【Kidney Failure】How much does dialysis cost? Learn about kidney failure symptoms, causes, and treatment methods

Early symptoms of kidney failure are often subtle and easily overlooked. By the time it is detected, kidney function may already be severely impaired and dialysis may be needed to sustain life. According to Hospital Authority data, there are currently over 10,000 end-stage kidney failure patients in Hong Kong, and kidney disease ranks as the 7th leading cause among Hong Kong’s top ten fatal diseases. So what exactly is kidney failure? What are the symptoms? What treatment options are available? How much does dialysis cost? In this article we summarize the causes of kidney failure and information about dialysis.

The kidneys are important organs of the body, primarily responsible for excreting waste produced by metabolism and regulating the body's fluid and electrolyte balance. When the kidneys are damaged and cannot function normally, kidney failure may occur. Kidney failure, also known as end-stage renal disease (ESRD), affects the functioning of all organs in the body. When it progresses to end-stage renal failure, without dialysis (hemodialysis) or a kidney transplant, it can be life-threatening.

Kidney failure can be divided into acute and chronic:
Acute kidney failure refers to a sudden decline in kidney function over a short period , leading to the accumulation of toxins, waste and fluids in the body. Kidney function may rapidly deteriorate within hours to days. If treated early, kidney function can generally be restored; however, if not properly managed, it may progress to chronic kidney failure.

Chronic kidney failure refers to severe damage to the kidneys caused by certain factors, with function continuously and progressively declining. Waste products accumulate in the body and cause multiple functional problems; in severe cases, dialysis is required to sustain life. Chronic kidney failure is a serious, irreversible condition.

According to signs of structural damage to the kidneys and the degree of decline in kidney function, chronic kidney disease can be divided into five stages.

Stage 1: GFR normal or mildly reduced

• Kidney function is essentially normal, but abnormalities may appear on urine or imaging tests, such as hematuria 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, hematuria, etc., but kidney function is still maintained above about 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, hypertension, and shortness of breath
• Glomerular filtration rate (GFR) 15-29mL/min/1.73㎡.

Stage 5: End-stage renal failure

• Kidney function is below 10 to 15% and requires dialysis treatment (dialysis) or kidney transplantation to sustain life.
• Glomerular filtration rate (GFR) ＜15mL/min/1.73㎡。

Early symptoms of chronic kidney failure are not obvious; the following are common symptoms of chronic kidney failure:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Insomnia
• Frequent urination or decreased urination
• Foamy urine
• Cloudy urine
• Painful or burning sensation when urinating
• Passing small stones or gravel in the urine
• Muscle pain and cramps
• Swelling of the feet and ankles
• Dry, itchy skin
• Lower back and abdominal pain
• High blood pressure
• Shortness of breath
• Wheezing
• Blood in the urine
• If fluid accumulates around the heart lining, chest pain may occur

According to the Hong Kong Hospital Authority's renal registry data, the following are the causes of end-stage renal failure:   

• Diabetes: accounts for 49%
• Glomerulonephritis: accounts for 22%
• Hypertension: accounts for 11%
• Unknown causes: accounts for 9%
• Other causes: accounts for 3%
• Genetic (e.g., polycystic kidney disease): accounts for 3%
• Urinary tract problems: accounts for 3%

The following are some common diagnostic methods for kidney diseases:

• Urine test: checks red blood cells, white blood cells, and protein in the urine to determine whether there are abnormal substances.
•  Renal function tests:    

Blood tests: measure urea, creatinine, proteins and their levels, etc., to assess kidney function.

24-hour urine test: collect all urine over 24 hours and measure creatinine concentration and protein quantity.

•  Imaging studies: 

Ultrasound examination: uses ultrasound to check the size, shape and structure of the kidneys to detect abnormalities such as obstructions.

Intravenous pyelography: inject a contrast agent into a vein and then use X-rays to image the kidneys and ureters; it can detect structural abnormalities of the kidneys and ureters, such as tumors, stones, etc.

• Renal biopsy: under local anesthesia, a small piece of tissue is taken from the kidney for microscopic examination, which can more accurately diagnose kidney diseases, such as nephritis and polycystic kidney disease.

