【Kidney Failure】How much does dialysis cost? Learn about the symptoms, causes and treatments of kidney failure.

The early symptoms of kidney failure are often subtle and easily overlooked. By the time it is detected, kidney function may already have deteriorated severely, making dialysis necessary to sustain life. According to data from the Hospital Authority, Hong Kong currently has more than 10,000 patients with end-stage kidney failure, while kidney disease ranks seventh among Hong Kong’s top 10 causes of death. What exactly is kidney failure? What are its symptoms? What treatments are available? How much does dialysis cost? In this article, we will outline the causes of kidney failure and provide information about dialysis.

The kidneys are vital organs in the human body. They are primarily responsible for excreting waste products generated by metabolism and regulating the body’s fluid and electrolyte balance. When the kidneys are damaged and unable to function normally, kidney failure may occur. Kidney failure, also known as end-stage renal disease (ESRD), affects the functioning of all the body’s organs. When it progresses to end-stage kidney failure, it may become life-threatening without dialysis treatment or a kidney transplant.

Kidney failure can be classified as acute or chronic:
Acute kidney failure refers to a sudden decline in kidney function over a short period, causing toxins, waste products and water to accumulate in the body. Kidney function may deteriorate rapidly within hours to days. If treated promptly, kidney function can generally be restored; however, if not properly managed, it may develop into chronic kidney failure.

Chronic kidney failure refers to a gradual and persistent decline in kidney function resulting from severe damage to the kidneys caused by certain factors. Waste products accumulate in the body and cause problems with various bodily functions. In severe cases, dialysis may be required to sustain life. Chronic kidney failure is a serious and irreversible disease.

Based on signs of structural damage to the kidneys and the extent of declining kidney function, chronic kidney disease can be divided into five stages.

Stage 1: Normal or slightly reduced GFR

• Kidney function is essentially normal, but abnormalities may be detected in urine or imaging tests, such as blood in the urine and/or proteinuria.
• Glomerular filtration rate (GFR) ≥90mL/min/1.73㎡.

Stage 2: Mild kidney function impairment  

• Mild chronic kidney disease. Patients may experience symptoms such as frequent urination, nocturia and blood in the urine, but kidney function remains above 60% of normal  
• Glomerular filtration rate (GFR) 60-89mL/min/1.73㎡.

Stage 3: Moderate kidney function impairment

• Kidney function is 30 to 59% of normal
• Glomerular filtration rate (GFR) 30-59mL/min/1.73㎡

Stage 4: Severe kidney function impairment

• Kidney function is 15 to 29% of normal. Patients may experience symptoms such as fatigue, high blood pressure and shortness of breath
• Glomerular filtration rate (GFR) 15-29mL/min/1.73㎡.

Stage 5: End-stage kidney failure

• Kidney function is below 10 to 15%, and dialysis (kidney dialysis) or a kidney transplant is required to sustain life.
• Glomerular filtration rate (GFR) ＜15mL/min/1.73㎡.

The early symptoms of chronic renal failure are not obvious. The following are common symptoms of chronic renal failure:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Insomnia
• Frequent urination or reduced urination
• Foamy urine
• Cloudy urine
• A burning sensation when urinating
• Passing small sand-like stones in the urine
• Muscle pain and cramps
• Swelling in the feet and ankles
• Dry, itchy skin
• Lower back and abdominal pain
• High blood pressure
• Difficulty breathing
• Shortness of breath
• Blood in the urine
• If fluid accumulates around the endocardium, chest pain may occur

According to the Hong Kong Hospital Authority Renal Registry, the causes of end-stage renal failure are as follows:   

• Diabetes: 49%
• Glomerulonephritis: 22%
• Hypertension: 11%
• Unknown cause: 9%
• Other causes: 3%
• Hereditary causes (such as polycystic kidney disease): 3%
• Urinary tract problems: 3%

Some common diagnostic methods for kidney diseases are as follows:

• Urine test: Detects red blood cells, white blood cells and protein in the urine to determine whether any abnormal substances are present.
•  Kidney function tests:     

. Blood tests: Measure indicators such as urea, creatinine, protein and protein quantity   to assess kidney function.

. 24-hour urine test: Collects all urine produced over a 24-hour period and measures creatinine concentration and protein quantity.

•  Imaging tests: 

. Ultrasound examination: Uses ultrasound to examine the size, shape and structure of the kidneys and detect abnormalities such as blockages.

. Intravenous pyelography: A contrast agent is injected into a vein, followed by X-rays to capture images of the kidneys and ureters. This can detect structural abnormalities in the kidneys and ureters, such as tumours and stones.

