The Cost of Dialysis in Malaysia: Haemodialysis and Continuous Ambulatory Peritoneal Dialysis

Authors: Naren Kumar Surendra, Mohd Rizal Abdul Manaf, Hooi Lai Seong, Sunita Bavanandan, Fariz Safhan, Mohamad Arif Muhammad Nor, Shahnaz Shah Firdaus Khan, Ong Loke Meng, Abdul Halim Abdul Gafor

Affiliations: Department of Community Health, UKM Medical Centre; Hospital Sultanah Aminah Johor Bahru; Hospital Kuala Lumpur; Hospital Tengku Ampuan Afzan Kuantan; Hospital Tengku Ampuan Rahimah Klang; Hospital Pulau Pinang; Nephrology Unit, UKM Medical Centre

Published: Malaysian Journal of Public Health Medicine, 2018, Vol. 18(2): 70–81  |  ISSN: 1675-0306

Last reviewed: July 2026 — patient and caregiver guidance added; assistance figures verified July 2026

On this page: Research summary · Information for patients, families & caregivers (2026)

Background

End-stage renal disease (ESRD) represents one of the most significant chronic disease challenges facing the Malaysian healthcare system. The number of dialysis-treated ESRD patients in Malaysia has been increasing rapidly, driven by the rising prevalence of diabetes mellitus and hypertension — the two leading causes of kidney failure. According to the Malaysian Dialysis and Transplant Registry (MDTR), the acceptance rate for haemodialysis rose from 414 per million population (pmp) in 2004 to 1,097 pmp in 2015, representing nearly a threefold increase over eleven years. The total number of dialysis patients was 6,696 in public settings alone (representing 20% of the total dialysis population), with the remainder treated in private and non-governmental organisation (NGO) facilities.

Dialysis treatment consumes a disproportionately large share of healthcare resources. In Malaysia, ESRD expenditure has been estimated to constitute approximately 4.2% of total health expenditure by the public sector — a figure that is relatively high compared to other countries at similar income levels. As the dialysis population continues to grow, understanding the precise costs of different dialysis modalities is essential for healthcare planners seeking to optimise resource allocation while maintaining quality of care.

Study Design

This was a one-year prospective multicentre study conducted from October 2016 to September 2017. The study assessed direct medical costs of dialysis treatment from the Ministry of Health (MOH) perspective. Five large MOH dialysis centres were selected: Hospital Sultanah Aminah (Johor Bahru), Hospital Kuala Lumpur, Hospital Tengku Ampuan Afzan (Kuantan), Hospital Tengku Ampuan Rahimah (Klang), and Hospital Pulau Pinang. A mixed-method approach combining activity-based costing and step-down costing was employed to capture both capital and recurrent costs.

Cost Components

Haemodialysis Costs

The per-session cost of haemodialysis ranged from RM182 to RM241, with a mean cost of approximately RM206 per session. At the standard frequency of three sessions per week, this translates to an annual cost of approximately RM32,000 per patient. The major cost drivers for HD were capital expenditure (dialysis machines, water treatment systems, building infrastructure), staff costs (HD requires intensive nursing supervision throughout each 3-5 hour session), and utility costs (HD units consume substantial quantities of purified water and electricity).

CAPD Costs

CAPD costs ranged from RM1,400 to RM3,200 per patient month, with a mean of approximately RM2,186 per month. CAPD is more consumables-intensive, as patients use twin-bag dialysis solution systems requiring four exchanges daily. However, CAPD requires less capital infrastructure and significantly fewer staff, as patients perform their own dialysis at home after receiving appropriate training. Only seven private centres provided PD services to 95 PD patients at the time of the study, reflecting the relatively low uptake of peritoneal dialysis in the private sector.

Cost-Effectiveness Considerations

The study’s findings supported the case for increasing the proportion of CAPD as the initial dialysis modality for new ESRD patients. A subsequent cost-utility analysis using a Markov model demonstrated that increasing CAPD uptake from the then-current 40% to 55% or 60% would be cost-effective from the MOH perspective. The incremental cost-effectiveness ratio favoured increased CAPD utilisation, suggesting that shifting the modality mix toward peritoneal dialysis could generate significant savings without compromising patient outcomes.

