Over 50,000 Dialysis Patients Die Annually; Indonesian Dialysis Patients Community Urges Kidney Service System Reform
The Indonesian Dialysis Patients Community (KPCDI) has accused the government of failing to provide transparent information about alternative kidney replacement therapies, resulting in patients being trapped within the haemodialysis (HD) system and causing uncontrolled budget expansion within BPJS Kesehatan (the national health insurance scheme).
KPCDI Chairman Tony Richard Samosir explained that data from the Indonesian Renal Registry (IRR) 2024 reveals a concerning situation: of 136,793 active patients and 60,034 new patients, approximately 98% undergo HD alone. Meanwhile, more independent alternative therapies such as Continuous Ambulatory Peritoneal Dialysis (CAPD) account for only 2%, and kidney transplantation—which is medically the optimal solution—remains below 1%.
“In Indonesia, kidney failure patients are effectively directed straight to dialysis machines without full explanation regarding other options such as CAPD or kidney transplantation. This is not merely a medical issue; it constitutes a violation of patient rights to information,” said Tony in Jakarta on Thursday (12 March).
This poor transparency reflects government failure in establishing policies that encourage diversification of kidney therapies. Near-total dependence on dialysis machines is propelling Indonesia towards an HD service crisis, with patient numbers continuously rising whilst service capacity cannot keep pace, patient waiting queues lengthening, and potential explosion of health budget burdens.
BPJS Kesehatan data from 2019 showed kidney disease costs reached Rp6.5 trillion, surging sharply to Rp11 trillion by 2024. This figure demonstrates that without strategic changes to the national kidney service system, pressure on health financing could increase significantly over the next 10–20 years.
Beyond costs, HD therapy also exhibits lower patient quality of life compared to other kidney replacement therapies. The Indonesian Renal Registry shows HD patient mortality remains extremely high, exceeding 90,000 deaths in 2023 and approximately 50,000 in 2024.
Furthermore, if this situation continues unchecked, healthcare infrastructure requirements will increase substantially. The annual growth in kidney failure patients necessitates additional dialysis machines, treatment facilities, and trained healthcare personnel; without corresponding increases in healthcare service capacity and available treatment options for patients, lives will continue to be jeopardised.
“For years, the disparity in kidney replacement therapy information has been minimal. Many newly diagnosed patients only learn of CAPD or transplantation from fellow patients in the community, not from medical professionals or official healthcare systems,” he stated.
Coinciding with this year’s World Kidney Day, KPCDI is demanding that the government immediately undertake reform of the national kidney service system. Going forward, patients must become subjects determining their own fate, not merely objects of lifetime treatment. When therapy information is concealed or access is complicated, this becomes not a health issue but rather a matter of healthcare injustice.
Therefore, the government and healthcare professionals must ensure every patient receives comprehensive education about all therapy options—HD, CAPD, and kidney transplantation—before their first dialysis. Simultaneously, transplantation access must be expanded and cost barriers lowered so patients have better life prospects rather than being trapped for life on dialysis machines.
Additionally, home dialysis programmes should be promoted to reduce pressure on health facilities and government budget burdens. Prevention and early detection must become priorities, given that 90% of patients remain unaware of their condition until advanced stages.
“If this year’s World Kidney Day theme is ‘Kidney Health for All’, then Indonesia’s kidney service system must also provide fair treatment choices for every patient,” he concluded.