First, it is important to understand that chronic renal failure cannot be completely cured, but with appropriate treatment, symptoms can be controlled and complications reduced. If chronic renal failure is caused by diabetes, hypertension, or nephritis, treatment should address the root cause, with regular follow-up and strict adherence to the doctor's advice and instructions, including dietary control, regular medication, and consistent exercise to manage the condition.

Dietary control

Patients with chronic renal failure should strictly control their diet, such as limiting protein intake to preserve kidney function. In addition, patients need to restrict intake of potassium, phosphorus, sodium, and fluids, and control cholesterol levels. Patients should work with healthcare professionals and dietitians to discuss and develop an appropriate meal plan.

Medication

There is currently no medication that directly cures chronic renal failure, but the following drugs can be used to reduce complications:

•  Antihypertensive drugs: Hypertension can accelerate the decline of kidney function. Therefore, blood pressure control is the foundation of kidney disease treatment. Common antihypertensive drugs include angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).
• Erythropoiesis-stimulating agents: Impaired kidney function can lead to anemia. Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can stimulate the bone marrow to produce red blood cells and improve anemia.
• Vitamin D: Impaired kidney function affects vitamin D metabolism, so vitamin D should be supplemented to increase the body's available calcium and prevent fractures.
• Phosphate binders: Impaired kidney function affects phosphate excretion, leading to hyperphosphatemia, and phosphate binders can lower blood phosphate levels.

Dialysis treatment 

At end-stage renal failure, the kidneys can no longer function on their own, and patients need dialysis to remove waste products and excess fluid from the body to sustain life. Dialysis treatment refers to dialysis, which is mainly divided into hemodialysis and peritoneal dialysis.

Hemodialysis, also known as "blood washing," uses a dialyzer to remove excess fluid, electrolytes, and waste from the blood and return the filtered blood to the body. Patients usually undergo hemodialysis 2 to 3 times per week, each session lasting about 4 to 6 hours. "Blood washing" is rapid and effective, but patients need to go to a designated dialysis center for treatment, and it can be costly.

Peritoneal dialysis, also called "abdominal washing," uses the network of tiny blood vessels on the peritoneum to perform dialysis, but patients must first have a peritoneal dialysis catheter implanted. Dialysate is introduced into the abdominal cavity through the catheter, where it stays for 4 to 10 hours before being drained along with body wastes. Patients can perform peritoneal dialysis at home, but treatments are required 3 to 4 times daily.

Kidney transplantation

Kidney transplantation is currently the most effective treatment for renal failure, allowing patients to be free from dialysis and return to normal life. In Hong Kong, kidney donors mainly come from two sources: deceased donors and kidney donations from relatives or friends. However, the surgery may cause various complications and rejection. According to data from the Hospital Authority, as of March 31, 2024, the cumulative number of people on the waiting list for kidney transplantation in Hong Kong was 2,429.

While waiting for a kidney transplant, patients with end-stage renal failure need regular dialysis to sustain life. Below are the dialysis fees at major private hospitals:

The government does not require the Voluntary Health Insurance Scheme (VHIS) to provide outpatient dialysis coverage, but some flexible VHIS plans on the market do include outpatient dialysis coverage; however, relevant medical proof must be provided, such as a referral letter or a statement from the attending physician or a registered medical practitioner on the claim application form.  

Many insurance companies in Hong Kong offer Voluntary Health Insurance Scheme plans, including Standard Plans and Flexible Plans. The coverage of Standard Plans is largely similar, while Flexible Plans vary by company, so you should choose carefully before applying. Want to know which VHIS is best? As an insurance comparison platform in Hong Kong, 10Life understands people’s needs and has designed a simple interface that lets applicants easily compare different VHIS plans at a glance. It has also introduced an actuary-designed scoring system to fairly compare the details of different insurance products, helping applicants choose the product that suits them. To learn more about VHIS, you can check 10Life's VHIS comparison.

Sources: Centre for Health Protection (Department of Health), the Hospital Authority’s Patient Information portal, and data 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.