The economic viability of promoting both modalities was reinforced by the finding that the cost-effectiveness of HD and CAPD were nearly equal when life-years saved were considered — HD was associated with 10.96 life-years saved versus 5.21 for CAPD. The cost per life-year saved was RM33,642 for HD and RM31,635 for CAPD, representing reasonable value by Malaysian health technology assessment standards.

Policy Implications

These cost data have informed several important policy discussions in Malaysian nephrology. The government provides a subsidy of RM100 per haemodialysis treatment, which was increased from RM50 effective January 2018. NGOs such as the National Kidney Foundation (NKF) play a crucial role in subsidising treatment costs, with NKF providing dialysis at RM170 per treatment, of which patients receiving MOH subsidy pay nothing, while the balance of RM80 is funded through NKF’s fundraising efforts.

The study’s evidence has supported the MOH’s peritoneal dialysis-first policy, which encourages suitable new ESRD patients to begin on CAPD before transitioning to HD if needed. This approach optimises the use of limited HD infrastructure while offering patients the quality-of-life benefits of home-based dialysis. The findings also highlight the need for continued investment in dialysis infrastructure and workforce development to accommodate the growing dialysis population. Current (2026) subsidy amounts and the full range of financial assistance schemes are summarised in the patient information section below.

Limitations

The study was conducted from the MOH perspective and therefore captured only direct medical costs borne by the public healthcare system. Indirect costs such as patient transportation, caregiver burden, and lost productivity were not assessed. The study period coincided with a depreciation of the Ringgit Malaysia (US$1 = RM4.30 in 2017), which may affect international cost comparisons. The sample of five MOH centres may not capture cost variations in private and NGO dialysis facilities. Sensitivity analysis using varying Consumer Price Index rates (2.9% per year) was conducted to address uncertainty in cost projections.

Information for Patients, Families and Caregivers

There are now over 55,000 Malaysians on dialysis — cuci darah, as most people call it. About 9,500 new patients join them every year, and most of those will be on haemodialysis three times a week for the rest of their lives. That number comes from the 32nd Report of the Malaysian Dialysis and Transplant Registry (2024), cited in Parliament in January 2026. It is a lot of people, and it is a lot of families rearranging how they live.

If you are reading this, someone close to you probably just got the diagnosis. The two things you most need to sort out in the first few weeks are money and routine. Money, because dialysis without subsidies will eat your household income alive. Routine, because dialysis — whichever type — does not forgive inconsistency. This page deals with both.

What the family member sitting in that chair is going through

A quick note before the practical stuff. When someone is told their buah pinggang has failed and they need dialysis, the patient absorbs it in stages. First there is shock. Then the practical panic — how much, how often, who will drive me. Then, for many, a quiet grief that never fully goes away. They are not just losing kidney function. They are losing the version of their life where Wednesday morning was free, where they could eat mak’s masakan without counting, where their arm was just an arm and not a medical access point.

Some patients handle it well from the start. Many don’t. About a third to a half of dialysis patients will go through a period of clinical depression, usually in the first year. The family’s job in that early phase is not to fix it — you can’t — but to stay present, keep routines normal where you can, and not pretend everything is fine when it obviously isn’t. If the patient stops eating, stops going to sessions, or starts talking about being a burden, tell the nephrology team. They see this all the time and they have ways of helping.

Some patients eventually decide they do not want to continue dialysis. This is their right. It is not suicide — declining a medical treatment is not the same thing. If it comes to that conversation, the family needs support as much as the patient. The hospital’s palliative care team exists for exactly this.

What it actually costs — not the textbook numbers, the real ones

The study above tells you what each session costs the government. That is interesting to policy makers. What matters to you is what comes out of your pocket.

The costs nobody warns you about: transport, three times a week, every week of every year. Even at RM10 per Grab or RM5 in petrol, that is RM1,200 to RM1,500 a year in transport alone — more if you live far from the centre. Then EPO injections if not fully covered, phosphate binders, blood pressure pills, and the one-off surgery to create a fistula in the arm (nominal at a government hospital, potentially several thousand privately). Over a decade of dialysis, transport quietly becomes one of the biggest line items.

Where the money comes from — every scheme worth applying to

Very few dialysis patients in Malaysia should be paying full price. Most of the schemes below can be stacked — use several at once. The main exception is the KKM subsidy, which does not apply if the patient’s treatment is already fully covered by an employer, JPA, or PERKESO.

