Taiwan's high dialysis rate prompts call for national prevention office

Taiwan faces the world's highest prevalence of dialysis treatment, leading medical professionals and advocacy groups to call for the establishment of a dedicated "national-level project office" to better coordinate chronic kidney disease prevention efforts.

Multiple nephrologists and the Legislative Health and Welfare Promotion Association are urging the government to elevate the coordination of chronic kidney disease (CKD) prevention policies to at least the Executive Yuan level. This move, they argue, is crucial for ensuring unified authority and sufficient decision-making power to tackle the issue effectively. A core key performance indicator (KPI) proposed for this initiative is the reduction of new dialysis patients.

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The incidence and prevalence of end-stage renal disease have remained high for many years. Currently, there are more than 90,000 dialysis patients in our country, and about 12,000 new dialysis patients are added each year. The treatment costs account for nearly 8-9% of our country's total health insurance expenditure, causing a considerable financial burden.

Professor Hsu Chih-cheng, executive director of the National Institute of High-Altitude and Health Welfare Research at the National Health Research Institutes, highlighted that approximately 10% of Taiwan's population suffers from CKD, with the rate rising to 24% among the elderly. The incidence and prevalence of end-stage renal disease remain high, with around 90,000 patients currently undergoing dialysis. The annual addition of approximately 12,000 new dialysis patients places a substantial financial burden on the national health insurance system, accounting for nearly 8-9% of its total expenditure.

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In the past, government attempts to promote integrated plans lacked unified authority and sufficient power, ultimately becoming mere indicator review units. Although there are many policies and foundations for prevention and treatment, the overall situation is like a 'hodgepodge,' which is truly regrettable.

Hsu also pointed out an imbalance in dialysis treatment methods, with 90% of patients undergoing hemodialysis and only 10% using peritoneal dialysis, despite encouragement from the National Health Insurance Administration. He stressed the importance of early intervention through health education, lifestyle adjustments, and timely medication to slow the progression of CKD and reduce the incidence of end-stage renal disease, especially given the common comorbidities like hypertension and dyslipidemia.

Legislator Liu Chien-kuo, who co-established the "Chronic Kidney Disease Prevention Policy Promotion Committee," emphasized that CKD prevention involves multiple facets, including health promotion, general check-ups, primary care, specialist referrals, insurance coverage, and long-term follow-up. He believes a national-level office, potentially integrated across ministries and systems, is necessary to truly connect policy resources. Huang Shang-chih, chief physician of nephrology at Kaohsiung Medical University Hospital and the committee's chairman, echoed this sentiment, noting past attempts at integrated plans lacked unified authority and sufficient impact, likening the current approach to a "hodgepodge."

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To advance our country's chronic kidney disease prevention, we not only need to truly reduce the number of new dialysis patients but also prevent kidney disease from occurring from the front end. The government should establish a unified, responsible unit at the Executive Yuan level or above, using a national-level project office as the executive body and means.