CHRONIC kidney disease (CKD) is a growing spectrum disorder in the Philippines that needs a better understanding from among the populace to prevent its progression, take care of, save, or even reverse, the deteriorating condition of patients with long-standing renal malfunction.
While various treatments are now available for this disease, including its underlying conditions, the most common cures at its worse phase are dialysis and kidney transplantation.
“When you are on stage five, then, that’s the time you’ll be on dialysis. Actually, the increase in the number of dialysis patients is like 17 percent per annum, or maybe getting to 20 percent now,” Dr. Rose Marie R. Liquete, executive director of the National Kidney and Transplant Institute (NKTI), said in a news briefing following the opening ceremony for the National Kidney Month (NKM) held at the hospital on Monday, June 5, 2023.
Since one patient develops a CKD every hour, it is no doubt that many of the more than a hundred million population of Filipinos have been diagnosed with end-stage renal disease (ESRD).
“It will be either dialysis or a kidney transplant,” Dr. Concesa C. Casasola, deputy executive director for education, training and research services at NKTI, said of the procedures they need. “In NKTI, our priority is for our patients to have a kidney transplant. We do more than 320 kidney transplants every year.”
With this figure, NKTI is the top leading hospital that performs kidney transplants in the Philippines. It is also among the top in Asia with a big number of patients that are transplanted with a kidney from a single center, according to her.
“So we really push and encourage our patients to have a new life and to have a kidney transplant,” she said.
Challenges
BY and large, there remain hindrances as regards the lesser popularity of transplantation among ESRD patients in the country.
“These are the main problems: social-economic and the lack of donor,” Liquete emphasized.
Due to poverty, underprivileged people who cannot afford to ease their suffering from kidney failure fail to engage in preventive management. Hence, their condition is, more often than not, severe already when they come to seek treatment as they come to the hospital very late.
In the case of those with financial means yet living in the provinces or far areas, some think of NKTI right away or other private hospitals, yet they cannot come to Manila.
“They can go to their barangay, to the local government unit, or to the regional hospitals,” she pointed out. “That’s why in Universal Health Care, we should take care of them from the very start—on the barangay level and up. And our hospitals should be the end referral for [simple] transplantation and difficult transplantation.”
Even though there is the PhilHealth to turn to, beneficiaries qualified to avail of its Z benefit package for kidney transplantation ought to have a donor first. And that is another challenge.
In the Philippines, a living donor must be the next of kin of the patient, either a legal spouse or children. To avail of a giver who is alive and, of course, in good health condition is ideal, while organ donation from the deceased is another option. These are the donors who met an accident mostly, or died of cerebral, vascular, or neurological illnesses.
Unlike in the US and Europe, wherein 25 percent of donations are coming from living givers and 75 percent are dead ones, it’s the other way around in the Philippines.
“I believe also in Singapore, Thailand and Asia in general, that is a problem. Even if some of the countries are very active in organ donation, let’s say Spain and also the US, that are mainly cadaveric,” Liquete said.
AI-driven education
ORGAN donation and transplantation are complex processes that need ample understanding for both the giver and recipient to meet in the middle of these life-saving procedures.
“We found that there was a gap between our patients and donors who are coming to attend our pre-kidney transplant orientation and their next follow up. Some of them don’t even come back [afterwards],” revealed Dr. Romina A. Dañguilan, deputy executive director for medical services at NKTI.
Knowing that patient and donor education is complicated, time-consuming and stressful, the NKTI has found a way to do it faster, more effectively and with less effort, in just a click of a button—thanks largely to artificial intelligence (AI).
This government-owned and -controlled corporate tertiary specialty center attached to the Department of Health (DOH) has strengthened its partnership with Singapore-based Bot MD to make kidney care education simpler, easier to access anytime, anywhere via messaging applications.
