Top 5 Things You Need to Know About Dialysis

What are the different types of dialysis?

There are two types of dialysis available namely haemodialysis (“blood” dialysis) and peritoneal dialysis (“water” dialysis).

Haemodialysis is a process that involves a patient’s blood being pumped through a dialyser that allows toxins and excess fluid from the patient’s body to be removed during the dialysis session.

Peritoneal dialysis is a process where a special fluid (dialysate) is introduced into the patient’s peritoneal space (abdomen). The toxins and excess fluid are diffuse out into the dialysate and are subsequently removed after the dialysate is drained out from the abdomen.

What does haemodialysis entail?

Usually, haemodialysis is performed three times a week in a four-hour session at an outpatient dialysis facility. A vascular access is required in the form of a haemodialysis catheter, an arteriovenous fistula (AVF) or graft (AVG) for haemodialysis to be carried out.

An arteriovenous fistula (AVF) or graft (AVG) is preferred to a catheter for long term haemodialysis, as the risk of serious blood borne infections is much higher on catheter-based dialysis verses via AVF or AVG.

The formation of an AVF or AVG is essentially a joining of the artery to a vein or graft to allow for a high flow of blood through the vein / graft so that blood can be easily accessible for dialysis on a regular basis. This usually involves a surgery done under local anaesthesia as a day case. After the AVF or AVG is mature and suitable for use, it can be needled for dialysis (usually one to three months from creation).

What does peritoneal dialysis (PD) entail?

Peritoneal dialysis (PD) is a form of home-based therapy where dialysis is done daily at home by the patient and / or caregiver. There are several forms of peritoneal dialysis, but it is broadly divided into automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD).

Automated peritoneal dialysis (APD)

APD requires an APD machine that assists in automating peritoneal dialysis exchanges during from eight to 10 hours daily.

Continuous ambulatory peritoneal dialysis (CAPD)

CAPD requires the patient to carry out several bag exchanges three to four times a day (each exchange usually only takes 30 minutes). Both methods have their advantages and disadvantages. The most suitable method for a patient is a joint decision between patient / caregiver and doctor.

For peritoneal dialysis to be done, a patient will need to have a peritoneal dialysis catheter placed in his / her abdomen to allow for the introduction and removal of dialysate. This is mostly a minimally invasive procedure that can be performed under local anaesthesia and sedation. That said, more advanced techniques for insertion may be required in some cases.

How much does it cost to undergo dialysis in Singapore?

The cost of dialysis is largely dependent on the type of dialysis the patient is undergoing.

Haemodialysis costs more due to facility, dialysis equipment, and labour needs. Depending on the type of haemodialysis performed, the fees range from $2,500 to $3,000 per month (before MediShield / MediSave deductions) in a private dialysis facility. There are also numerous charitable organisations (i.e the National Kidney Foundation and Kidney Dialysis Foundation) that support eligible needy patients in their dialysis centres.

Peritoneal dialysis is a home-based therapy, the fees are comparatively lower per month. They range from $1,500 to $1,900 (before MediShield / MediSave deductions). The dialysate and APD machine (if required) is supplied by the vendor on a monthly basis.

Can we use MediShield and MediSave for dialysis treatments?

Yes. Currently a patient can use up to $1,100 per month from MediShield to pay for dialysis treatments (regardless of dialysis modality) and some portions can also be claimed via MediSave.