Outpatient Kidney Dialysis Explained: Treatment Options and Medical Insurance Coverage in Malaysia

Kidney dialysis is a life-saving intervention for people with chronic kidney disease or kidney failure. For many patients in Malaysia, outpatient kidney dialysis offers the flexibility to receive treatment without being admitted to a hospital.

However, the financial burden of long-term dialysis can be disconcerting, making medical insurance an essential consideration.

This article provides a comprehensive look at outpatient kidney dialysis, covering treatment options, how dialysis works, common costs, and how insurance can play a critical role in managing expenses. Understanding these aspects will help patients and caregivers make informed decisions about treatment regimes and financial planning.

What is kidney dialysis?

Kidney dialysis is a life-sustaining medical procedure that mimics the natural functions of healthy kidneys when they can no longer do so effectively. Think of it as an artificial kidney—it removes waste products and excess fluids while maintaining safe levels of electrolytes like potassium and sodium in your blood.

Dialysis helps patients live longer and stay healthier. However, it is not a cure for kidney disease—it is a treatment designed to manage symptoms and prolong life while waiting for a transplant or as a long-term solution for those who cannot undergo surgery.

Furthermore, dialysis does not fully replace all of the activities of healthy kidneys. For instance, it is unable to activate vitamin D to preserve bone health or create hormones needed for the creation of red blood cells.

This treatment has evolved considerably since its introduction, and today's kidney dialysis machines are sophisticated pieces of medical technology that offer various treatment options to suit different patient needs.

When is kidney dialysis needed?

You might need kidney dialysis when your kidneys function at less than 10-15% of their normal capacity. Such a condition is known as end-stage renal disease (ESRD) or kidney failure.

Doctors typically recommend dialysis when the glomerular filtration rate (GFR), which measures kidney function, falls below 15 mL/min/1.73 m².

Several conditions may lead to this situation:

• Chronic kidney disease (CKD).

• Severe acute kidney injury.

• Diabetes complications.

• Uncontrolled high blood pressure.

• Polycystic kidney disease.

• Severe infections affecting the kidneys.
  
  

Key indicators that suggest one might need dialysis include:

• High levels of waste products in one's blood (particularly urea and creatinine).

• Severe fluid overload.

• Dangerous electrolyte imbalances.

• Persistent nausea and vomiting.

• Difficulty breathing.

• Confusion or difficulty concentrating.

 

How does kidney dialysis work?

The basic principle of kidney dialysis involves cleaning one’s blood using a specialised filter. The process eliminates waste products and excess fluid while maintaining proper chemical balance in the body. Here's a step-by-step breakdown of how the process works:

1. Blood access: One's blood is accessed through a surgically created entry point, typically in the arm. This may be done using one of three methods:

   • Arteriovenous (AV) fistula: where a connection is made between an artery and a vein.

   • AV graft: where a graft (a synthetic tube) connects an artery to a vein.

   • Central venous catheter (where a catheter is inserted into a large vein, often in the neck or chest).
     
     

2. Filtration: During this step, blood passes through a dialyser (artificial kidney). Inside the dialyser, blood flows through hundreds of tiny fibres, retaining red blood cells and proteins while allowing waste materials and extra fluid to pass through. The dialyser uses a unique solution known as dialysate to help remove toxins and preserve electrolyte balance.

3. Cleaning: Waste materials like urea and creatinine are eliminated from the blood as it flows through the dialyser, along with extra fluid. These wastes are absorbed by the dialysate, guaranteeing that the patient receives only clean blood.

4. Return: Following filtration, a different tube that is attached to the venous needle returns the cleansed blood to the body. This process lasts roughly three to four hours each session.

5. Monitoring: Healthcare professionals monitor patients' vital signs and ensure the dialysis machine is operating properly. To ensure patient safety, they look for issues with access points or filtering effectiveness and make the required adjustments.

 

Types of kidney dialysis

There are two main types of dialysis— each suited to different patient needs and circumstances.

Hemodialysis

Hemodialysis is the most common when it comes to of kidney dialysis. During this procedure, blood is pumped through a dialysis machine for cleaning. It typically takes 4 to 5 hours and needs to be performed 3 times per week.

Key aspects of hemodialysis include:

• Requires surgical creation of vascular access (fistula or graft).

• It can be done at dialysis centers.

• Requires strict schedule adherence.

• More rapid removal of waste products.

• Higher risk of cardiovascular complications.

 

Equipment needed for hemodialysis:

• Dialysis machine.

• Blood pressure monitor.

• Water purification system.

• Dialysis chair or bed.

 

Peritoneal dialysis

Peritoneal dialysis involves infusing dialysate into the peritoneal cavity through a catheter. The fluid absorbs waste products by using the lining of one's abdomen (peritoneum) as a natural filter.

