Health Talk @ Workplace

As part of its public education initiative to increase kidney and renal disease awareness amongst the working population, KDF organized health talks for staff from OCBC on the 23rd of September and 14th of October 2011. The theme was “What You Do Not Know, CAN Hurt You”.

It was heartening to see a large turnout for the health talks on both occasions – more than 150 OCBC staff came for each session. After a short welcome and introduction, the health talk started with Dr Tan Chee Eng, a consultant Endocrinologist speaking on the topic “Do I have diabetes? Do I need to control my cholesterol?”. Dr Grace Lee, a Consultant Nephrologist and Medical Director with KDF, then moved onto the topic of “Am I at Risk of Getting Kidney Failure? How Do I Prevent It?”.

OCBC had made prior arrangements with its health provider for its staff to undergo health screening. Tying in with the objective of the health talk, participants were requested to bring along the results of their health screening to the talk, which both speakers made ample references to.

The message on the importance of regular health checks and early detection were delivered through a talk that was informative and beneficial, yet thoroughly entertaining at the same time. Complete with light banter and jokes, both speakers customized the contents of their talk to enable OCBC participants to interpret and find meaning in the test results. This helped to make the talk relevant and meaningful to participants.

By the end of the talk, the OCBC employees who attended were better able to understand their level of risks to having diabetes and chronic kidney disease. The Q&A segment saw many participants eagerly asking the two doctors health questions which were close to their hearts. Equipped with enhanced understanding of their health screening results and risks levels, the participants with abnormalities detected in their test results were encouraged to seek further medical advice from their doctors to manage their risks. There were also plenty of informative brochures on various health and kidney related topics for participants to bring home for reference.

KDF is looking to hold more of such customized health talks in conjunction with organizations’ health screening programmes as part of its workplace education initiative. Should your organisation wish to raise health awareness amongst staff, please contact our Resource Development and Communications Executives, Ms. Tan Chieu Fern or Ms. Samantha Png at 6559 2630/6559 2650 or email chieufern.tan@kdf.org.sg / Samantha.png@kdf.org.sg so that an effective programme can be delivered through partnership with your organisation and health provider.

A Visit to Kidney Dialysis Foundation at Bishan

A group of Year 3 biology students from Raffles Institution visited KDF on 26th September 2011. They had studied about the role of the kidney in osmoregulation and excretion in their biology lesson. In addition, they learnt through role play about what a kidney patient would go through when he finds out that he has kidney disease. They were really looking forward to the KDF visit to see for themselves how dialysis is carried out.

The visit started with a short lecture by Mrs Foo on the function of the kidney, what happens when the kidneys malfunction, warning signs and symptoms of kidney disease as well as the causes of kidney disease. Students learnt the importance of maintaining a healthy lifestyle such as eating a balanced diet and exercising regularly for a healthy heart, blood pressure and blood glucose level.

Kidney patients undergo dialysis whilst waiting for a kidney transplant. Mrs Foo explained that dialysis works on the main principle of diffusion of substances across a membrane. There are two forms of dialysis, haemodialysis and peritoneal dialysis. Haemodialysis involves pumping the blood out of the body, passing it through a series of very fine tubes which are immersed in a dialysate, before pumping the blood back into the body. This has to be done for 4 hours each time, three times a week. Very pure water is needed for the dialysis machine to work properly and the centre has its own water treatment room for producing very pure water that is free of microbes. There is a backup generator to ensure that blood can be pumped back into the patient’s body in the event of a power failure. For cost effectiveness, each patient has their own dialyser, which is sterilised and reused for the month. Before a patient starts going on dialysis he has to go for an operation to create a vascular access that allows the needles to be attached during the dialysis treatment. The students learnt that dialysis is an expensive process as besides all the equipment that is needed, trained personnel must be present. Non-profit voluntary organisations, like KDF play an important role in supporting needy patients. In turn, KDF depends on the generous donations of the sponsors and the public to keep the centres running.

