Yong Jun Yuan/TODAY
Mr Nathaniel Alejandrino (pictured), who is 25 years old and has end-stage kidney failure, goes for haemodialysis three times a week.
Published27 JUNE, 2020UPDATED 27 JUNE, 2020
SINGAPORE — Mr Nathaniel Alejandrino is 25 and is building up his savings not to get his first flat or to plan for a wedding like his peers. The sales executive is working hard to save up for a kidney transplant, which is likely to cost him around S$100,000.
He was only 22 when he was diagnosed with end-stage kidney failure and he is now on the waiting list for a renal transplant.
The average waiting time for a cadaver kidney donor is around nine years.
Mr Alejandrino, a permanent resident from the Philippines who has lived here since he was nine, was a recruit undergoing Basic Military Training during National Service when he started experiencing severe feet swelling, loss of appetite, altered taste, and fatigue — the classic warning symptoms of kidney failure.
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He was hospitalised for a month and underwent emergency dialysis.
Although he had severe hypertension — one of the risk factors for kidney failure — Mr Alejandrino said he was shocked to learn that his kidneys could no longer function properly.
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“I had just graduated (from polytechnic), and was looking towards a bright future. I wanted to pursue a degree after completing National Service. Then all of a sudden, I was diagnosed with end-stage kidney failure. It was overwhelming and traumatising,” he said.
One of the 3,805 patients in the haemodialysis programme by the National Kidney Foundation (NKF) as of May this year, Mr Alejandrino spends his Monday, Wednesday and Friday evenings undergoing haemodialysis — a process whereby the blood is cleansed of toxins, extra salt and fluids through a dialysis machine.
Without it, he would not be able to survive.
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As people with kidney disease are also more vulnerable to Covid-19 complications if they get infected, Mr Alejandrino has been extra cautious during this period.
MORE CASES OF KIDNEY FAILURE CASES
Kidney failure is on the rise here. The number of people diagnosed with end-stage kidney failure has jumped by more than 50 per cent in the past decade, from 1,275 in 2009 to 1,999 in 2017, data from the Singapore Renal Registry Report 2018 showed.
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Dr Behram Ali Khan, director of medical services at NKF, said that the situation is mainly due to an increase in people with diabetes and an ageing population.
Decline in kidney function rises with age, but he pointed out that kidney failure is preventable.
While kidney failure affects mainly older adults, it can hit younger adults as well.
Dr Behram said that about 1 per cent of applicants who wants to join the NKF haemodialysis programme between the period of January 2019 and May 2020 are aged between 20 and 29.
In Singapore, diabetes remains the main cause of kidney failure, causing two in three cases of kidney failure, he said.
Hypertension, which Mr Alejandrino has at age 20, can also damage the kidneys if uncontrolled.
Of the 561 new patients seen at NKF in 2018, more than a third (69 per cent) have diabetes while around one in 10 (10.7 per cent) had hypertension.
High blood sugar can damage the blood vessels and the tiny filtering units, known as nephrons, inside the kidneys over time. The damage is permanent and worsens over time, Dr Behram said.
In hypertension, the arteries have narrowed, weakened or hardened, which prevent blood flow to the kidney tissue. The damaged arteries limits nephrons in the kidney from receiving essential oxygen and nutrients, causing the kidneys to lose their functions of filtering waste and water from the body, he added.
Dr Behram said most of the patients admitted to NKF who are diabetic also suffer from hypertension. When longstanding diabetes affects kidney function, the kidneys are not able to regulate blood pressure adequately, he said.
Describing diabetes and hypertension as silent killers, Dr Behram said that people with these chronic diseases may not experience symptoms. Even after they are diagnosed, most people may not feel the need to change their lifestyle and diet.
“Some would even skip their medication. By then, it would be too late and their kidneys would have failed. They would require dialysis or kidney transplant to survive,” Dr Behram said.
POOR EATING HABITS INCREASE RISK
For Mr Alejandrino, an unhealthy diet consisting of regular fast-food meals, stress and a lack of sleep from juggling his academic studies and school projects led to poor health.
At 20, he was diagnosed with severe hypertension. At the time, he tipped the scales at around 110kg.
An old photo of Nathaniel Alejandrino when he was overweight. Photo: Nathaniel Alejandrino
Ms Lim Zetong, a dietitian at NKF, said research shows that poor eating habits, smoking and obesity are linked to an increased risk of kidney failure.