A note on NKF specifically: the organisation rebuilt itself after the 2005 scandal, restructured completely, and is now one of the most transparent NGOs in Malaysia. Some families are still wary, which is understandable, but the centres are well-run and the subsidies are real.

Insurance: if the patient already has a active medical card policy, check the “outpatient kidney dialysis” benefit. Most Malaysian plans include one, subject to an annual limit. But buying a new policy after diagnosis is pointless — pre-existing conditions are excluded. Some critical illness policies bought before diagnosis pay a lump sum on confirmation of kidney failure. Check any old policy documents gathering dust in the house.

Do this first: find the medical social worker (Pegawai Kerja Sosial Perubatan). Every MOH hospital has one attached to the nephrology team. This person runs the means-testing, knows which NGO centres nearby have open subsidised slots, and can start the KKM, JKM, and zakat applications in parallel — ideally before the patient is even discharged. Bring photocopies of everyone’s ICs, recent payslips or an income declaration, utility bills, and the medical report. The same set of documents works for almost every application.

HD or CAPD — what the choice actually means for your household

Malaysia runs a “Peritoneal Dialysis First” policy, partly because CAPD costs the system less and partly because HD centres are full. But the choice has a big impact on your family’s daily life regardless of policy.

Haemodialysis means the patient goes to a centre three times a week, sits in a chair for four to five hours while a machine cleans their blood, and comes home exhausted. Someone needs to drive them. On dialysis days, the patient is usually good for very little — the treatment drains them, sometimes for hours afterwards. The centre becomes a second home, and the other patients become a kind of community.

CAPD means the patient does their own dialysis at home, four times a day, every day. Each exchange takes about 30 minutes. They need training first (usually a week or two at the hospital), a clean corner of the house, and storage space for roughly 30 cartons of fluid delivered monthly. The family’s job shifts from driving to supervising hygiene and watching for infection.

Some patients can do CAPD. Some can’t — they lack the discipline, the home setup, or a family member able to help. Not everyone is cut out for it, and the nephrologist will assess this. Don’t feel pressured one way or the other.

If the patient is on haemodialysis: what the family needs to know

The fistula arm is sacred. That bump on their forearm where the needle goes in? That vascular access is keeping them alive. The rules are non-negotiable: no blood pressure taken on that arm, no blood drawn from it, no injections into it. The patient should not sleep on it, wear a watch over it, or carry heavy bags with it. They will be taught to feel the “thrill” — a faint vibration under the skin — every morning. If the thrill is gone, call the dialysis unit the same day. A clotted fistula is an emergency.

After each session, the needle sites need firm pressure for at least ten minutes. If bleeding restarts at home, press hard with a clean cloth and don’t peek for the full ten minutes. If it still won’t stop, go to the emergency department.

Between sessions, fluid builds up. This is the part that kills people when it is ignored. The patient will want to drink. They will want to eat curries and soups. Resist. Most HD patients are limited to 500ml to 1 litre of total fluid per day — and that includes everything: water, teh tarik, soup, watermelon, ice cubes. Salt drives thirst, so salty food (kicap, budu, belacan, sambal, anything heavily processed) makes fluid restriction that much harder. Weight gain of more than one or two kilos between sessions means too much fluid, and the next session will be longer and more painful as the machine pulls it all out.

Rapid weight gain, leg swelling, or breathlessness — especially when lying flat at night — means fluid overload. Don’t wait for the next scheduled session. Call the unit.

Sessions must not be skipped. Not for Raya, not for CNY, not for a cousin’s wedding, not because they feel fine this week. A missed session is not a break — it is accumulating potassium and fluid that can stop the heart. The dialysis nurses see this pattern every festive season and it breaks theirs too.

Plan for the off days. The day between sessions — if the patient is on a Mon-Wed-Fri schedule, that’s Tuesday and Thursday — is when they feel most themselves. Use those days for normal life: errands, family time, even work. On dialysis days, keep expectations low.

If the patient is on CAPD: what the family needs to know

CAPD sounds straightforward — drain fluid, put fresh fluid in — but it lives and dies on hygiene. The exchange area needs to be treated like a small operating theatre: hands washed properly, mask on, fan and air-conditioning off during the exchange, pets and small children out of the room. This every single time, four times a day, every day. Not “most of the time.” Every time.

