The NEMO programme aims to reduce kidney deterioration in diabetic patients with kidney disease.
More than 11 percent of Singaporeans have diabetes, and diabetic kidney disease (DKD) is one of the top complications for those whose diabetes is poorly controlled.
How Does Diabetes Cause Kidney Failure?
DKD, also known as diabetic nephrology, is a condition in which the kidney’s filters are damaged and abnormal amounts of protein are leaked from the blood into the urine. It is also the main cause of end-stage kidney disease (ESKD), in which less than 15 percent of kidney function is still present, and which can prove fatal unless the patient undergoes dialysis. In 2014, Singapore had the second-highest incidence of ESKD due to diabetes, with figures rising to 65 percent compared to 46 percent in 1998.
Addressing the Problem of Diabetes and Kidney Failure
In 2010, National University Hospital and National Healthcare Group Polyclinics established a kidney disease work group and the Nephrology Evaluation Management and Optimisation (NEMO) programme was developed.
With funding from the Ministry of Health, the work group implemented strategies in 2011 to cut the rate of DKD progression. Through urine tests for protein leakage, diabetic patients with early DKD are identified and evaluated by a trained NEMO coordinator. From October 2011 to March 2016, nearly 100,000 diabetic patients were evaluated, of whom some 10,500 were enrolled in the programme. Among those patients, about 3,300 completed the treatment optimisation programme in 2015.
The results were promising: 51 percent of patients had either no more, or a significant decrease in protein leakage into the urine. Additionally, doctors saw a 28 percent lower rate of deteriorating kidney function.
The benefits of reducing the progression of kidney disease has wider benefits as kidney disease also increases the risk of stroke, cardiovascular and other vascular diseases.
NEMO patients receive treatment and holistic care within the primary care setting, which can help slow the progression of kidney disease and also lead to better management of their chronic conditions.
Based on article titled “Fight Early Diabetic Kidney Disease”, which first appeared in Lifeline, Issue 4, 2016.
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