• Kidney biopsy: A small piece of tissue is removed from the kidney under local anaesthesia for microscopic examination, allowing kidney diseases such as nephritis and polycystic kidney disease to be diagnosed more accurately.

First, it is important to understand that chronic kidney failure cannot be completely cured. However, appropriate treatment can control the symptoms and reduce complications. If chronic kidney failure is caused by diabetes, high blood pressure or nephritis, treatment should address the underlying causes. Patients should attend regular follow-up appointments and strictly follow their doctor’s advice and instructions on dietary control, taking medication regularly and exercising regularly to control the condition.

Dietary control

Patients with chronic kidney failure should strictly control their diet, such as limiting their protein intake, to preserve kidney function. In addition, patients should limit their intake of potassium, phosphorus, sodium and fluids, and control their cholesterol levels. Patients should discuss and devise a suitable meal plan together with healthcare professionals and a dietitian.

Medication

There are currently no medicines that directly treat chronic kidney failure, but the following medicines can be used to reduce complications:

•  Antihypertensive medicines: High blood pressure can accelerate the deterioration of kidney function. Therefore, controlling blood pressure is the foundation of kidney disease treatment. Commonly used antihypertensive medicines include angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB).
• Erythropoietin supplements: Impaired kidney function can cause anaemia. Erythropoietin supplements, such as erythropoietin (EPO), can stimulate the bone marrow to produce red blood cells and improve anaemia.
• Vitamin D: Impaired kidney function can affect the absorption of vitamin D. Vitamin D supplements should be taken to increase the availability of calcium in the body and prevent fractures.
• Phosphate binders: Impaired kidney function can affect the excretion of phosphorus, leading to hyperphosphataemia. Phosphate binders can lower blood phosphate levels.

Dialysis treatment 

In end-stage kidney failure, the kidneys can no longer function independently, and patients need dialysis treatment to remove waste products and excess fluid from the body in order to sustain life. Dialysis treatment is mainly divided into haemodialysis and peritoneal dialysis.

Haemodialysis, also known as “blood washing”, uses a dialyser to remove excess fluid, electrolytes and waste products from the blood, before returning the filtered blood to the body. Patients usually undergo haemodialysis 2 to 3 times a week, with each session lasting approximately 4 to 6 hours. “Blood washing” is quick and effective, but patients need to receive haemodialysis at a designated dialysis centre, and the treatment is expensive.

Peritoneal dialysis, also known as “abdominal washing”, uses the network of small blood vessels in the peritoneum for dialysis, but patients must first have a peritoneal dialysis catheter inserted. Dialysis fluid is introduced into the abdominal cavity through the catheter and remains there for 4 to 10 hours, after which the dialysis fluid and waste products in the body are drained simultaneously. Patients can undergo peritoneal dialysis at home, but need to carry out 3 to 4 treatment sessions every day.

Kidney transplant surgery

Kidney transplantation is currently the most effective treatment for kidney failure. It can free patients from dialysis and help them resume a normal life. In Hong Kong, there are mainly two sources of kidney donors: deceased donors and kidney donations from relatives or friends. However, surgery may cause various complications and rejection. According to data from the Hospital Authority, as of 31 March 2024, the cumulative number of people in Hong Kong waiting for a kidney transplant was 2,429.

While waiting for a kidney transplant, patients with end-stage renal failure need to undergo regular dialysis to sustain life. The haemodialysis fees at various private hospitals are as follows:

The Government does not require Voluntary Health Insurance Scheme plans to provide outpatient renal dialysis coverage. However, some flexible Voluntary Health Insurance Scheme plans on the market do offer outpatient renal dialysis coverage, although relevant medical certification must be provided, such as a referral letter or a statement from the attending or registered doctor in the claims application form.  

There are several insurance companies in Hong Kong offering Voluntary Health Insurance Scheme plans, including Standard Plans and Flexi Plans. The coverage of Standard Plans is broadly similar, whereas Flexi Plans vary from one company to another, so it is advisable to make a careful choice before taking out a policy. Want to know which Voluntary Health Insurance Scheme plan is the best? As an insurance comparison platform in Hong Kong, 10Life understands your needs and has designed a simple interface that enables policyholders to easily compare different Voluntary Health Insurance Scheme plans at a glance. It has also introduced a rating system designed by actuaries to fairly compare the details of different insurance products, allowing policyholders to choose an insurance product that suits them. To learn more about Voluntary Health Insurance Scheme plans, please refer to 10Life's Voluntary Health Insurance Scheme comparison.

Sources: the Department of Health's Centre for Health Protection, the Hospital Authority's Smart Patient Website, and information from medical institutions

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.