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Brunei Darussalam, a small nation in Southeast Asia with a population of just under half a million people, grapples with one of the world's highest incidences and prevalences of end-stage kidney disease (ESKD) and need for kidney replacement therapy (KRT). The profound challenges posed by the COVID-19 pandemic in 2021 continued to impact the local healthcare system in 2022. In response, Project One was initiated under the leadership of Brunei's Ministry of Health, with the goal of elevating ESKD care and promoting home-based KRT. This transformative project, launched in mid-2022, set ambitious benchmarks to rival the best in Southeast Asia, including a transplant incident rate of 20 per million population (pmp), a peritoneal dialysis (PD) penetrance of 20%, and a haemodialysis (HD) arteriovenous fistula (AVF) prevalence of 85%.
In mid-2022, following the relaxation of pandemic restrictions, transplant activities resumed with local and government sponsored transplants in Singapore. Initiatives to establish a local deceased donor transplant program within the next few years were undertaken, emphasizing ethical principles. PD penetrance was significantly increased through a shift to nephrologist-led PD catheter insertions and a PD preference policy. In addition to laparoscopic PD catheter insertions by surgeons, the nephrologists were able to offer Seldinger and peritoneoscopic PD catheter insertions locally and this diversity of techniques allowed for patient-centered choices in line with their medical conditions and preferences. National surgical capacity for AVF creations were augmented through collaborations with surgeons and hospital managers to enable AVF surgeries to be performed on most working days and in different hospitals across the country which also eases the distance and accessibility for patients from rural parts of the country.
In 2022, the annual transplant incidence rate reached 13 pmp, indicating progress despite a late start and building public confidence in transplants.
By the end of 2022, the PD program achieved a significant milestone with 125 prevalent PD patients, reflecting a penetrance rate of 14.7%, a historic high for PD in Brunei and second only to Thailand within Southeast Asia.
AVF creation rates improved, resulting in a national AVF prevalence rate of 79% by the close of 2022, promising continued growth in 2023.
Project One has made remarkable strides in enhancing kidney care in Brunei. The transplant program shows promise, and the high PD penetrance is a significant achievement. The increasing AVF rates are promising, while addressing the challenges posed by ESKD remains paramount. To sustain this progress, a focus on fiscal sustainability, social accountability, and public-private partnerships is essential. Collaborations with healthcare professionals and public health initiatives are pivotal for a comprehensive approach to alleviate the burden of ESKD in Brunei. Given the backdrop of global kidney disease trends and rapid urbanization, this holistic strategy is critical for future success. As we move into 2023, we remain hopeful that these transformative changes will continue to bear fruit and further improve kidney care in Brunei.