​A renal coordinator is a guide, a source of comfort, and a steady hand leading patients through the uncertainties of chronic kidney disease.  

When 72-year-old Madam Lee* first heard the words “chronic kidney disease” from her doctor, a wave of anxiety washed over her. The doctor spoke about declining kidney function, dietary restrictions, and the possibility of dialysis in the future. It was too much to take in at once. As she sat in the consultation room, trying to process it all, she wondered—what happens next? Who would help her understand what to do? 

That’s when she met Lydia, her renal coordinator. Lydia took the time to sit beside her and explain, in a warm and patient manner, what the diagnosis meant and what steps she could take to slow the progression of her disease. 

Renal coordinators like Lydia Lim, play a vital role in bridging the gap between medical professionals and patients like Madam Lee, who may struggle to keep up with the many blood tests, medications, and lifestyle changes required. Managing kidney disease isn’t just about visiting a nephrologist—it involves dietitians, pharmacists, social workers, and sometimes transplant teams. Lydia’s job is to make sure Madam Lee doesn’t feel lost amid these moving parts. 

The different stages of Chronic Kidney Disease

Explains Lydia, who started off as a renal coordinator 22 years ago at Singapore General Hospital (SGH), “We are case managers for each patient. Managing chronic kidney disease is complex. There are five stages each requiring different aspects of care. The goal is to present all treatment options to patients and their families before they reach stage 5 – end stage kidney disease - to help them make informed decisions”.

In the first three stages, the coordinator focuses on slowing down the progression of the disease by educating the patient on self-care. 

Once the patient progresses to stage 4, we have to start to monitor the patient closer - because chronic kidney disease progresses very slowly often without noticeable symptoms. At this stage, we also prep the patient for long-term treatment options like haemodialysis, peritoneal dialysis and transplantation. If the patient opts for conservative kidney management – that is not to do any dialysis or transplant - we will give them our utmost support to ensure that they have quality of life.

Kidney transplantation is offered as a treatment option for eligible patients.  If there is any family member willing to donate, a referral will be made to the renal transplant team for further follow up. Patients who are fit for kidney transplantation but have no donor will be started on dialysis, and subsequently placed on the wait list for transplant, which has average waiting time of nine years.

Only when they are at stage 5 - end stage kidney disease - do they need dialysis, transplant or conservative kidney management.

Educating the patient to care for Chronic Kidney Disease

Beyond coordinating appointments and treatments, Lydia is also an educator. She explains why Madam Lee must watch her salt intake, how her medications work, and why regular follow-ups are crucial. Says the Assistant Director of the Renal Coordinator Unit at SGH, "Majority of our patients are elderly in their 60s to 70s. Many have multiple chronic conditions such as diabetes, heart disease and even stroke. Hence, they need a coordinator to manage their care comprehensively. For example, they will have a long list of more than 10 medications.  As part of our counselling, we will have a one-on-one session, that is at least 45 minutes, with the patient to go through every single medication ensuring they understand the dosage, frequency and timing and what it is for. We will also suggest measures like managing their blood sugar or blood pressure if they have diabetes or high blood pressure, and treatment regime including lifestyle modifications, for example smoking cessation or low salt diet, to retard the progression of kidney disease.

Providing emotional and social support

But medical knowledge alone isn’t enough. Living with kidney disease can be emotionally exhausting, especially for elderly patients who fear losing their independence. Madam Lee worried about being a burden to her children, the cost of treatment, and whether she would have to rely on dialysis in the future. Lydia reassured her, offering not just clinical guidance but emotional support. She connected Madam Lee with support groups where she can meet others facing similar challenges. 

Says Lydia, “For dialysis patients, we refer them to befriender services where they can learn from other patients on the same dialysis treatment and get mutual support. Also if patients are on peritoneal dialysis (PD), we will refer them to the home support team where community nurses visit patient’s home to provide support and guidance.”

The financial adviser

To ease patient concerns about medical costs, Lydia helps them to explore government subsidies and financial assistance.  Says Lydia, “Once patients get started on dialysis, it is for life. So they will want to know the cost of dialysis. The renal coordinator will provide financial counselling. The charges of long term dialysis is around $2,800 - $3,600 per month for haemodialysis and $1,600 - $2,200 per month for peritoneal dialysis. Patients can claim medishield life and medisave for dialysis treatment. Private insurance coverage can be utilized for dialysis treatment as well. For patients who are financially needy, they can apply for subsidised dialysis with the voluntary welfare organisations, which will take time.  We will guide the patient to apply for voluntary welfare organisation application early and refer them to the SGH Medical Social Services to get interim funding such as SGH Needy Patient fund for dialysing at private haemodialysis centers whilst waiting for the volunteer welfare organisation application to be approved.

With Lydia’s guidance, Madam Lee started to feel more in control. She followed her treatment plan, made adjustments to her lifestyle, and gained the confidence to manage her condition. Most importantly, she knew that she was not alone—if she had a question or worry, Lydia was just a phone call away. 

For patients like Madam Lee, a renal coordinator is a guide, a source of comfort, and a steady hand leading them through the uncertainties of chronic kidney disease.  See what a day in their life is like...

*Mdm Lee represents the typical patient assisted by our Renal Coordinators