Three red flags, same day, call the PD unit:

• Cloudy drained fluid. Not slightly hazy — cloudy, like diluted milk. This is peritonitis until proven otherwise. Keep the bag and bring it to the hospital; they will test the fluid.
• Abdominal pain, even without cloudy fluid.
• Fever — any unexplained fever in a CAPD patient needs investigation.

Redness, tenderness, or discharge at the catheter exit site also needs prompt review. These are not things to Google and wait on.

For supplies: rotate stock so the oldest cartons are used first, keep them off the floor, dry, out of direct sunlight. Check expiry dates monthly. Always keep at least one week’s extra supply — delivery delays happen.

For the patient emotionally: CAPD patients are home alone with their treatment for long stretches. There is no centre community, no chatting with other patients, no nurses checking on them. The isolation catches up. Make sure they have a routine that involves leaving the house at least once a day — even a walk to the kedai — and that someone is checking in regularly.

Food — what the renal dietitian will tell you (and what they won’t)

Ask for a referral to the renal dietitian at the hospital. This is free at MOH hospitals and almost nobody uses it enough. The dietitian will give you numbers — how many grams of protein, how much potassium, how much fluid — tailored to the patient’s blood results.

The general shape is the same for most patients:

Salt and fluid are the big ones. Less salt means less thirst means less fluid between sessions. Malaysian food is aggressively salty — kicap, budu, belacan, sambal, MSG in everything, pickles (acar), salted fish (ikan masin), salted eggs. The dietitian will give you a list. Read it. Then learn to cook without these things, because the patient will still want to eat at home and “a little bit won’t hurt” compounds across a week.

Potassium needs watching, especially for HD patients. High-potassium Malaysian foods: banana, durian, coconut water, dried fruits, spinach (bayam), tomato-based dishes (asam pedas, kari tomato), sweet potato (ubi keledek). Replace with apples, pears, and lower-potassium vegetables. Boiling vegetables and discarding the water reduces potassium — this trick makes a real difference.

Phosphate — another one to limit. Nuts, chocolate, colas, dairy, and processed foods are the main sources. Phosphate binders must be taken with meals (not before, not after) to work properly.

Protein — this one is different from what people expect. Dialysis patients need more protein than healthy adults, not less, because dialysis strips amino acids from the blood. Egg whites, fish, lean chicken. CAPD patients need even more because they lose protein into the dialysis fluid every exchange.

One practical tip: cook for the patient as part of the family meal, adapt the seasoning. Don’t make them eat separately or differently in a visible way — that just makes them feel sick in a literal and metaphorical sense. Use herbs, garlic, ginger, lime, and chilli (in moderation) instead of salt and soy sauce. The food can still taste like food.

Work, travel, and the rest of life

Working on dialysis is possible, especially with CAPD. HD patients need workplace flexibility for three half-days per week, though some centres offer evening slots. If the patient registers with JKM as a person with disabilities, the Persons with Disabilities Act requires reasonable accommodation from employers.

Travelling on HD requires planning. Any MOH hospital across Malaysia can do “holiday dialysis” — apply at your home centre at least two to four weeks before travel. For CAPD patients, you can arrange fluid delivery to your destination hotel or relative’s house. Both are manageable but need advance arrangement.

International travel is more complex and expensive. Some private dialysis chains have international partnerships. Ask your nephrologist — they will know which countries are feasible and the costs involved.

Transplant — worth asking about early. For suitable patients, a living related donation is the best outcome by a wide margin: better quality of life, lower lifetime cost, and no waiting in the deceased-donor queue (several thousand patients long and several years deep). Ask the nephrologist whether transplant assessment makes sense now, and whether any family members are potential donors. It costs nothing to ask.

One last thing: close to seven in ten new dialysis patients got there through diabetes. If there are other family members with diabetes or high blood pressure, the disease is telling them something. A simple blood test (creatinine and eGFR) and a urine test (albumin-to-creatinine ratio) at any klinik kesihatan can catch kidney damage years before it gets to this point. The RM10 and the half-hour might save someone else in the family from ending up in the same chair.

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