Singaporean kidney doctor shed light on a newer technique of dialysis

News Hour:

Dr. Tan Seng Hoe is a Renal Physician and an Internist runs SH Tan Kidney and Medical Clinic Pte Ltd. at the Gleneagles Hospital, Singapore. He has more than 20 years of experience in the field. He currently practises out of his clinics at Mount Elizabeth Novena, Mount Elizabeth and Gleneagles Hospitals where he sees patients with various kidney-related conditions.

Dr. Tan Seng Hoe graduated from the Faculty of Medicine at the National University of Singapore (MBBS, 1990). Upon completing his basic training in Internal Medicine, he underwent Advanced Specialty Training in Renal Medicine at the Division of Nephrology in National University Hospital. Then in 2000, through the Health Manpower Development Programme scholarship, he pursued further training in Peritoneal Dialysis at the Division of Nephrology at the University of Missouri-Columbia, USA. He was inducted as a Fellow of the Academy of Medicine, Singapore in 2000 as well as of the Royal Colleges of Physicians of Edinburgh in 2004.

Prior to coming into private practice, Dr. Tan was a senior consultant at the Renal Medicine Unit at Tan Tock Seng Hospital. He spearheaded the Unit’s development and served as the Founding Head subsequently. Dr. Tan’s commitment to the field of nephrology extends into many aspects. A firm believer of educating and molding future doctors, he is a Senior Clinical Lecturer at the National University.

He recently came to Bangladesh and shared some of this views with News Hour.

 
News Hour: What are the main differences in the modality of renal diseases in Bangladeshi patients, in your region or rest of the world?

Dr. Tan Seng Hoe: I think the overall scenario is quite similar in terms of the group of patients that we see – but I think, predominantly the risk of hypertension and diabetes are very prominent in Bangladesh. Lots of them end up with kidney problems and kidney diseases.

News Hour: What are the cutting edge services you provide – like transplantation is one thing (kidney transplant), but you know, it’s also happening in Bangladesh. From a business point of view, if I ask you – why should patients from Bangladesh seek treatment in Singapore? What are the services you offer not available here in Bangladesh?

Dr. Tan Seng Hoe: The fact, the kidney transplantation nowadays is so easy that it quite happens everywhere. The service that we have (apart from transplant) is sophisticated dialysis – it’s a little bit different. It led us a few years ago. There’s a lot of thought about hemodiafiltration. This is actually another form of dialysis (hemodialysis). This is a little more advanced form of dialysis from the conventional dialysis.

Basically, the filters are different, the machines we use are a little bit different, and the advantage of this form of dialysis is particularly useful for patients who have heart problems – where somebody may be unstable on hemodialysis.

The other advantage of the hemodiafiltration is – it helps clear better. Those patients with a big size, the clearance may not be adequate. So, hemodiafiltration actually helps to increase the clearance of the toxins applied.

News Hour: Does it provide any benefit in comparison to the conventional dialysis for less frequency or any other compliance issue?

Dr. Tan Seng Hoe: I think there’s no head to head comparison between these two – hemodiafiltration do less frequency versus conventional dialysis with normal frequency.

It’s actually better than the dialysis which is three times a week for example, but if we do hemodiafiltration, generally I may have patients who want hemodiafiltration twice a week dialysis.

News Hour: So, what are the main benefits heart patients get from this?

Dr. Tan Seng Hoe: It is a bit more stability in the blood pressure. A lot of the heart patients, when they do hemodialysis, blood pressure drops; so they cannot do it in fact. Hemodiafiltration gives them a little more cardiac stability.

News Hour: Is it more expensive?

Dr. Tan Seng Hoe: Yeah, definitely. The treatments are different, the machine is a bit different as well.

News Hour: We are seeing the dialysis technique for quite a long time; there have not been that significant changes, for example, if I say about insulin and insulin pump; is there any advancement in portable kind of dialysis?

Dr. Tan Seng Hoe: There is currently some research going on; we’ve got through wearable dialysis which a few countries are actually developing this. Singapore has got one company which is developing a portable dialysis at this point. And this is a variant form of peritoneal dialysis where you bring the machine around. It’s still right now in development.

News Hour: Can you tell us about some lifestyle modification for kidney disease?

Dr. Tan Seng Hoe: Yeah, I see a whole region of patients usually come to me. A lot of their lifestyle is not okay. One of the things when we come to patients, when we give them treatment – they don’t want it – they ask, can we avoid medication or reduce medication? So lifestyle modification is very important.

If we look at the risk of development or progression of kidney diseases – high blood pressure, diabetes, cholesterol, protein loss in the urine – these are receptors that increase the risk of progression including their habits – smoking, for example. So when we talk about lifestyle modification, it actually centers around all these few things that we want to manage – blood pressure, reduce salt intake, diabetes control is important, reducing sugar and being in control of high blood sugar level and for that, between hypertension and diabetes, exercise comes in; being active in the lifestyle, open to promoting exercises, reducing weight and stop smoking if there is smoking.

Thanks.

News Hour: Thank you.

Tareq Salahuddin

Dr. Tareq Salahuddin is an award-winning journalist and a Special Correspondent of News Hour. He is a Public Health Professional working in the development sector. Dr. Tareq, a medical graduate, is a member of Public Health Association of Bangladesh and a former member of the Governing Council and Policy Committee of the World Federation of Public Health Associations (WFPHA), a J2J Fellow on HIV/AIDS and a member of the International AIDS Society. To know more about Dr. Tareq, please visit his personal website (www.tareqsalahuddin.net) or simply Google his name.
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