We were there at about 4 pm and that is the time that patients start to come in for the third shift. We saw how the staff staggered the arrival of patients so that they can carefully settle each patient to make them as comfortable as possible. The schedule for dialysis is planned for each patient and they also have access to blood tests, the nephrologists, dieticians and medication.

Haemodialysis exacts a heavy toll on the body and after each session, the patient is very tired. The alternative to haemodialysis is peritoneal dialysis. Peritoneal dialysis makes use of the peritoneum, a natural membrane of the abdomen. A catheter provides an opening for dialysis fluid to enter and leave the abdomen. Peritoneal dialysis does not require close medical supervision and can be done at home. It is cheaper and also less tiring on the body. Students learnt that they are two types of peritoneal dialysis—continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

Mrs Foo encouraged the students to ask as many questions as possible. On the whole students have been enriched by this visit to KDF and gained understanding in knowledge of kidney function, prevention of kidney disease, dialysis, the role of KDF, the role of medical and support staff and the importance of support from the public. They are also now better able to empathise with kidney patients and others with chronic illnesses. We would like to thank Mrs Foo and KDF for this visit.

Your Kidneys

Why are kidneys important?
The kidneys are especially important as together, they function as the master chemist of the body keeping it chemically balanced and healthy.

What do healthy kidneys do?
The healthy kidneys essentially perform three 3 basic and important actions.

These are:

1. Regulation of chemical and water balance
For the body to function properly, it must contain just the right amount of water. One of the important tasks of the kidneys is to remove excess water from the body. The kidneys also retain water when intake is reduced so as to maintain balance. Many substances such as sodium, potassium, calcium and phosphate are minerals which come from food. These minerals are needed by the body. However, they must be kept at the correct levels.

2. Removal of waste
Many waste products in the body must be kept at a low level as high levels are toxic.

3. Production of certain hormones
Healthy kidneys also make important chemical messengers called hormones. Specifically, the kidneys make a hormone called erythropoeitin which acts on the bone marrow to produce red blood cells. Another hormone is Vitamin D which is changed to its active form in the kidneys. Vitamin D ensures that calcium is deposited adequately in bones to maintain its strength.

What is meant by the term “kidney disease”?
This is whatever disease process that potentially can damage the kidneys. This means that the state of kidney failure from its mildest form to the most advanced form is also known as kidney disease. We use the term kidney failure when damage has occurred and the function of the kidney is diminished. In chronic kidney failure (also known as chronic renal failure), the damage often occurs very gradually over the years. Thus, there may not be any obvious symptoms and unless one goes for screening, you may not be aware at all.

Who are at risk of kidney disease?
People who are at risk of developing kidney disease are the elderly, those with diabetes, hypertension, or who have family members with hereditary kidney disease. They should attend regular check-ups to detect early signs of kidney disease.

How do I know if I have kidney disease?
The simplest test is a blood and urine test. However, a full medical assessment is required to confirm presence of kidney disease.

What are the common warning signs of kidney disease?
Sometimes people with serious kidney disease may not present with any symptoms. This is because kidney disease progresses silently and can destroy much of the kidney function before causing any symptoms.

Listed below are some signs and symptoms that may indicate kidney disease.

What is kidney failure?
Kidney failure is a condition whereby the kidneys cease to work properly. This is either cause by disease or injury to the kidneys.

Why your kidneys fail?
Most kidney diseases attack the filtering function of the kidneys. The actual filtering occurs in tiny units inside your kidneys called nephrons. Once the nephrons are damaged, the kidney is unable to perform its normal functions. Damage to the kidneys may happen quickly, often as the result of injury or poisoning. However, most kidney diseases destroy the nephrons slowly and silently. Only after years or even decades will the damage become apparent. Most kidney diseases attack both kidneys simultaneously.