Types of peritoneal dialysis:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)

   • Performed manually.

   • Done 4-5 times daily.

   • Each session takes 30-40 minutes.
     
     

2. Automated Peritoneal Dialysis (APD)

   • Uses a machine called a cycler.

   • Performed while you sleep.

   • Takes 8-10 hours overnight.

 

Each type has advantages. Hemodialysis provides thorough cleaning but requires travel to a facility, while peritoneal dialysis offers more independence.

Nonetheless, both approaches call for continuous care, frequently multiple times per week. Furthermore, patients usually need to adhere to specific dietary recommendations to reduce side effects and optimize treatment efficacy.

Side effects and risks of kidney dialysis

While kidney dialysis is a life-saving treatment, it comes with potential side effects:

Common side effects:

• Low blood pressure.

• Muscle cramps.

• Nausea and vomiting.

• Dry or itchy skin.

 

Serious complications:

• Infection at the access site.

• Blood clots.

• Bone disease.

• Heart problems.
  
  

Patients need regular monitoring to manage these health risks. Working closely with healthcare providers ensures better outcomes.

What is outpatient dialysis?

Outpatient dialysis refers to treatment performed outside of a hospital setting, typically at a dialysis centre or at home. Outpatient options provide greater flexibility and convenience, allowing patients to integrate dialysis into their daily routines.

Inpatient vs outpatient dialysis

• Inpatient dialysis is administered to patients admitted to the hospital for medical reasons, such as emergencies or post-surgery complications.

• Outpatient dialysis serves patients who do not require hospitalisation. It helps individuals receive regular treatment while maintaining work, education, or social activities.
  
  

 

How much does kidney dialysis cost?

In Malaysia, kidney dialysis costs vary significantly between public and private facilities:

Public Hospitals:

• RM50-100 per treatment.

• Limited availability.

• Long waiting lists.

• Basic facilities.
  
  

Private Hospitals:

• RM200-500 per treatment.

• More comfortable environment.

• Shorter waiting times.

• Better facilities.

• Additional costs for medications and tests.
  
  

Monthly costs can range from RM2,000 to RM4,000 in private settings, making insurance coverage crucial for long-term management.

Does insurance cover outpatient kidney dialysis?

Many insurance policies in Malaysia cover dialysis, but the extent of coverage depends on the plan. Outpatient kidney dialysis often falls under major medical coverage, though limits may apply.

Policies such as PRUMillion Med Active from Prudential offer comprehensive benefits, including dialysis administered at an outpatient department of a hospital or registered dialysis treatment centre for chronic diseases like kidney failure. Additionally, this medical insurance plan also offers comprehensive cancer coverage. With Active Booster, policyholders will be able to enjoy high coverage with no annual limit when they opt for coinsurance, post-hospitalisation care for up to 365 days, and unlimited number of days for room & board/ICU. In addition, you can redeem up to RM1,000 No Claims Benefit annually at Prudential’s Marketplace for healthcare packages like medical checkups, vaccinations, diagnostic tests, subscription programmes and more.

Patients should carefully review their insurance plans to understand what is covered, including any co-payment or reimbursement arrangements. Some policies may also provide access to better facilities.

FAQ

Can a kidney patient survive without dialysis?

Without dialysis, individuals with end-stage renal disease will experience a dangerous buildup of toxins and fluids in their bodies, which can lead to life-threatening complications. While kidney transplantation offers an alternative, not all patients are eligible for a transplant, making dialysis essential for survival.

Is dialysis an outpatient procedure?

Yes, dialysis is often available as an outpatient procedure, particularly for individuals with stable conditions who do not require hospitalisation. Most patients with chronic kidney disease opt for outpatient dialysis at specialised centres, which provides the convenience of returning home after each session.

Can you live a normal life on kidney dialysis?

Yes, dialysis is often available as an outpatient procedure, particularly for individuals with stable conditions who do not require hospitalisation. Most patients with chronic kidney disease opt for outpatient dialysis at specialised centres, which provides the convenience of returning home after each session.

How painful is kidney dialysis?

Dialysis itself is not inherently painful, though some discomfort may arise from inserting needles or maintaining access points like catheters. Patients may also feel muscle cramps or fatigue during or after sessions. With time, most individuals adjust to the process, and healthcare providers offer support to minimise discomfort.

Conclusion

Outpatient kidney dialysis plays a vital role in sustaining the lives of individuals with kidney failure. With two primary treatment options—hemodialysis and peritoneal dialysis—patients can opt for what best suits their needs and lifestyle. While outpatient care offers convenience and lower costs, the financial burden can still be significant.

This is where medical insurance from Prudential Malaysia becomes invaluable, ensuring that patients access quality care without overwhelming financial strain.