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Can a peritoneal dialysis patient drink coffee?

Yes, all PD patients can drink coffee. Coffee is a high Potassium (K+) beverage. A tablespoon (7g) of coffee powder contains 66mg Potassium (reference: Nutrient Composition of Malaysia Foods, 4th Edition 1997). Potassium is easy to be excreted through PD session; Most PD patients, except those who have high level of potassium in their blood, do not have to avoid high Potassium beverage e.g. coffee.

However, sweetened condensed milk and evaporated milk that are normally added into the coffee contain high level of phosphate. High level of phosphate in the blood can cause bones to become porous and weak, nervous pain, skin itchiness, and eye irritation. 1 tablespoon (19g) of sweetened condensed milk contains 40mg phosphate whereas 1 tablespoon of evaporated milk (20g) contains 43mg phosphate.

According to the National Kidney Foundation (NKF), all PD and HD patients have to limit their intake of phosphate to 800-1000mg per day. Besides that, coffee is also a type of beverage that can account for total fluid intake, restriction of fluid intake is very important for all PD patients.

Therefore, PD patients are advised to limit their coffee intake to 1 cup per day so that the restriction of fluid and phosphate can be achieved at the same time.

-Lau Wai Pooi
Dietitian
Published on May 12, 2016

My father had been diagnosed with end stage renal disease (ESRD). Is kidney transplant a better treatment option as compared with dialysis? What are the complications/side effects for being a kidney donor?

Yes, kidney transplant is the best treatment option for kidney failure, but not all patients are healthy enough to undergo the surgery and there are short-term as well as long term risks for kidney recipients, which should be discussed further.

We need to determine whether your father can undergo the kidney transplant surgery safely, particularly from the cardiovascular aspect. We must also check that the potential donor does not have any health constraint, and also whether your father’s kidney failure originates from certain diseases that may be genetically inherited by you and your siblings. As explained by the consulting doctor, there is approximately less than 5% risk that in the future, the donor’s blood pressure may go up or that he/she will leak protein into the urine. For female donors who wish to have children, they are advised to do so before donating their kidney.

Your father, and any potential donor from your family, are advised to make an appointment for consultation with the transplant unit from one of the hospitals offering kidney transplant in Malaysia, namely Kuala Lumpur Hospital, Selayang Hospital or University Malaya Medical Centre (UMMC). The clinic telephone number can be obtained per request if you are interested to proceed with the consultation. In addition, you can also obtain further information about kidney transplant from:

National Transplant Resource Centre
Tel: (03) 2694 2704/2705
Website: www.dermaorgan.gov.my

-Dr Sunita Bavanandan
Consultant Nephrologist
Published on 7 August 2015

My parents have been diagnosed with chronic kidney disease (CKD) stage 3.
i) Are there any available supplements in the pharmacy that can reduce kidney disease progression?
ii) Is CKD a hereditary disease?
iii) Am I at high risk of getting this disease too? For your information, my father is suffering from high blood pressure and my mother is suffering from diabetes.

i) Are there any available supplements in the pharmacy that can reduce kidney disease progression?
Taking medicines or supplements from pharmacy is not recommended for patients with CKD. This is because there are several medicines which are found to be toxic to the kidneys and may lead to the deteriorate of the kidneys. Herbal supplements are also not recommended and have to be avoided. Before taking any alternative medicines, it is advisable to discuss and get advises from kidney specialists.

ii) Is CKD a hereditary disease?
When one is experiencing CKD, it is not always due to the hereditary factors. There are certain kidney diseases which are caused by hereditary factors such as genetic problems (Alport Syndrome, Polycystic kidney and etc.). More than 60% of the causes of CKD in Malaysia is due to diabetes. Diabetes is considered as an inherited disease.

iii) Am I at high risk of getting this disease too? For your information, my father is suffering from high blood pressure and my mother is suffering from diabetes.
Since your mother is suffering from diabetes, you have to undergo a health check-up to ensure that you are not developing that disease. Diabetes is a major factor in causing kidney damage, especially in Malaysia.

-Dr Lily Mushahar
Consultant Nephrologist
Published on July 2, 2015

I am wife of a chronic kidney disease (CKD) stage 5 patient. Can I conceive and what is the risk of conceiving?

A female patient with CKD is not encouraged to conceive since pregnancy can lead to further deteriorate of her kidney function.

As in this case, the CKD patient is a male and there is no relation or risk for his wife or girlfriend to conceive if the wife/girlfriend does not have any health problems. However, one has to know that the fertility of the male patient can be affected due to CKD and thus difficult to have a child.

-Dr Lily Mushahar
Consultant Nephrologist
Published on June 30, 2015

I am a patient with stage 1 chronic kidney failure with hypertension, which types of food are suitable for me?