What happens when the kidneys fail?
When the kidneys fail, imbalances of fluid and substances occur. Waste materials accumulate in the body. This will cause the symptoms as outlined earlier. In early stages of kidney disease, the body adapts and initially the patient may not feel unwell. However, in the advanced stages, one can get seriously ill and die if this condition remains untreated. Renal transplant (for those suitable) or long term dialysis treatment is then necessary.

How can you help prevent kidney disease?

If you are suffering from diabetes and high blood pressure, you belong to the group of people who are at risk of developing kidney failure. Measures can be taken to prevent or retard progression to kidney failure.

Points to remember:

Proteinuria

What is proteinuria?
Proteinuria is the condition where the urine contains an abnormal amount of protein.

How protein leaks in the urine?
Protein is found in the blood and usually is not present in the urine. Proteins are molecules that help in normal body processes such as enzymes, fighting infection (as antibodies), carriers of other substances and blood clotting.

There are millions of tiny filters called glomeruli in the kidneys. As blood passes through healthy kidneys, the glomeruli filter the waste products. Proteins are large molecules and are unable to pass through the glomeruli into the urine. However, when the glomeruli are damaged by a disease process, proteins are then able to pass through them and escape into the urine

Why is proteinuria dangerous?
Proteinuria is not a disease. However, it is an indicator that the kidneys have been damaged in some way. Protein should not appear in the urine in large quantities. Doctors usually say there is proteinuria if more than 150 mg per day is detected in the urine.

What causes proteinuria?
Some of the causes of proteinuria are:

1. Primary kidney disease called nephritis
2. Secondary kidney diseases due to:
   
   • Diabetes
   • Hypertension or high blood pressure
   • Cancers
   • Pregnancy
   • Medications
3. Others
   
   • Excessive weight gain
   • Heart failure

Slightly higher excretion of protein may occur normally in certain circumstances such as pregnancy, during fever and after strenuous exercise. These are not clinically significant if the amount is only minimally raised and returns to normal levels soon after.

Are there different types of proteinuria?
There are essentially two types of protein: albumin which is a smaller molecule and globulin which is larger. When the disease is minor or early, albumin leaks out first. The quantity is then small and not detected by conventional methods used for detecting protein. This is called microalbuminuria implying that the amount leaked out is in small amounts. When the disease is more advanced, larger molecules other than albumin leaks out and we term this state collectively as “proteinuria”.

Who are at risk of proteinuria?
People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. In both type 1 and type 2 diabetes, the first sign of deteriorating kidney function is the presence of small amounts of albumin in the urine (microalbuminuria). As kidney function declines, the amount of albumin in the urine increases, and microalbuminuria becomes full-fledged proteinuria.

What are the signs and symptoms of proteinuria?
By itself, proteinuria causes a foamy or frothy urine. Patients may also say they see bubbles in the urine. If loss of protein is in very large quantities (more than 3 grams per day), a patient may have the nephrotic syndrome where he complains of swelling of legs, abdominal distention and breathlessness especially on lying down.

If a patient also has kidney failure, the complaints will be that experienced by other renal failure patients.

How can I test for proteinuria?
Urine dipstick: This is a simple method using a test strip immersed into a urine sample to detect presence of protein in the urine. However, it only measures the concentration in that specific specimen. The concentration of urine passed throughout the day actually varies so this is not very accurate.

24hrs urine collection for protein or microalbumin is used to assess how much protein or microalbumin is passed into the urine over 24hours.

