Kidney disease often goes undetected until it’s too late, making it a silent killer. Dr. Lye Wai Choong explains how treatment has evolved over the last decade — especially for diabetic kidney patients — with new medicines now available to delay or prevent kidney failure. He highlights that kidney transplant is far superior to dialysis, doubling the patient's lifespan in many cases. In India, cultural habits around food and body image have led to rising obesity, which is a major cause of diabetes, hypertension, and kidney disease. Dr. Choong warns that excessive food is the real threat — calling obesity a silent epidemic that must be addressed to prevent serious kidney and other health problems.

Shahid Akhter, Editor, Healthyouonline, spoke to Dr. Lye Wai Choong, Kidney Specialist, Mount Elizabeth Hospital, Singapore, to understand the causes, risks, treatment advancements, and prevention strategies related to kidney disease — including dialysis, transplant, diabetes, obesity, and lifestyle factors.

Kidney Disease: Silent Killer 

Kidney disease is a silent disease.  Many patients with kidney disease are not aware that they have kidney disease until it's very late. In the past, say 15 years ago, there was no treatment for kidney disease. There is no longer applies and there are effective treatment for kidney disorders.

Managing Kidney Disease : Advancement   

Well, the treatment of kidney diseases has changed in the past ten years, especially with regards to the treatment of patients with diabetic kidney disease. Now there are new options. There are more medicines  available to prevent worsening of the kidney disease. 

Patients with diabetes and kidney disease should have more opportunities to prevent their kidneys from worsening and to prevent dialysis or require a transplant. The treatment of kidney disease has basically evolved from a time when little treatment was available to a time when there are many opportunities to prevent a patient from having failed kidneys. 

It is cultural for people in India to eat more. It is cultural too, locally in India to be a little on the overweight side. It is supposed to be healthy. Overweight is supposed to be better looking too. More positive is a person's physique when he is overweight. But being overweight carries with it the risk of diabetes and the risk of hypertension. So I see a lot of problems with diabetes now, among, patients from the Indian subcontinent. 

Kidney Diseases

Other reasons for kidney disease would be autoimmune kidney conditions like glomerulonephritis, kidney stone disease in this part of the world, hereditary hereditary kidney diseases like polycystic kidney diseases and of course, there are congenital kidney conditions in the pediatric population. 

60% of kidney diseases could be attributed to diabetes. 25 to 30%, from glomerulonephritis, which are what we call autoimmune kidney diseases. And then you have the miscellaneous 5 to 10% from hereditary kidney diseases and kidney stones. So it varies a bit from country to country.  

Kidney Dialysis vs Transplant

Well, for most patients, kidney transplant is the best mode of treatment for patients with kidney failure. I mean, of course you have dialysis, but dialysis is an inferior alternative. We are not talking about kidney transplant as improving just the quality of life. Kidney transplant increases the longevity of the patient. So if you have   a patient with kidney failure and if you have a kidney transplant, a successful kidney transplant approximately doubles the lifespan of the patient compared to a patient on dialysis. 

Well, the success of a kidney transplant has changed tremendously. Now we talk about a kidney transplant lasting 15 to 17 years in a patient, in 50% of patients who undergo a kidney transplant. 

Prevention

But being overweight carries with it the risk of diabetes and the risk of hypertension. So I see a lot of problems with diabetes now, among, patients from the Indian subcontinent. And it is important. And I remind them again and again that excessive food becomes a poison. 

Excessive food is a poison. And the patients always laugh at me. They called me the doctor who says food is a poison, but really obesity? It's a killer. And obesity is because of food, of excessive food. Unhealthy food, carbohydrates, refined sugar, all this are entirely, avoidable and preventable so that, one can, one can steer away from obesity related medical problems. Now that can be protected. 

There are no real specific restrictions. People talk about a lower protein diet, but that plays a very small role in kidney disease. Basically I think is still obesity. Obesity leading to diabetes, obesity leading to hypertension and obesity alone. Obesity per se leads to kidney disease. Even if you don't have diabetes. So obesity leads to a multitude of medical problems. Heart disease, hypertension. Heart disease. Joint diseases. Musculoskeletal diseases. Sleep apnea. I think obesity associated medical problems is not taken seriously. One should look into obesity. And I think if you reduce obesity you will get rid of a lot of medical problems. 

Of course, if you have kidney stones you need to drink more water  because water prevents kidney stones, but otherwise excessive water drinking does not protect against kidney diseases. Vitamins certainly do not protect against kidney diseases. Supplements do not protect against kidney diseases.