For patients with stage 1 chronic kidney failure, a healthy and balanced diet is sufficient without the need to stringently restrict your intake. At this stage, controlling the risk factors for kidney diseases such as high blood pressure and diabetes is extremely important to delay the onset of kidney damage.

A low salt and high fiber diet is strongly recommended. You are advised to reduce salt intake (including soy sauce, oyster sauce, MSG etc) in your cooking, besides limiting the intake of salty foods such as salted fish, crackers, shrimp paste and others.

In addition, you are advised to take 2 servings of fruits and at least 1 ½ cups of cooked vegetables every day to increase your fiber intake. Grains or wheat products are excellent choices as they contain a high amount of fiber.

Click here to view the recipes and dietary tips recommended by the renal dietitian for chronic kidney failure patients.

-Lau Wai Pooi
Dietitian
Published on March 31, 2014

Can I drink coffee if I have stage 1 chronic kidney failure with hypertension?

There is no evidence that coffee can adversely affect the kidneys; a cup of coffee a day normally does not cause any problem. As with other drinks, too much coffee will result in excessive intake of calories. This is due to the fact that in order for you to prepare a cup of coffee, you would normally use sugar, condensed milk or creamer which are categorized as high calorie foods with low nutritional values.

-Lau Wai Pooi
Dietitian
Published on March 31, 2014

Can I get pregnant if I have stage 1 chronic kidney disease?

There is no evidence that stage 1 CKD patients are incapable of conceiving. You are advised to consult the doctor if you are planning to get pregnant.

-Lau Wai Pooi
Dietitian
Published on March 31, 2014

What is the limitation for my daily water intake to care for the kidneys and delay the onset of kidney damage?

There is no limitation to your daily water intake, except when you have problems such as oedema and water retention.

-Lau Wai Pooi
Dietitian
Published on March 31, 2014

Can a proper exercise delay the onset of kidney damage?

As part of a healthy lifestyle, you are encouraged to exercise regularly. You are advised to work out at least 30 minutes a day, 5 times a week.

Routine daily physical activities such as doing household chores and going to work are not considered as exercise. You are encouraged to spend more time on your favorite activities such as swimming, jogging, cycling etc.

-Lau Wai Pooi
Dietitian
Published on March 31, 2014

Can I donate my kidneys to my husband while I am pregnant? Is the process feasible or should I wait until after childbirth?

Kidney transplant is the most optimum treatment option for patients with end stage kidney failure, especially for younger patients. This is due to the fact that kidney transplant is beneficial in improving patients’ quality of life compared to dialysis.

However, as you are pregnant now, you are not allowed to be a donor until the baby is born. At this time, doctors in charge of your husband’s case will help to find a suitable dialysis option for him and assess other potential donors, if any. Discuss with the doctors to obtain more information. You can also be referred to the kidney transplant unit for counseling and initial assessments.

-Dr. Sunita Bavanandan
Consultant Nephrologist

Hi, may I know the average cost of performing Peritoneal Dialysis (PD) in Malaysia? What are the places for PD? Thanks

Peritoneal Dialysis (PD) is a home-based therapy that can be performed at home or in any appropriate clean room or area. Before a patient or the patient’s care-giver is able to conduct PD therapy at home, they will have to undergo training by a PD nurse. Training usually takes place in the hospital and the duration can range from 3 to 5 days. Once the training is completed, the patient and/or care-giver will be independent to conduct the therapy at home and will only require to see the PD nurse and Nephrologist during their regular scheduled check-ups.

The PD solutions and ancilliary items required to perform PD therapy are packaged in monthly supplies. The cost per month can range from RM2,600 to RM6,000. The various factors influencing the cost are the type of PD therapy (Continuous Ambulatory Peritoneal Dialysis-CAPD or Automated Peritoneal Dialysis-APD) and the type of PD solutions required based on the doctor’s prescription. Under this monthly package, the PD solutions and ancilliary items will be delivered to the patient’s house once a month.

The cost for PD therapy is currently supported by various agencies for their members/employees, such as SOCSO (Social Security Organization), the Public Service Department, etc. PD therapy is also available through the government hospitals and PD patients in these hospitals are only required to pay a minimum amount every month. Please do consult with your Nephrologist on the therapy and the hospital PD team will be able to advise you on the various avenues for covering the therapy cost.

I am the wife of a dialysis patient. I am donating my kidney to him.
I have passed all the test and the transplant will be early next year.
I would like to learn more about the disease as i will be considered with a CKD once i live on one kidney?

I would like to take this opportunity to congratulate you for becoming a kidney donor.

When you donate a kidney, it will not change your lifestyle in a big way. There's no evidence to say that donating an organ will change your life expectancy and it does not increase your risk of getting kidney disease in your other kidney. In fact, some people are born with one kidney and live a completely normal life.

