S-41-3: HYPERTENSION AND KIDNEY DISEASE IN SINGAPORE

Abstract

The inter-related lifestyle non-communicable diseases of hypertension and diabetes accounts for 70 to 80% of all end-stage kidney disease (ESKD) in Singapore. Singapore is a multi-ethnic Asian society where the Chinese are the majority (76%), Malay (15%), Indian (9%), and other. The National Population Health Survey 2020 reported that the age-standardized prevalence of hypertension had increased from 21.9% in 2017 to 31.7% in 2019–2020, and more men (41.0%) were affected than women (30.2%). The prevalence of hypertension increased with age; starting at around 10% for those aged 18 to 29 years to 74.9% among those aged 70 to 74 years. Almost half (52.4%) of residents had not been previously diagnosed with hypertension. In adults with known hypertension, 35.7% had good control of their blood pressure (BP). Men (66.0%) had poorer BP control compared to women (62.2%). Among the ethnic groups, Malays (69.4%) had the highest proportion with poor BP control followed by Chinese (64.0%) and Indians (58.6%). The National Nutrition Survey 2018/9 reported that more than 90% exceeded the recommended amount of 5 g per day (average intake 9 g in 2018). This was due mostly to seasonings, salt, and sauces added during food preparation, which accounted for 75% of salt in the diet. We studied the usual clinical practice of hypertension management in chronic kidney disease (CKD) patients in the Nephrology clinics of an academic medical center. Despite intensive follow-up and access to medical care, many patients were unable to achieve the BP goals. We also compared the 24-hour urinary sodium excretion of healthy controls and CKD. Dietary habits vary by ethnicity, and the Indian population take more sodium than other groups. We developed a prediction equation in our population to determine the likelihood of exceeding 100 mmol of sodium in a 24-hour urine from an early morning spot urine sodium test. The age-standardized incidence rate (ASIR) of CKD5 was relatively stable at between 266.7 pmp and 295.3 pmp in 2011 to 2019. ASIR of CKD5 were higher among Malays than other ethnicities. ASIR of definitive dialysis increased from 169.6 pmp in 2011 to 187.3 pmp in 2020. About 39.6% of deaths in dialysis patients were due to cardiac causes. Overall, hypertension was a contributory factor to the main causes of death in the population of Singapore, being ischemic heart disease, cerebrovascular disease, CKD, and hypertensive disease.