We can grade proteinuria as follows:

The amount of proteinuria may also be reported as a ratio of protein to creatinine in the urine – urine protein/creatinine ratio. If both are measured in grams, it will parallel the 24 hour results. The urine microalbumin/creatinine ratio (both measured in mg) will also closely related to the 24 hour urine microalbumin result

Investigating proteinuria
There are many reasons for having protein in the urine and the treatment will depend on the cause and amount of protein leak. The doctor will perform a series of investigation which include:

• Blood test to check on the kidney function
• Urine test to determine amount of protein present in the urine
• Ultrasound of the kidney and bladder to determine cause of proteinuria
• Kidney biopsy may be indicated in some cases for more specific diagnosis and prognosis

Natural course and prognosis of proteinuria
If left untreated, proteinuria on occasion could disappear or could remain stable for many months and years. It could also get worse and cause kidney failure especially:

• If it is associated with high blood pressure
• If the proteinuria is heavy (more than 1 gm/day). The higher the proteinuria is the greater the risk of kidney failure
• If medications that are not ‘kidney friendly’ are used indiscriminately

Treating Proteinuria
Other than treatment for specific kidney diseases, the following needs to be observed to prevent deterioration to / of kidney failure

• Good blood pressure control with any class of antihypertensive suited to the patient. In cases of heavy proteinuria, the target blood pressure is 125/75.
• Use of medications to specifically reduce proteinuria and stabilize the kidney function such as the Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs).
• Diet modifications for a low salt diet as recommended by the dietitian and if appropriate, a low protein diet for renal failure.

Some Useful Hints:

• Proteinuria may be a sign that your kidneys are damaged and that you are at risk of kidney failure
• It is recommended that people in the high risk group be regularly checked for proteinuria so that kidney disease can be detected and prevented from progressing.
• Those at risk of proteinuria and kidney failure include people who have diabetes or hypertension and who have a family history of kidney disease
• If you have diabetes or high blood pressure or both, the first goal of treatment will be to control your blood glucose and blood pressure.

Specialist Diploma in Diabetic Management Field Visit

By Caroline Tay

In February 2011, KDF was approached by Nanyang Polytechnic’s School of Health Sciences (Nursing) to facilitate a field visit at KDF Bishan Centre for 26 of its Specialist Diploma in Diabetic Management students. The students, all registered nurses working full-time in various hospitals and polyclinics, were on hand to observe how patients undergo dialysis. Diabetes is one of the most common causes of kidney failure in Singapore, and this visit aimed to help students develop critical and clinical reasoning skills in the management of their diabetic patients.

During the visit, the students were oriented to various areas of the dialysis centre, and shown how patients undergo their dialysis treatments. The students interacted freely with the patients, who shared with them their stories of life as a dialysis patient. Although the visit lasted for only two hours, the students all had a fruitful time, learning more about dialysis and what dialysis patients have to go through. The visit ended on a high note with active discussion on diabetes and dialysis.

In the end, the students were all grateful for this opportunity to have been able to observe the process of haemodialysis, which will ultimately equip them with better skill sets and allow them to provide better care for their patients.

Travel Guide for Haemodialysis Patients

Can patients on haemodialysis treatment, travel?

Certainly!
Haemodialysis patients are encouraged to take a break, go for a holiday and spend time with their family and spouse. However, before planning for a trip, the patient should be reasonably healthy and also certified fit by doctor for any trips. Planning for the trip should start four weeks prior to departure date. If it is during peak season you will need to start six weeks prior to departure date.

What are the necessary preparations before the trip?

• Decide on the destination. E.g. Country, Cities
• Decide on the length of the trip. E.g. 3 days, 2 weeks
• How is the holiday organized?
      • Tour agency
      • Free and easy
• Decide on the type of holiday activities: Fishing, cruise, sightseeing, visiting family and friends, etc. The type of activities carried out may or may not be near a dialysis facility. This must be considered during the planning.

Who to inform?

Doctor-in-charge:
• You need to consult the doctor on medication and the number of dialysis needed during the trip. This will be according to the number of days planned for the holiday.
• To obtain a medical summary of your current condition. This will give the transient dialysis centers’ charge nurse an idea of your diagnosis, previous medical treatment and current status.

Nurse-in-charge:
• To help you to reschedule your treatment for your departure date & arrival date.
• To help with the medical summary.

How to find a dialysis facility convenient to the destination?

