Peritoneal dialysis and green nephrology: Malaysia's path to sustainable kidney care

October 12, 2025

Healthcaretoday, chronic kidney disease, peritoneal dialysis, green nephrology, kidney health, CKD, kidney disease, Healthcare Malaysia, Sustainable Healthcare, dialysis, kidney failure, NKF, National Kidney Foundation, Datuk Seri Dr Haji Dzulkefly Ahmad, Renal health,

Health Minister Datuk Seri Dr Dzulkefly Ahmad addresses the National Kidney Foundation's conference, revealing dialysis costs surged from RM572M to RM3.3B annually, with NCDs costing Malaysia RM64.3B yearly.

Chronic kidney disease (CKD) stands as one of the most pressing health challenges of our generation. In Malaysia, more than 5 million people are living with CKD, yet alarmingly, only 5% are aware of their condition. Each day, 28 Malaysians receive the life-altering diagnosis of kidney failure, embarking on a lifelong journey of dialysis treatment. This escalating health crisis demands immediate attention and comprehensive action from healthcare authorities and the public alike.

Economic burden of kidney disease
Speaking at the National Kidney Foundation's 18th Annual Dialysis Conference, Health Minister Datuk Seri Dr Dzulkefly Ahmad highlighted the staggering economic impact of kidney disease. The financial burden has escalated dramatically from RM572 million in 2010 to RM3.3 billion annually today for end-stage renal disease and dialysis treatment. When considering the broader context of non-communicable diseases (NCDs), the total annual cost reaches RM64.3 billion, encompassing both direct treatment expenses and indirect costs such as productivity loss, absenteeism, presenteeism, and premature mortality. Without significant intervention, projections indicate that by 2040, approximately 106,000 Malaysians will require dialysis, further straining the nation's healthcare system and economy.

This growing challenge has gained international recognition with the recent adoption of Resolution No. 78 by the World Health Assembly in May 2025, marking a historic milestone that formally recognizes kidney disease as a non-communicable disease (NCD). This global prioritization of kidney health acknowledges the significant burden of kidney disease worldwide and paves the way for increased international attention, resources, and collaborative efforts to address this pressing health challenge.

Peritoneal Dialysis First policy
In response to this growing challenge, the Ministry of Health has implemented the "Peritoneal Dialysis (PD) First" policy, encouraging eligible patients to begin treatment with PD at home. This approach offers numerous advantages, including greater patient independence, reduced congestion at dialysis centers, and lower costs for both families and the healthcare system. Despite these benefits, implementation faces significant hurdles. As of 2022, only 5,784 patients were on PD compared to over 43,000 on hemodialysis, revealing a substantial imbalance that needs addressing.

The imperative for prevention and early detection
"This imbalance must change," emphasized Dr Dzulkefly, stressing the need to build confidence among clinicians and patients to embrace PD as the first-line treatment option. However, he cautioned that treatment alone cannot sustain the healthcare system, particularly as CKD prevalence has risen from 9% in 2011 to 15.5% today. "We must move upstream through education, lifestyle interventions, and community-based screening," he stated, highlighting the critical importance of early detection and preventive measures to curb the growing CKD epidemic.

Green nephrology: Sustainable kidney care
Green nephrology has emerged as a crucial focus area, integrating environmentally sustainable practices into kidney care. Traditional dialysis treatment is resource-intensive, consuming substantial amounts of water, electricity, and generating large volumes of single-use plastic waste, including tubing, filters, and bags. This contributes significantly to the global microplastic pollution problem. Green nephrology aims to transform kidney care by making nephrology practices more environmentally friendly and sustainable, reducing carbon footprint, minimizing waste, and conserving resources while maintaining high-quality patient care.

Innovation and Malaysia's potential
Malaysia has the opportunity to become a regional leader in sustainable kidney care through innovation in peritoneal dialysis and prevention strategies. "If we innovate, elevate and transform - that would be the way forward," stated Dr Dzulkefly, emphasizing that transformation must follow innovation to achieve meaningful outcomes. He highlighted the potential of integrating AI tools capable of predicting kidney failure risk earlier than conventional methods into applications like MySejahtera 2.0 for real-time screening. Additionally, the Minister noted promising developments in cell therapies being trialed globally, which offer hope for slowing or even reversing CKD progression. Value-based care models, successful in other countries at slowing CKD decline, present another approach worth studying for implementation in Malaysia.

Beyond machines: Comprehensive kidney care
Modern kidney care extends beyond dialysis machines to encompass better care models, smarter financing, and bold innovation. Digitalization, addressing human resource challenges, and developing diverse care models are essential components of a modernized healthcare system. Both systemic and delivery improvements are necessary to create a comprehensive and effective kidney care ecosystem that meets the growing needs of the population.

Universal health coverage commitment
Universal health coverage (UHC) remains a fundamental priority, defined by two essential criteria: accessibility across the continuum of care and protection against financial hardship. "If you suffer financial hardship, then that is not universal healthcare," Dr Dzulkefly asserted. He emphasized that the true test of a vibrant healthcare system lies in its ability to deliver care that defends and safeguards the interests of the weakest and most underserved populations. Behind every statistic are patients, families, and communities with unique narratives, all deserving equitable access to healthcare facilities, whether in urban centers or rural villages, including remote areas in Sabah and Sarawak.

National Kidney Foundation's contributions
Earlier in his welcoming speech, Dato' Dr Zaki Morad Mohamad Zaher, Chairman of the National Kidney Foundation (NKF), outlined the organization's longstanding commitment to promoting kidney health since 1969. Through public education, early detection initiatives, and prevention programs conducted via public events and social media, NKF has made significant strides in raising awareness. To date, the organization has screened 700,000 people for kidney disease through five dedicated screening clusters across the country, including the northern, eastern, Sarawak, and southern regions. NKF supports 1,800 patients across 30 different centers and has been actively promoting kidney transplantation in the country, advocating for both living and deceased donors through comprehensive public education efforts. Operationally, NKF has allocated funds to assist those awaiting kidney transplants with necessary tests, helping them secure positions on the waiting list for deceased donor organs.

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