Waiting Until Kidneys Fail: The Philippines' Peculiar Health Policy
The issue is not a choice between prevention and dialysis. People need both. The central issue is why public financing becomes so much more generous after kidneys fail than before they do.
“Governments can count dialysis stations, treatment sessions, financing packages, and new facilities. And politicians like to cut ribbons to open new dialysis centers. People with hypertension or diabetes whose CKD was detected early and who never progressed to kidney failure are invisible... The Philippines cannot solve the growing problem of CKD one dialysis center at a time. The better measure of success may ultimately be the patient who never needs one.”
Chronic kidney disease (CKD) is a growing epidemic in the Philippines, largely driven by poor diet and lifestyle choices. While the government spends heavily on dialysis after kidneys fail, investing in prevention and early detection would be far more cost-effective and humane.
The issue is not a choice between prevention and dialysis. The central issue is why public financing becomes so much more generous after kidneys fail than before they do.
Chronic kidney disease is a growing health issue in the Philippines, largely driven by high consumption of salt and sugar, leading to hypertension and diabetes. The government spends significantly on dialysis treatment after kidneys fail, but much less on preventive measures, despite the cost-effectiveness of early detection and intervention. CKD is often asymptomatic until advanced stages, highlighting the importance of early screening and prevention to reduce the emotional and financial burden on patients and the healthcare system.
The Daily Habits Driving a Silent Crisis
Consider two very ordinary things Filipinos eat and drink. A packet of instant noodles can contain about 800 to 2,000 milligrams of sodium. And that sachet of 3-in-1 coffee? Sugar is often its largest ingredient; there is surprisingly little actual coffee in it.
The problem is not one packet of noodles or one cup of coffee. It is the habit of consuming too much salt and sugar, often without thinking about the hypertension, diabetes, and obesity that may follow. These are among the major risk factors for chronic kidney disease or CKD.
Which brings us to a peculiar public policy choice: why is the government willing to spend enormous sums of money once kidneys fail, but much less to prevent them from failing?
Annual Direct Cost per Patient as CKD Progresses
Data from Philippine cost-of-illness studies comparing early management against hemodialysis:
Annual management, dietary guidance & kidney-protective medications.
Pre-dialysis monitoring, specialized diagnostics, and clinical intervention.
Direct annual medical cost per patient, recurring year after year.
A study covering 31 countries, including the Philippines, projected that by 2027, patients requiring dialysis or transplantation would make up just 5.3% of diagnosed CKD patients but account for nearly 46% of total CKD expenditures.
CKD has emerged as one of the world’s fastest-growing non-communicable diseases. The World Health Organization ranks it as one of the leading global causes of mortality. The Philippine Renal Disease Registry shows a steady rise in patients needing dialysis or transplantation. CKD is becoming not only a serious health problem but an increasingly costly one. That makes prevention and early treatment all the more important.
Among patients starting dialysis, the largest age group is 51 to 70. In 2025, diabetes was the leading cause of chronic dialysis, followed closely by hypertension, and chronic glomerulonephritis, a disease that gradually damages the kidneys’ filtering system. There are three main treatments for kidney failure: hemodialysis, peritoneal dialysis, and kidney transplantation.
The “Silent Period” — A Precious Lost Opportunity
CKD is often described as a “silent disease” because most patients do not experience any symptoms until their kidneys have already been severely damaged. This silent period is a precious opportunity: health workers can identify people at high risk—particularly those with hypertension or diabetes—before further kidney damage occurs.
A straightforward test determines the urine albumin-to-creatinine ratio (uACR). This test examines urine for protein that can signal early kidney damage. The same test can reportedly cost ₱1,500 to ₱3,500 in hospitals and diagnostic centers. Between 2024 and 2025, more than 44,000 Filipinos were screened under an earlier initiative, with nearly 2,000 receiving positive results.
Several measures to prevent and control the conditions that lead to CKD, such as hypertension and diabetes, do not come with a single price tag. But evidence suggests that screening and treating people at greatest risk can save immense fiscal and human costs.
Once CKD develops, the interventions are more specific: early detection, control of hypertension and diabetes, the use of kidney-protective medicines, monitoring of kidney function, and prevention of progression toward kidney failure.
As the disease progresses, the emotional and financial costs grow. We cannot quantify the emotional costs, but the financial burden increases dramatically as CKD progresses and kidney function declines.
The Politics of Visibility
In these studies, the differences between early and late interventions are staggering. Yet much of our health spending becomes visible only at the expensive end of the disease—when patients need dialysis to stay alive.
The government knows CKD is costly and is pursuing both prevention and treatment. The issue is not a choice between prevention and dialysis. People need both.
The central issue is why public financing becomes so much more generous after kidneys fail than before they do.
Perhaps it is because the success of dialysis is visible. A patient arrives at a dialysis center three times a week and receives treatment that keeps her alive.
Governments can count dialysis stations, treatment sessions, financing packages, and new facilities. And politicians like to cut ribbons to open new dialysis centers.
People with hypertension or diabetes whose CKD was detected early and who never progressed to kidney failure are invisible. They do not appear in a dialysis registry. Neither do the families spared the anxiety, expense, and disruption of reorganizing their lives around treatment several times a week.
“The Philippines cannot solve the growing problem of CKD one dialysis center at a time. The better measure of success may ultimately be the patient who never needs one.”