They are taking a cue from the success of their initial team-up with the Hospital Super App that uses the Bot MD AI so clinical teams can instantly search duty schedules, hospital directory guidelines and protocols, drug and lab formularies, and even PhilHealth case rates within a single chat interface. Now, they have just launched the expansion of the second platform called the Bot MD Care to help automate patient education and monitoring.
“Since 2021, we have used Bot MD Care to remotely monitor over 700 patients in NKTI with great results. We have seen how the AI can help doctors and nurses triage their patients for early signs of infection so they can intervene earlier,” Bot MD CEO Dorothea Koh said.
This new feature of the Bot MD Care will enable potential kidney donors and recipients to undergo pretransplant orientation at their own pace and time, not only through Viber, but also through Facebook Messenger, without having to download a separate mobile app. With it, NKTI transplant coordinators can now automate the entire process of orienting them prior to the procedure by instantly answering their queries in English and Tagalog, and also send quizzes to test the knowledge of both. If they do not complete their quizzes, the bot will also send automated reminders to follow up.
Another interesting feature of the program is that it enables patients and donors to enroll themselves into the platform by scanning a simple QR code. The bot then allows them to select either Facebook Messenger or Viber to receive their orientation process, which includes details about kidney transplant and donation, as well as educational quizzes. Should they have questions on the kidney giving and transferring process, they can ask the AI in both languages.
They will also receive education videos and interactive quizzes within their preferred chat platform. This ensures that donors and recipients can learn more about the kidney transplant and finish the orientation at their own time. What’s more, the AI helps to automatically score and triage quizzes to alert kidney transplant coordinators for patients or donors who fail their quizzes, and sends nudges to patients who have not followed up with their coordinators.
“It’s not intended to replace a doctor. But it’s really intended to help scale their knowledge,” she reiterated. “So unlike a human, which can educate 10 people, this can educate thousands. And we can pretty much scale it to anybody that has the Viber or Facebook app.”
Dialysis command hub, kidney transplant manuals
THE inaugural ceremony of this year’s NKM, themed “Bato’y Alagaan Para sa Kinabukasan,” also kicked off various activities on kidney disease prevention awareness such as advocacy campaigns and lectures on organ donation and transplantation.
Also unveiled during the event was the NKTI One Dialysis Command (ODC), a transformative platform that revolutionizes the transition patient-to-patient—from in-patient to outpatient—who needs care. With this innovation, patients and their families now have access to a directory of health-care sectors, where they can make inquiries, upload documents and book procedure slots in just few clicks.
“The NKTI ODC is one system. It is an embodiment of training, a driver of progress and a sign of sustainability in every evolving landscape of healthcare. It is a testament to our commitment to improvement and sustainability. It is a powerful tool that enables us to provide care to ease the burden on those unserved by the healthcare system. Through these remarkable innovations, we unlocked the possibilities for our patients and pave the way for a more accessible, efficient and sustainable approach to quality healthcare,” said Dr. Mel Hatra Arakama, head of Organ Transplant Unit at NKTI.
Meanwhile, the fourth edition of both the Kidney Transplant Recipient and Kidney Donor handbooks also had their debut at the event.
The former aims to guide patients with ESRD who are candidates for kidney transfer by introducing them to the process at NKTI, while giving them the basic and most vital information regarding the transplantation and answers on the most frequently asked questions on the subject.
The latter, on the other hand, seeks to empower and guide readers interested in becoming kidney donors. This manual answers FAQs in the simplest and most concise way so potential givers and their families can reach an informed decision regarding organ donation.
“They are really educational tools. We hope to do more since the thrust of NKTI is to educate and empower our patients. We want to do activities that are patient-centric. Because if you know about your illness, if you know why you’re taking medicines, then compliance is better,” Dañguilan noted.
“With better education, we feel that there will be more patients that will want to have a kidney transplant because kidney transplantation offers the highest quality of life and the highest patient survival among the options for end-stage kidney disease. Opt for kidney transplant. Do it early,” she stressed.
Image credits: Aksabir | Dreamstime.com, Nonoy Lacza