You can find this information from:
• Doctor in charge
• Nurse in charge of dialysis center
• Medical social worker
• Dialysis journals such as Dialysis & Transplantation (July issue every year)
• Internet

What is the basic information you should give the dialysis facility?

• Nurse in charge to fill up the ‘Patient information data’ which the doctor in charge has to sign.
• The days in which dialysis is needed

How do you get this information to the transient dialysis facility?

• You can fax it to them.
• If the center does not have a fax machine, you should bring the documents to the dialysis facility when you get there.

What about payment?

• You need to ask the nurse in charge of the transient dialysis facility about the amount to pay for each treatment. Preferably this should be done before you start your trip to help you with your budget. Note that most centers differentiate charges between Hepatitis B positive and negative status.
• Find out how you can pay. E.g.: cash, credit card or travelers check, etc.

Do I need to confirm treatment reservation?

• Yes. Two weeks before the departure, call the facility again to confirm.
• When you arrive at your destination, call the dialysis center again to reconfirm appointment.

What else must I do?

• You might need Resonium for this trip. Remember to take the medication according to the instructions.
• You may visit the dietitian for some advice especially if dialysis treatment is reduced during the trip.

You may visit these websites for more information:

http://www.kdf.org.sg/health.aspx
http://www.davita.com
http://www.uptodate.com/patients/index.html

Why Are Kidney Patients More Prone to Heart Disease?

By Dr Grace Lee, Medical Director (Peritoneal Dialysis), Kidney Dialysis Foundation

We are all aware that people with chronic kidney disease (CKD) are more likely to develop kidney failure and require dialysis and transplantation. However, most of us are less aware that people with CKD are also at greater risk of developing cardiovascular (heart attacks and strokes) disease (CVD) than the general healthy population. Studies have shown that the risk of CVD increases with the severity of kidney disease and this means that patients on dialysis have the highest risk of CVD. In Singapore, heart disease accounted for 32.8% of the deaths in dialysis patients in 2006 (Singapore Renal Registry).

What is perhaps more important to realise is that even with minor kidney dysfunction (those not requiring dialysis), the risk of CVD is increased. Researchers have found that the risk of a cardiovascular event (heart attack or stroke) is increased by 13% in people with Stage 3 CKD (see below for staging). Those with CKD are at higher risk because they are exposed to both traditional and non-traditional (or kidney-related) risk factors for CVD. Traditional risk factors include age, diabetes, hypertension and elevated LDL-cholesterol levels while the non-traditional risk factors include anemia, uremia and mineral (calcium and phosphate) abnormalities. In fact, CKD itself is an independent risk factor for CVD.

While risk-reduction measures are important in reducing cardiovascular events in patients with CKD, it is equally important to identify those at risk by screening people for CKD. Those at increased risk of developing CKD are people with diabetes, hypertension or a family history of kidney disease. Early detection of those with CKD will allow early intervention and prevention of CVD.

CKD Staging
The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation (NKF) of America has produced guidelines for the staging of CKD. This staging allows doctors to “speak a common language” when managing people with CKD and also helps researchers clearly define their study populations. The staging uses the glomerular filtration rate (GFR) as a measure of kidney function and this is calculated from the serum creatinine (a blood test) of the patient.

Table 1: CKD staging

The stages usually do not progress from one to another except from Stage 4 to 5. With age, kidney function deteriorates and the GFR falls. Older people above the age of 60 years may have GFRs below 60 ml/min and be categorised as having Stage 3 CKD. This does not mean that they will develop progressive kidney failure and require dialysis in later life.

Risk Factors for Cardiovascular Disease
There are traditional and non-traditional (kidney-related) risk factors.

Table 2: Risk Factors of CVD

Traditional risk factors may be classified as non-modifiable or modifiable. We cannot alter the non-modifiable risk factors such as an older age, the male gender, race or a family history of premature heart disease. However, adopting a healthy lifestyle and taking appropriate medications when indicated can control or eliminate the modifiable risk factors that have been listed in Table 2.

