Behind this ‘quiet’ organ lies a growing crisis, and Malaysians must break bad habits and take a few simple steps that make all the difference
Most people don’t realise they have kidney disease until it’s too late. In Malaysia, the burden of kidney failure continues to rise. While dialysis centres are mushrooming across the country, prevention and early detection remain far more powerful than treatment. In this interview, Prof. Dr. Lim Soo Kun, a consultant nephrologist shares what Malaysians need to know, the normalised habits silently harming our kidneys, and why simple steps can make a life-changing difference.
1Twenty80: What made you choose the kidneys as your lifelong passion?
Prof. Dr. Lim Soo Kun: Like many doctors, my specialty was shaped by early work experiences. After completing my housemanship, I was posted to Sungai Petani as a medical officer. At that time, I actually wanted to become a paediatrician and even approached the hospital director about joining the paediatric department. Unfortunately, the department was full, so I was placed in internal medicine instead.
There, I was asked to oversee the dialysis unit. Back then, if a hospital didn’t have a kidney specialist, medical officers would be tasked with running the dialysis unit and caring for patients. That early exposure really sparked my interest. From there, I went on to pursue my MRCP (UK) and later completed subspecialty training in nephrology.
1Twenty80: You’ve led numerous clinical trials. What was one discovery that truly changed how you see kidney care?
Prof. Dr. Lim: One landmark study that stands out for me is the CREDENCE trial in 2015. I was invited to be the national leader for this study, which involved 6-10 hospitals across Malaysia. My role was to coordinate the trial process and oversee its progress locally.
CREDENCE was the first renal outcome study on a new class of drugs called SGLT-2 inhibitors. The findings were groundbreaking, it showed that this drug could slow down the worsening of kidney function in patients with diabetic kidney disease. Following its publication, many other drugs in the same class were studied for kidney protection, and today SGLT-2 inhibitors have become the standard of care for kidney disease management.
This was especially significant because, after almost 20 years, we finally had a drug proven to protect the kidneys. It has changed our clinical practice tremendously. Now, we can confidently tell patients that even with kidney disease, there are effective treatments that can slow its progression.
1Twenty80: Malaysia has one of the highest rates of kidney failure in the world. What is wrong?
Prof. Dr. Lim: The top two causes of kidney failure are diabetes and hypertension, and together they account for about 80% of cases in our country. The majority are due to diabetes. This tells us that we are still not doing well enough in managing diabetes.
Of course, this is not to say that endocrinologists are not doing their jobs. Rather, it highlights how complex diabetes is. Once a person has diabetes, it is very difficult to completely avoid complications, including kidney failure. About 40% of people with diabetes will eventually develop kidney disease.
A lot also depends on when diabetes is diagnosed. Some people may only find out years later, when complications have already set in. That’s why we sometimes see patients who say they’ve had diabetes for only two or three years, but their kidneys are already badly damaged. In reality, their diabetes probably started much earlier, but went undetected. Early detection is critical, because if diagnosed early, complications may take 15 to 20 years to develop, instead of appearing ‘almost immediately’.
1Twenty80: Since you’re a part of the National Kidney Foundation and the Malaysian Society of Nephrology, what do you think is still lacking at the national level?
Prof. Dr. Lim: After more than 20 years in nephrology, I see several gaps in our healthcare system and how we manage patients with kidney disease.
- Awareness: Many people know they are at high risk, but they don’t get their kidneys checked. The high-risk groups are clear: people with diabetes, hypertension, heart disease, obesity, or a family history of kidney disease. We’ve been doing public awareness campaigns for a long time, but people still do not pay attention and often think kidney disease is not relevant to them.
- Action: Even when screening detects problems, such as protein in the urine or reduced kidney function, many do not follow up. They are advised to see a doctor but ignore it or delay until the condition becomes much worse. This is unfortunately common in our community.
- Access to treatment: Today we finally have effective drugs that can slow down kidney damage and preserve function for longer. However, not all patients who need them have access. About 70% of patients rely on public healthcare, but due to budget constraints, only around 40 to 50% receive these drugs. But of course this depends on different settings, such as in UMMC (we conducted a study), our coverage is already over 80%.
The challenge is cost. Even if the drug isn’t extremely expensive, when you scale it up to a large population, the total cost is significant. Yet, in the long term, the benefits are clear—fewer patients will end up needing dialysis. That’s why we say it is cost-effective: an upfront investment that saves far more later.
Some countries have already taken steps to ensure all patients who need these drugs can access them. That’s something we’re still striving towards in Malaysia.
“The high-risk groups are clear: people with diabetes, hypertension, heart disease, obesity, or a family history of kidney disease.”
Prof. Dr. Lim Soo Kun
1Twenty80: What are some everyday habits Malaysians have that silently harm their kidneys?
Prof. Dr. Lim: I’ll highlight three:
- The unnecessary use of painkillers: Painkillers can be very effective in relieving pain, but many people make a habit of taking them too often. For example, I’ve seen young patients with gout who, whenever they have a pain attack, take painkillers just to get through work. Over time, this reliance can seriously harm the kidneys.
- Poor sugar control, especially among diabetics: Many know they have diabetes, but still struggle with controlling their diet. Take durian season, for instance. I’ve had patients admitted because they overindulged, thinking one or two seeds wouldn’t hurt. This loss of control compromises blood sugar and worsens kidney function.
- Not drinking enough water: It’s a simple but important habit. If someone has normal urine output and no leg swelling, I usually advise at least two litres or about 8 glasses of water a day. Proper hydration is key to keeping kidneys healthy.
1Twenty80: What’s one myth Malaysians still believe about kidney disease?
Prof. Dr. Lim: One of the biggest myths is that if you don’t have symptoms, your kidneys must be fine. Many patients are shocked when I tell them their kidneys are already at stage 3 and deteriorating quickly. Their response is often, “But doctor, I feel fine.”
The truth is, kidney disease is a silent killer. By the time symptoms appear, it’s usually too late. You’ve missed the golden opportunity for early treatment. This is especially crucial today because we now have very effective medications that can help preserve kidney function. But the key is early detection! Without it, those treatments may come too late.
“For anyone at risk, my advice is simple: go for screening.“
Prof. Dr. Lim Soo Kun
1Twenty80: As kidney disease is notorious for being a ‘silent killer’ with few early symptoms, how can one tell if their kidneys are in trouble?
Prof. Dr. Lim: The best way is through screening. There are three simple tests that can give us a clear picture of kidney health:
- Blood pressure: If you’re under 45 and suddenly develop high blood pressure, your kidneys should be checked immediately. It’s more often one of the earliest warning signs.
- Urine test: Since urine comes directly from the kidneys, it tells us a lot. Healthy urine should be free from protein and blood cells. If protein or blood is detected, it’s an early red flag for kidney problems. This test is quick, affordable, and often the first indicator of damage, even before blood tests.
- Blood test: Measuring creatinine levels allows us to estimate how well the kidneys are functioning. Traditionally, this required lab testing, but today we even have point-of-care devices, much like glucometers for sugar that can check kidney function from just a drop of blood.
These tests are simple, accessible, and cost-effective. The key is making sure people use them wisely and regularly, especially if they’re at higher risk.
1Twenty80: If you could give every Malaysian just one piece of kidney health advice, what would it be?
Prof. Dr. Lim: For anyone at risk, my advice is simple: go for screening. Early detection is always the key to managing kidney disease.
That way, if there’s an issue, it can be detected and managed early.
