Young, Hardworking, and on Dialysis

Ridwan Fadhil never imagined his life would depend on a dialysis machine from the age of 23. There was no history of hereditary disease in his family. No diabetes. No prior hypertension.

“It was purely down to lifestyle,” Ridwan told detikX last week.

The change in Ridwan’s lifestyle occurred because he had to struggle to make ends meet. After graduating from a pesantren at 19, he studied at university while working as a sales representative at a shopping centre in Bandung. From there, everything changed. He was frequently forced to stay up until the early hours.

“I never expected it — suddenly at 9pm there’d be an impromptu meeting. The time meant for rest would stretch until around 10pm. Then I’d carry on with unfinished university assignments until 3am,” he said.

This was compounded by his habit of consuming packaged sweetened beverages and rarely drinking water. He also frequently ate fast food.

“Well, as a boarding house kid, you’re never far from instant noodles. Every day it was noodles again and again,” he said.

That was not all. Ridwan also had a habit of consuming pain relief medication without medical supervision for years.

“I used to take painkillers frequently for toothache — both my molars. Because I didn’t want them pulled out, I’d always take painkillers every day, whenever it hurt. That went on for two years,” he said.

Similarly, for the past nine years, Teguh Triono has lived a life entirely dependent on a dialysis machine. The diagnosis of end-stage chronic kidney failure he received in 2017 changed everything.

Before falling ill, Teguh worked at an event organiser company in the Blok M area of South Jakarta, handling exhibition decoration. The job demanded he work until late at night, even into the early hours. A routine his family later recognised as a serious risk factor.

“Yes, it was hypertension. But we didn’t know that my husband had been suffering from hypertension all along,” said Teguh’s wife, Dwi Novia (35), speaking to detikX last week.

Undiagnosed hypertension was the primary cause of Teguh’s kidney damage. The condition progressed silently, beginning with mild complaints such as frequent dizziness and lower back pain.

“His only complaints were frequent dizziness and lower back pain,” she said.

Additionally, Teguh had a habit of consuming beverages high in sugar and sodium. Dwi recalled that her husband rarely drank water.

“He used to smoke, and he liked drinking things like soda, milk soda, Kuku Bima milk, those energy drinks,” said Dwi.

These beverages, she said, were consumed almost daily to stave off drowsiness at work. “I admit that throughout my time as Teguh’s wife, I hardly ever saw him drink water.”

Even during meals, Teguh would choose sweet drinks over water. This habit persisted for years without being recognised as a serious threat.

“Even when he ate a proper meal with rice, he wouldn’t drink water — he’d have sweet iced tea instead. Or iced drinks like syrup or Nutrisari. He very rarely drank water,” she said.

BPJS PBI Deactivation Worsens the Situation

Since first undergoing dialysis, Teguh has relied on BPJS Kesehatan. The high cost of a single dialysis session made this service the main lifeline sustaining his survival.

However, access has not always been smooth. He experienced a situation where his Contribution Assistance Recipient (PBI) BPJS Kesehatan service was suddenly deactivated on the very day of his scheduled dialysis.

“My husband’s BPJS had already been cut off. We’d already experienced my husband missing haemodialysis because his BPJS was suddenly deactivated,” said Dwi.

The situation caused her to panic because, without dialysis, her husband’s condition could deteriorate within days. Meanwhile, the BPJS Kesehatan reactivation process was not instantaneous. She had to visit the BPJS office and process re-registration through a primary healthcare facility.

“The BPJS staff said we had to go to the primary healthcare facility first. So the process would take a long time and couldn’t be activated immediately — they said a minimum of 3 to 7 days,” she recounted.

Fortunately, with the help of community health centre staff, her husband’s BPJS Kesehatan was reactivated on the same day. However, similar incidents occurred repeatedly.

“It was deactivated several times. How many times — 2 to 3 times. But whenever the PBI service was cut off, I’d go straight to BPJS. Cut off, straight to BPJS,” she said.