CKD itself is an independent risk factor of CVD, even in the milder stages. An important “early” sign of increased CVD risk is the presence of protein in the urine. Uremia (a high blood urea level) alters the cardiac structure and impairs function, anemia (lack of red blood cells) leads to high output cardiac failure and enlargement of the heart and fluid volume overload (due to the inability of the kidneys to excrete fluid) also results in cardiac failure. Malnutrition triggers oxidative stress mechanisms that may promote atherogenesis (thickening of the blood vessels).

Reducing the Risks of Cardiovascular Disease in People with CKD
The first step would be to realise that people with kidney disease have an increased risk of cardiovascular disease. Early detection of the kidney disease would allow early intervention (for both cardiovascular disease and progressive kidney failure).
Screening for kidney disease includes:
• measurement of the blood pressure,
• urine test for blood and protein,
• urine albumin/creatinine ratio, and
• blood test for creatinine level.
People with diabetes, hypertension and a family history of kidney disease are at increased risk of developing kidney disease and should be screened annually.

Once a person has been identified as having CKD, aggressive management of the CVD risk factors, both traditional and non-traditional, should be instituted.

Teaching Points
• People with chronic kidney disease (CKD) have increased risk of cardiovascular disease (CKD).
• The risk of CVD increases with the severity of CKD.
• CKD has its own set of risk factors for CVD.
• Screening and early detection of CKD can reduce the incidence of CVD.

How Do I Know I Have Kidney Disease?

By Dr Roger Tan, Consultant Nephrologist, Gleneagles Medical Centre

The important functions of the healthy kidneys are to remove waste from our blood and to regulate the water status in our body. The waste and excess water then leave our body via the urine we pass out. The kidneys also help to control blood pressure and make red blood cells in our body to prevent anemia. When the kidneys are damaged progressively over a period of months or years, they are unable to perform the various vital functions optimally. This is called chronic kidney disease (CKD). When the kidney condition worsens further and requiring dialysis support, this is termed end stage kidney failure (ESRF).

In a report published recently, 26 million Americans, or 1 in 9 American adults, have CKD and millions of others are at increased risk, but most do not even know it. In the 6th Report of the Singapore Renal Registry 2005/2006, 990 new patients were diagnosed to have ESRD in 2005 and 1111 patients in 2006. Similar to the United States, there are probably thousands of Singaporeans who have CKD or are at risk of developing CKD in the future.

Unfortunately, most CKD patients do not have any symptoms early in the disease. Most of them will feel well until their kidney diseases are in the advanced stages. Majority of the symptoms for CKD are rather nonspecific and these include:
• Feeling more tired and having less energy
• Having trouble concentrating
• Decrease in appetite
• Not sleeping well
• Dry and itchy skin
• Frequent muscle cramps at night
• Swelling of the feet and ankles
• Puffiness around the eyes, especially in the morning
• Frothy urine
• Blood in urine
• Needing to urinate more often, especially at night
• Decrease in urine output over a period of time

Such symptoms are due to the progressive lost of the vital kidney functions and hence resulting in the build up of toxins and excessive water in the body as urination decreases.

As kidney function progressively worsened, patients may develop symptoms and signs related to the complications associated with CKD such as hypertension and anemia.

The main cause of CKD in Singapore is diabetes which accounts for more than 50% of the cases. Other causes that may affect the kidney are:
• Glomerulonephritis, a group of diseases that cause kidney inflammation
• Inherited diseases, such as polycystic kidney disease, which is associated with large cystic formation in the kidneys and destroying the healthy kidney tissue
• Hypertension
• Obstructions caused by problems such as kidney stones, enlarged prostate in the elderly or tumors
• Recurrent urinary tract infections

CKD can affect people of all ages. Prevention and early identification of kidney disease increase the chance of slowing or stopping its progression. Some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:
• Have diabetes
• Have hypertension
• Have a family history of CKD
• Are elderly

There are three simple tests that the doctor might perform if there is a suspicion of CKD:
• Blood pressure measurement
• Urine test for protein and blood
• Blood test for creatinine, which is a reflection of the kidney function

Such tests should be done at the first instance the underlying disease (e.g. diabetes) is diagnosed and subsequently on an annual basis.

