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New drugs can prolong life of failing kidneys, delaying need for dialysis

2024-03-16 00:00:00.0 海峡时报-新加坡原网页

SINGAPORE – There are new treatments that can significantly slow down the progression of kidney disease, giving hope to the hundreds of thousands of people in Singapore suffering from early-stage kidney disease.

This is especially since the class of drugs called sodium glucose co-transporter-2 (SGLT2) inhibitors was placed on the standard drug list in November 2023, meaning it has become subsidised. It had been on the Medication Assistance Fund for the past two years, but that provides subsidies only for patients who have been means-tested.

SGLT2 inhibitors can slow down the progression of kidney failure by 37 per cent, said Dr Chua Horng Ruey, an expert in kidney disease at the National University Hospital (NUH).

While such drugs had originally been marketed as medication for diabetes, they have since been proven effective in slowing down the deterioration of kidney function in both people with and without diabetes.

Dr Chua, who heads the division of nephrology, or kidney disease, at NUH, said there is now “a wealth of more advanced therapeutics to treat chronic kidney disease, and especially diabetic kidney disease”.

He said that if SGLT2 treatment is started in the early stage of kidney disease, when kidney function is still good, it might add 20 more years of kidney function versus without medication. If treatment is started later, when the disease is more advanced, it could still delay the need for dialysis by a couple more years.

How long it takes for someone to progress from stage 1 to 5 can vary significantly, from a few years to two decades or more.

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Doctors say a healthier lifestyle and medication can help to slow the progression of kidney disease. The earlier it is diagnosed, the sooner interventions can start, and the better the outcome.

Dr Sheryl Gan, a senior consultant in renal medicine at Singapore General Hospital, said: “Optimal control of blood pressure and diabetes is paramount to slow down the progression of kidney disease.

“In particular, some medications to treat blood pressure and diabetes have been shown to be effective in slowing down the progression of chronic kidney disease and, more importantly, delaying the need for dialysis.”

She said that aside from SGLT2 inhibitors, blood pressure-lowering medications from the angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers classes have been shown to reduce the progression of kidney disease and need for dialysis by 15 per cent to 20 per cent.

Dr Gan stressed the importance of early detection, as treatment can be started “when there is any trace of protein leak in the urine or used to control blood pressure or diabetes before the onset of protein leak in the urine”.

Lifestyle changes such as lowering sodium intake, not smoking, weight control and exercising are just as important in slowing damage to kidneys.

Dr Yeo See Cheng, who heads renal medicine at Tan Tock Seng Hospital, said people with diabetes or high blood pressure, who are obese, have cardiovascular disease or a family history of kidney failure, should get screened for chronic kidney disease.

This is because while lifestyle interventions and kidney protective medications are still effective in stage 3 chronic kidney disease (moderate) and stage 4 chronic kidney disease (severe), they are more effective when they are started earlier, he said.