond the confines of the patient's ability to pay," he noted, emphasizing the need for systemic changes in healthcare delivery. Early intervention strategies show promise Healthcare must now begin even before patients see a doctor, focusing on chronic kidney disease (CKD) risk factors. While diabetes and hypertension remain the two primary sources of CKD, other factors including genetics, family history of CKD, and obesity also play significant roles. Policymakers have begun recognizing these connections and the importance of early intervention. Choo referenced a UK study that demonstrated the necessity of early intervention for overweight or obese school children to prevent a future tsunami of middle-aged adults with multi-morbidity issues such as insulin-deficient diabetes and chronic kidney disease. Based on this research, treating obesity in young people emerged as one of the most cost-effective strategies. The UK implemented school-based screening, early interventions including weight loss medications, and population-wide screening programs. Their approach combined moderate calorie restriction, exercise, and Sodium-Glucose Transport 2 (SGLT2) Inhibitors treatment. Social determinants impact kidney disease outcomes Social determinants play a crucial role in identifying adverse social and environmental factors associated with CKD progression. Non-medical factors including social support, housing, food security, healthcare discrimination, stress, and personal finances significantly impact patients' ability to maintain health and access necessary medical care. While kidney transplantation remains the most preferable treatment option, Malaysia faces challenges with low kidney transplant and donor rates. Most patients currently rely on hemodialysis, though an increasing number are starting on peritoneal dialysis (PD) due to the Ministry of Health's PD First policy. Technological innovations transform kidney care The technological landscape in kidney care is rapidly evolving. In transplantation, novel interventions primarily targeting donor-specific metabolic risks are improving patient outcomes. Interventions before and after organ retrieval permit the use of kidneys from older donors with comorbidities. Advances in xenotransplantation show promise, though regulatory and cultural gaps must still be addressed. On the scientific front, human leukocyte antigens (HLAs) remain important drivers for low immune response, with current allocation algorithms including points for HLA matching. "The good news is that HLA matching is now possible at the molecular level, thanks to the advent of genomics and personalized medicine," Choo explained. This technology enables the diagnosis of genetic diseases, particularly rare conditions, representing a new area that can be measured and addressed. As costs decrease, genomic sequencing may become part of neonatal care for rare inherited disorders, with potential expansion to pre-implantation embryo and antenatal settings. Today, individuals at highest risk of developing kidney disease—such as family members of current patients—can be identified, enabling targeted screening and early intervention. However, a comprehensive regulatory framework and clinical support system are essential to address the challenges associated with this technology. AI and data analytics revolutionize patient care Advanced AI algorithms are central to these technological advances, analyzing generated data with cloud-based storage solutions and computational power enabling rapid global data access. These systems facilitate iterative machine learning and computation, processing data to refine and customize prediction models. This allows for personalized models based on patients' unique genomic and biomarker profiles, providing clinicians with evidence-based guidance for clinical decision-making and proactive patient management. "A decade ago, most of this technology would have been out of our reach, mainly due to cost and technological limitations. But today, that technology is affordable and at our doorstep. This represents a very promising step toward the future of kidney care," Choo noted. Patient advocacy emerges as critical component Advocacy has become an essential lever in kidney care, empowering patients through engagement and creating channels of communication for healthcare systems to understand and address patient needs. By including patient perspectives in decision-making, healthcare systems can develop more effective and responsive programs. Choo highlighted that patients are no longer merely recipients of care but active participants in their healthcare journey. "Patient engagement is a common thread that ignites these efforts. Patients drive change by sharing their experiences and insights," he stated. Unfortunately, many patients remain unaware of their options until they arrive at emergency rooms in crisis situations. This underscores the critical importance of awareness and prevention working hand-in-hand to ensure early detection. Integrating CKD screening into primary care, especially for high-risk groups such as those with diabetes, remains extremely important. With limited healthcare resources, catching CKD early helps reduce the number of patients eventually requiring dialysis and transplants, representing a crucial strategy in addressing the looming kidney care crisis in Malaysia. |
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