The goal of therapy in the treatment of CKD is to retard or halt the otherwise relentless progression of CKD to ESRF. Control of blood pressure and treatment of the underlying disease, whenever feasible, are the broad principles of management. If you have hypertension, it is important to lower the blood pressure to less than 130/80mmHg. Generally, 2 groups of medicines called ACE inhibitors and Angiotensin II receptor blockers can be of beneficial effect. These medicines not only can control the blood pressure, they also can help to reduce protein in the urine and help to prevent the kidney disease and function from worsening. Regular exercise and a healthy diet can also help to maintain your blood pressure under target level.

Controlling the blood sugar level to the recommended target level is of paramount importance in those diabetic patients. Uncontrolled diabetes not only predisposes a diabetic patient to risk of developing CKD, it also accelerates the rate of worsening of kidney function. Besides the use of various oral hypoglycemic agents and insulin, lifestyle modifications such as diet and exercise play a pivotal role in the control of diabetes.

Smoking cessation is also an important step in the management of CKD. Smoking not only damages the kidneys, it also increases the blood pressure and interferes with the medicine used to treat hypertension.

Dietary advice includes reduction in the intake of salt and protein. Too much protein can make the kidneys work too hard and increase the protein excreted in the urine which may further insult the kidneys. CKD can cause other associated complications such as hyperlipidemia (high cholesterol level), anemia and weak bones. Medications may be given to treat these complications in CKD patients.

In summary, CKD is a common disease and is associated with various serious complications. Early identification through screening, especially in those people who are at risk, increases the chance of retarding the disease progression.

Preventing Kidney Failure in Diabetes

By Vina Sim

Early intervention through education and health-screening will help build awareness for the general public to take care of their kidney health. Thus in conjunction with World Kidney Day this year, KDF has organised a Public Forum entitled “Preventing Kidney Failure in Diabetes” to highlight the importance of the connection between kidney diseases and diabetes and to draw attention to the threat present.

On 19 March 2011, close to a thousand people turned up for this complimentary forum held at the Suntec Convention Centre. In support of the forum, several companies had set up exhibition booths and conducted various health screenings and basic consultations to demonstrate the importance of monitoring one’s health condition.

The Health Promotion Board promoted their campaign on healthy Body Mass Index and did a BMI screening for forum attendees using their two BMI machines. Random cholesterol, blood glucose and blood pressure checks were available, courtesy of Steward Cross, Abbott and the Diabetic Society of Singapore, respectively. With the participation of Terumo, attendees also had the opportunity to have their vital body measurements taken, charted and advised on. The audience were each given a goodie bag which contained health brochures, Special K Cereal, Vicks lozenges, a Pokka can drink and NeWater, all of which were donated by sponsors.

The Public Forum also saw the exclusive launch of Dim Sum Stories, a collection of 15 short stories chronicling the struggles and achievements of dialysis patients and their caregivers. Dr Grace Lee, one of Dim Sum Stories’ co-editors, was on hand to promote the book and even took time out to personally autograph copies of the book for a lucky few.

During the second half of the forum, specialists and a dietitian built awareness for the topics that they covered. Some of the topics addressed were the relationship between diabetes and kidney failure, the meaning of a “diabetic diet’”, and explanations on the mechanisms and effects of diabetic medications. A question-and-answer session also allowed the audience the opportunity to have their queries answered by the health professionals present.

The forum ended on a high note with KDF’s 15th Anniversary Lucky Draw and 10 lucky winners walked away with attractive prizes sponsored by Steward Cross, Abbott, Terumo and KDF.