Although BPJS covers the cost of dialysis, many other needs are not included, such as transport, supplementary medication, and daily necessities.

As a cleaning worker earning approximately Rp 2.3 million to Rp 2.5 million per month, Dwi must support three children, pay rent, and fund her husband’s treatment.

“It’s truly, truly not enough for me,” she said.

The situation has forced her into debt to survive. “We’ve become like we’re ‘robbing Peter to pay Paul,’” she said.

A similar fate has befallen Budi, aged 53. For the past seven years, he has been forced to undergo dialysis. However, at the start of 2026, he suddenly received news that his PBI BPJS Kesehatan service was no longer active.

“The initial impact was shock. It was genuinely the first time in seven years there’d been a problem. On Saturday morning, I came as usual and was told, ‘Sir, your BPJS is no longer active,’” Budi told detikX last week.

The situation meant he could not undergo dialysis on schedule. To make matters worse, because it was a weekend, he could not immediately process the BPJS Kesehatan activation paperwork.

“The community health centre was also closed because it was Saturday. So in the end, I didn’t get dialysis that time,” he said.

Budi attempted to sort out his membership status on Monday. He visited the kelurahan, the local BPJS Kesehatan office, and the community health centre. But the process did not move quickly.

“I processed it, I got it, but was told to wait. Until the afternoon. So I missed it again. Because of that delay, the impact was quite severe,” he said.

As a result of the postponement, he experienced swelling in both legs. He also suffered shortness of breath. The condition made it difficult for him to move. Nevertheless, Budi was only able to undergo dialysis on Thursday, and only because he was forced to switch to independent membership, which requires paying contributions.

“Both legs were swollen right up to the top. The calves had already gone hard,” he said.

Rising Every Year

Kidney failure cases in Indonesia show a worrying trend. The number of patients is reportedly increasing, and the age of patients requiring dialysis therapy is getting younger. The government sees this change as closely linked to modern lifestyles. Meanwhile, regulations limiting the consumption of sugar, salt, and fat are still in the early stages of implementation.

Director of Non-Communicable Diseases at the Ministry of Health, Dr Siti Nadia Tarmizi, said kidney failure is essentially the final stage of non-communicable diseases that develop over a long period.

She explained that kidney damage usually occurs over many years, primarily due to hypertension and diabetes. Both diseases force the kidneys to work harder until they eventually fail. For this reason, kidney failure has traditionally been associated with older age groups. However, many dialysis patients are now of productive age.

“We are seeing cases beginning to appear at ages 35-40, whereas previously we typically found them in those over 50,” Nadia told detikX last week.

She added that the upward trend in cases is also evident from national health financing data. Previously, during a hearing at the House of Representatives on 9 February, Health Minister Budi Gunadi Sadikin stated that the number of dialysis patients in Indonesia stands at approximately 200,000. Each year, around 60,000 new patients are added. At the start of this year, 12,226 dialysis patients had their BPJS Kesehatan membership forcibly revoked by the government.

According to Nadia, the biggest factor driving the increase in kidney failure among the productive-age population is the consumption of food and beverages high in sugar, salt, and fat. Such foods can lead to obesity, diabetes, and hypertension, which ultimately have the potential to damage the kidneys. Additionally, the consumption of medication and herbal remedies without supervision also poses a risk.

She explained that urban communities frequently consume packaged sweet beverages or other drinks such as coffee between work tasks. This unconsciously reduces the intake of water that the body desperately needs.

“So, in principle, kidney damage is not something that happens instantly — it is a long process that is heavily influenced by lifestyle,” she said.

In fact, a legal framework already exists to protect consumers from excessive exposure to sugar, salt, and fat. Government Regulation No. 28 of 2024 on the control of sugar, salt, and fat (GGL) content in processed food products mandates the government to set limits on GGL usage in fast food and processed food and beverages. Unfortunately, to date, no derivative technical regulations have been issued establishing GGL thresholds for processed and fast food and beverages.