Once you have recovered from your surgery after donating your kidney, the doctor will adviced you to have regular medical check-up for life. You will be required to have monitoring of your blood pressure, blood tests ( to assess your renal function, blood sugar, cholesterol level etc) and urine test for any evidence of protein leak or microscopic blood cells in the urine. This is to ensure that you are healthy and medically fit after the surgery.

Do not worry, your doctor will monitor you regularly and adviced you accordingly for any problems encountered after donating your kidney.

- Dr Lily Mushahar
Kidney Health Education Panel
Published on November 19, 2012

What advice do you have for someone who has been diagnosed with kidney failure?

Once you have been diagnosed with renal failure, although you may feel angry, upset and disappointed, try to accept it early. There are many new things you need to set your mind to doing and this includes living a whole new lifestyle. Your life now will revolve around your treatments which may include multiple dialysis sessions. In addition, your schedule, diet, leisure time, financial spending, holidays and so on will all have to take into account your dialysis treatment and schedule.

By all means, patients should get a second opinion about their diagnosis. But they should not be like many patients I have encountered that harbour a hope that their kidneys will recover. They get caught up seeking many different opinions before finally accepting their condition. They should realise that such delays will only cause their health to deteriorate.

Remember, with a whole new range of treatment options available now, it is possible for kidney patients to do most things you do in life even when you are on dialysis, with some modifications. Patients will benefit most from maintaning a positive attitude.

- Dato' Dr Zaki Morad
Consultant Nephrologist

Is kidney disease more prevalent in Malaysia than in other countries?

It is not that kidney disease is more prevalent in Malaysia than in other countries. It is just that we are detecting the illness more efficiently now than in the past. We have better medical facilities and improved access to treatment.

Diabetes, however, which is a major cause of renal failure is more common in this country reflecting the fact that the disease is poorly treated here. There are generally similar lifestyle habits that may make kidney disease worse as they do for cardiovascular disease - these include obesity, smoking, lack of exercise and diet.

Kidney disease, like hypertension and diabetes, is a silent disease. It takes a lot of convincing and committment on the part of patients to get regular check ups and take medication regularly for conditions that, at that point in time, do not seem to affect them physically at all.

Many Malaysians do not take their health seriously. Perhaps this is because healthcare is readily available and cheap good quality care is provided by the government to almost anybody who needs it. This does not seem to be related to education levels as there are even highly-trained professionals and academics who ignore their health.

There is also an increasing trend of people wanting to try all kinds of unproven medications and traditional and complementary treatment. Direct selling, unsubstantiated claims in media advertisements and the lack of critical appraisal of products by the population lead to this state. Studies have shown that excessive consumption of certain medications such as painkillers can harm the kidney, yet large numbers of people habitually take more than the accepted dosage a day?

- Dato' Dr Zaki Morad
Consultant Nephrologist

What support is there for patients to help them and their families adapt to living with kidney disease?

Being told that you have renal failure and need to go on dialysis is indeed a traumatic experience and most, if not all, patients go through various phases of something akin to a grief reaction. In Hospital Kuala Lumpur, support is offered to new patients who are trying to adjust to the diagnosis of end stage renal failure and the reality that they must regularly undergo dialysis treatment. We have social workers that offer counselling and, in certain cases, the liaison psychiatrist is called upon to help patients adjust.

Similarly, support is also offered to patients that are already on some form of renal replacement therapy (RRT), and those that are dealing with depression and other reactions to their condition. Staff of the dialysis units may not be specifically trained as counsellors but experienced staff are an incredible support and source of encouragement to patients.

Another valuable resource to new kidney patients are the 'veteran' patients that have gone through similar experinces. Their accounts of how they have lived well with kidney dysfunction for many years carry a lot of weight with new patients. Through informal counselling, they offer compassion and friendship. All these can make a tremendous difference in other patients lives.

- Dato' Dr Zaki Morad
Consultant Nephrologist

What should be done if fistula surgery is unsuccessful, and the patient encounters shortness of breath, fatigue and sometimes tremor while putting on the catheter?

Having a fistula for haemodialysis is the optimal treatment for patients with chronic kidney failure. However, there are patients who encounter problems or difficulties accessing a fistula, especially for patients with diabetes.

As a result, these patients have to rely on catheters for a long period of time or for a lifetime to access dialysis. Using catheters for long term is not encouraged UNLESS it it inevitable, considering higher risks for infections (fever, chills, etc) and blocked veins. The nephrologist or vascular surgeons will advise patients to consider changing treatment to peritoneal dialysis if the difficulty to access dialysis/fistula persists.

We advise the patient to see the Nephrologist at the nearest government hospital for proper treatment and consultation.

-Dr Lily Mushahar
Consultant Nephrologist