A poor quality diet is defined as one that is high in sodium, red and processed meats and sugar-sweetened beverages, and low in fruit, legumes, nuts, wholegrains and low-fat dairy.
After the health scare, Mr Alejandrino swore off fast food, ate more healthily and started exercising, losing more than 10kg in the process. He also learnt to manage his stress levels better.
However, his success in overhauling his lifestyle made him overconfident in managing his hypertension.
“When my medications ran out, I didn’t follow up, thinking that exercising and eating healthily would treat my hypertension naturally. Gradually, it came back,” he said.
RISK FACTORS CAN BE CONTROLLED
For people with early-stage kidney damage, medication and diet can help slow down and control the progression of kidney failure, Dr Behram said. However, there are no clear warning signs in the early stage.
By the time a person gets kidney failure, it generally cannot be reversed, especially if it is due to long-standing illnesses such as diabetes and hypertension, he added.
However, chronic diseases such as diabetes and hypertension can be prevented or controlled, and prevention of kidney disease should start from young, Dr Behram said.
One of the ways that NKF raises awareness on kidney health is through its kidney health education buses, which are powered by augmented reality technology and equipped with interactive exhibits. These buses mainly make their way to schools or to NKF’s events.
“By promoting food eating habits and active lifestyle from a young age, these young change-makers would be able to proactively nudge their peers and family towards a long-lasting healthier lifestyle, and ultimately keep kidney disease and kidney failure at bay,” Dr Behram said.
For those with diabetes or hypertension, Ms Lim emphasised the importance of a healthy balanced diet and active lifestyle that includes at least 150 minutes of moderate-intensity physical activity such as brisk-walking, cycling or jogging.
They should also take their medications as prescribed to manage their pre-existing chronic conditions effectively.
RETHINKING LIFE CHOICES AND FINANCES
Although Mr Alejandrino could have been exempted from National Service due to his medical condition, he chose to complete it.
“To be honest, I struggled to make a decision. If I had (taken the exemption), I would have been ahead of my peers and started work earlier. In the end, I continued my National Service because of gratitude. I was very grateful for SAF’s support during my hospitalisation,” he said, adding that he is also grateful to have MediShield, an insurance scheme under the Central Provident Fund, and to NKF for treatment subsidies.
Mr Nathaniel Alejandrino (left) in a picture taken in 2019. Photo: Nathaniel Alejandrino
Having to confront mortality at a young age made him think deeply about end-of-life issues and his finances. He spent the long hours at the dialysis centre doing e-learning on financial literacy.
He tries to save and invest whatever he can from his monthly salary of less than S$3,000, after paying for his daily expenses and dialysis treatment. He estimated a kidney transplant would cost him around S$100,000.
He has considered the worst-case scenario that he might die before a donor is available.
“Will my personal savings be enough to cover my own funeral? Before I think like an ordinary person and dream of having a house and raising a family, these are some real considerations that young patients like me should face first. I don’t want to be a liability to my parents so part of my preparation for death is in my own finances,” he said.
Even as he plans for death, his illness has also made him more appreciative of life.
“Not many people like to think about death or prepare for it. But reflecting on our own mortality, even for healthy people, makes us more appreciative of everything we do today. It gives us a sense of urgency to fulfil our purpose,” he said.
HEALTHIER EATING
A healthy diet can reduce your risk of chronic diseases that increase the risk of kidney failure. However, it does not mean that you have to give up your favourite foods all at once.
Ms Lim Zetong, a dietitian at the National Kidney Foundation, said that the key is to consume food in moderate amount, keeping portion control in mind.
Here are some tips:
Use the “My Healthy Plate” concept to fill one quarter of the plate with whole grains, one quarter with meat and half of the plate with fruit and vegetables.
Choose fresh foods instead of processed foods.
Use natural ingredients such as garlic, onions and garlic when cooking instead of salt and sauces.
When dining out, opt for foods prepared using healthier cooking methods such as steaming, boiling and stir-frying, and ask for less salt and less oil. For example, opt for fish slices rather than fried fish slices when ordering fish soup.
Choose lower-sugar beverages such as coffee or tea “siu dai” or those with no milk
Topics
hypertensiondiabeteskidney failureNational Kidney Foundationhealth
Read more at https://www.todayonline.com/singapore/young-mans-cautionary-tale-how-he-had-kidney-failure-22
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