The organising committee of the KDF Public Forum 2011 would like to thank our sponsors: Lee Foundation, Asiapharm Biotech Pte Ltd, Baxter, Gambro, Tan Ean Kiam Foundation, Sime Darby and all our working partners for their contributions and kind support towards our annual forum.

We welcome your participation in our future educational events, and hope that our public education effort is encouraging the public to take preventive measures to curb the rise of kidney diseases in our community. It is important to understand that early detection and prevention could reduce your chances of becoming a victim to chronic kidney diseases.

The Kidney Heart Connection

We are all aware that people with chronic kidney disease (CKD) are likely to develop kidney failure and require dialysis and transplantation. However, many of us are unaware that people with chronic kidney disease are also at greater risk of developing cardiovascular diseases (CVD) as compared to the general population.

Studies have shown that the risk of developing CVD increases with the severity of the kidney disease and this means that patients on dialysis have the highest risk of CVD. To create a growing awareness of the relationship between the kidneys and heart, organizing committee for the annual public forum decided that it would be ideal to use this platform to spread that message.

The free forum held on 6th March 2010 attracted more than 1,400 people of all ages at the Suntec Convention Centre with the exhibition and the talk. To create greater awareness, this year KDF invited the Singapore Heart Foundation and Health Promotion Board to set up counters at the forum exhibition in the morning. They provided the attendees with more information about the heart and healthy living. The forum sponsors were also invited to provide the participants with various health screenings and information on the kidneys.

The cholesterol check counter set up by Hypocol was as popular as it was last year, with people lining up to have their cholesterol check the moment the exhibition started. And once again, Hypocol has generously donated all the proceeds from the cholesterol check to KDF. This year with the participation by Singapore Heart Foundation, we were able to provide our forum goers a blood glucose check as well as a body fat measurement. Drink samples of milk were provided by Nestle and all forum attendees received a free packet of Sunflower Oil provided by Sime Darby.

During the afternoon, the public forum attendees were treated to talks given by the doctors and dietitian. The speakers addressed heart and kidney issues as well as how these two organs are connected, the deterioration of one could lead to related diseases in the other.

With an overwhelming response at the question and answer session, the forum ended on a high note and also showed the audience’s strong interest in learning more about diseases related to the kidneys and heart.

The organizing committee of KDF Public Forum 2010 would like to thank our sponsors; Asiapharm Biotech Pte Ltd, Baxter, Lee Foundation, Roche Singapore Pte Ltd, Nestle, NEWater, Sime Darby Edible Products Ltd and Singapore Totalisator Board and all our working partners for their contributions and kind support towards this successful forum. We look forward to organizing the next public forum and welcome you to join us next year.

Nanyang Polytechnic Clinical Attachment

By Caroline Tay

Since 1999, KDF has been accredited for the Nanyang Polytechnic Advanced Diploma in Nursing (Nephro-Urology) Course. Each year, small groups of students from the Polytechnic are sent forward to KDF Dialysis Centres for field visits and clinical placements.

During these visits, the students were given a brief introduction of our Foundation and oriented to various areas of the dialysis centre. They were attentive and showed great interest while touring the specialised areas of the centre. The students were especially keen when it came to the section where they were shown the before and after dialysis procedures, as demonstrated by the professional nurses working at the centre.

The clinical attachment not only provided the students with the opportunity to be exposed to how dialysis procedures are performed, it also gave them an opportunity to learn about the wide scope of work that KDF is doing, such as the patient support group, brochures for the patients and public, and educational programmes for its patients and nurses.

Many of these students are from the restructured hospitals. Thus, the clinical placement is also a means for them to find out how satellite dialysis centres function. Unlike the restructured hospitals where more immediate short-term services are provided, satellite dialysis centres are involved in the maintenance of dialysis treatment and long-term care. This creates another impetus for learning.

Through this programme, we hope to achieve and maintain high-quality care and standard of nursing practice through the exchanging of ideas on the best practice in renal care.