Division of Nephrology
2024/09/26
Our Division embraces a vision of creative and inclusive nephrology community that will have a global impact on all stakeholders in kidney disease management, from healthcare providers to patients and their caregivers. We will harness our academic network of innovation, translational science, and novel health services and continously implement these to enhace our clinical practice. Our mission is to provide affective care for our people, build their skills to achieve the former and, in turn, deliver effective patient care.
NUH Nephrology provides the full breadth of services to optimise kidney health for our patients across all acute and chronic care settings. We broadly categorise our services into the following five domains:
- Comprehensive nephrology and chronic kidney disease care aligned with Healthy SG: We support all healthcare practitioners in the NUHS cluster across primary and tertiary institutions with current knowledge and health informatics to scale evidence-based management of all aspects of chronic kidney disease that range from diabetes, hypertension, cardiovascular, nephrolithiasis and electrolytes, and cystic kidney disease for every affected resident and prevent kidney failure in the community. We are the Western Cluster's leading tertiary care resource for complex kidney diseases. We provide adjuncts to care that include point-of-care ultrasonography and 24-hour ambulatory blood pressure surveillance for outpatient workups and monitoring of disease parameters. We continuously monitor the quality of kidney disease care delivery via informatics dashboards and work to improve on the former in partnership with the National University Polyclinics and Primary Care Network.
- Preventive and acute care nephrology: We develop programs with multidisciplinary partners supported by health informatics and bedside ultrasonography to reduce the severity of acute kidney injury in hospitalised patients. We provide acute dialysis, including continuous renal replacement therapy and transitional kidney failure organ support for patients with critical illness, cardiovascular events, heart failure, major surgery, nephrotoxicity, transplantation, and cancers. We work closely with the healthcare teams from the National University Heart Centre and National Cancer Institute Singapore to deliver end-to-end support for all stages of acute kidney disease and achieve the best outcomes for cardiovascular diseases and cancers.
- Immune nephrology for kidney transplantation and glomerulonephritis: We diagnose and risk segment patients with nephritis using biomarkers, tissue from kidney biopsies, and genetic testing in selected individuals; we provide personalised immunosuppression and biologics to manage their conditions. We engage appropriate patients in specific international clinical trials to offer them options for cutting-edge medical therapies. We work closely with the National University Centre for Organ Transplantation partners to evaluate every individual's immunological risk profile and tailor specific kidney transplant management, including paired kidney donation, simultaneous kidney-pancreas transplantation, desensitisation protocols and comprehensive care of high immunological risk transplant recipients.
- Organ sustenance and interventional nephrology: Our multidisciplinary team of physicians, nurses, pharmacists, coordinators, social workers, and dieticians supports a complete range of maintenance dialysis experiences for patients with kidney failure, including community-based haemodialysis, outpatient high-dependency haemodialysis, in-centre haemodialysis, hospital-based and home peritoneal dialysis; we will be embarking on our home-haemodialysis program. We support the training and delivery of a variety of therapy options that include incremental haemodialysis, haemodiafiltration, extended low-efficacy haemodialysis, and ultrafiltration, as well as incremental and urgent-start peritoneal dialysis; we prescribe these therapies based on unique case requirements and residual kidney function. We provide peritoneal dialysis catheter and haemodialysis catheter insertion services to facilitate rapid access for dialysis, and we collaborate closely with our surgical partners on vascular access surveillance and intervention for malfunction. We have equipped our centres with adjuncts for patient care, including bioimpedance analysis, vascular ultrasonography and access flow monitoring devices.
- Conservative care nephrology to support renal supportive care maximally: We help patients and their caregivers journey through advanced kidney disease and failure. Our multidisciplinary healthcare team supports the care of our patients' renal anaemia, resistant hypertension, fluid management, mineral bone disease, nutrition, mental well-being, and socioeconomic needs. We review their comorbidity burden and clinical frailty and provide rational care for ailing health in old age. We tailor care based on patient's needs and introduce advanced care planning to help patients and caregivers understand that chronic dialysis is not always the preferred option. We partner with our advanced practice nurses and community home medical and hospice teams to deliver the best symptomatic care for our patients and focus on improving patient-centred outcomes.
We structure our clinical services with the following objectives:
- To provide incredible care and up-to-date kidney disease management for the best patient experience.
- To build a strong faculty with life-long learning that straddles the best academic medicine of international repute.
- To bring kidney specialist care to the community and homes and make top-quality care accessible to residents.
- To involve all multidisciplinary stakeholders in supporting kidney disease care for synergy and inclusiveness.
- To partner with our patients and develop their personalised medical care plan to help achieve their best health span.
We welcome clinicians to our team who embrace our shared goals in service delivery. Interested clinicians may apply for either a Resident Physician or Hospitalist position.
NUH Nephrology conducts clinical and academic training in chronic kidney disease, acute kidney injury, glomerulonephritis, haemodialysis, peritoneal dialysis, kidney transplantation, and diagnostic and interventional nephrology through the three and half years Renal Medicine Senior Residency Programme, which ACGME-International accredits. Our unit provides the full range of training subspecialties for a complete in-house nephrology learning experience. Advanced clinical fellowships in kidney transplantation, dialysis, interventional nephrology, and critical care nephrology are also available for international candidates. Our Division also supports the NUS Department of Medicine in training its undergraduates in Medicine, Nursing, and Pharmacy. Majority of our specialists are adjunct faculty members while the rest hold regular faculty positions in NUS Yong Loo Lin School of Medicine.
NUH Nephrology supports the institution's mission as a tertiary medical academic centre. We conduct a wide range of clinical and translational research; these include the epidemiology of chronic kidney disease and kidney failure in Singapore and the estimation and measurement of kidney function in healthy and multiethnic Asian populations. We are a collaborating centre with the DYNAMO research consortium on diabetic kidney disease research that examines disease risk segmentation using biomarkers and optimal management of metabolic health. National-level grants have funded our research on biomarkers of nephrotoxicity, acute kidney injury diagnostics using artificial intelligence, diabetic kidney disease, obesity and kidney elastography, and the effects of vitamin K supplementation on vascular calcification in kidney failure. Research in clinical transplantation is on post-transplantation outcomes and complications and the pharmacokinetics of immunosuppressive drugs; we collaborate with NUS on basic science research that provides insights on immune tolerance, immunogenicity and surveillance post-transplantation. Innovation grants and industry support have funded our projects on clinical nephrotoxicity, diabetic foot screening and advances in dialysis care. We work with data scientists on health informatics research to improve our Cluster's kidney disease management. We regularly conduct quality improvement projects and report on safety outcomes in our dialysis centres. We collaborate with Alexandra Hospital on health service research that examines new chronic disease care models. We also collaborate widely with national and international groups in investigator-initiated clinical research in kidney disease and sponsored clinical trials on small molecules and biologics for glomerulonephritis and chronic kidney disease; these include emerging treatment options for IgA nephropathy, diabetic kidney disease, and renal anaemia.
Head of Division and Senior Consultant 
