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Senior doctor says kidney failure figures alarming

With around two thirds of premature deaths in Samoa at the hands of non-communicable diseases like obesity and hypertension, the National Kidney Foundation is eager to see less people on dialysis and more enjoying life.

Clinical Director of the National Kidney Foundation (N.K.F.), Leituala Dr. Ben Matalavea, said watching people suffer while on the gruelling treatment is “not a pretty sight,” and not necessarily one he recommends to every patient with kidney disease at its various stages.

His comments come after new research into hypertension (high blood pressure) care found gaps in treatment, from patients not being followed up on to supplies running dry, and in many cases, patients not taking their own health into their hands.

When patients do finally come to the N.K.F. for what they hope will be lifesaving treatment, they are in a “very bad state,” Leituala said.

“They will not get a whole lot better quickly, though that will be the expectation," he said.

“That is the biggest challenge, because you cannot promise anybody if they do the treatment now, they will be better tomorrow [though] for a long time were advised to have treatment.”

Kidney failure, a condition when the kidneys cannot filter waste from the blood, is often a direct result of chronic N.C.D.s. It affects the entire body, including making patients blind or partially blind, causes limbs to require amputation and can result in heart disease.

Research into Samoa shows it is largely older adults who succumb to this disease, but younger and younger patients are walking through Leituala’s doors all the time, he said, and the rates are not slowing down.

He is beginning to see patients in their 30s and 40s, when for a long time they were in their 70s or 80s, leading him to believe perhaps teenagers should start being screened for hypertension and diabetes.

“Our aim is we try and prevent people from getting to the dialysis machine whatever way we can do that,” Leituala said.

“We must revisit our old ways, we have to look at new ways, and communicate our message to the community to make a difference because at the moment it is just not working.”

At some stage, if patients come in with severe and late stage kidney failure, dialysis stops being a helpful treatment options for them. Leituala said a gentle conversation with as many concerned family members as possible will often lead to a preferred outcome: palliative care.

“We don’t want to prolong the agony, and we have to be upfront and honest with them, and be sincere,” he said.

“Our purpose is to provide a better quality of life. The last thing you want is to see someone suffering while they’re undergoing treatment.

“That’s the tragedy of it all. Diabetes and high blood pressure are treatable conditions, they can be prevented from the beginning, but if you have it, it does not mean you will end up on dialysis, no way.” 

The research made six recommendations to improving the care of chronic NCDs, among them ensuring that body weight monitoring and managing overweight and obesity join hypertension and diabetes care.

It suggests that if patients have a better understanding of the risks of obesity and the links between being overweight and the success of treatment for hypertension or diabetes, they may be more able to help themselves manage their condition.

“The patient data showed that bodyweight is poorly measured, recorded and tracked in [hypertension] patients,” the report states.

“Increased focus on bodyweight and [body mass index] by health personnel addresses the obesity problem in multiple ways. 

“It communicates to patients that body weight is an important parameter, is part of the clinical management and changes are being tracked. It provides health staff with opportunities to address body weight in patient feedback and treatment counselling. It also enables health staff to spot weight gain and the presence of severe obesity, which may require patient referral to a dietician.”

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