A patient is undergoing dialysis. Photo by VnExpress/Dinh Tien

In a room at the Hanoi Medical University Hospital, Duy sits motionless as a doctor announces: “You have end-stage kidney failure and need to start dialysis immediately.”

At the age of 23 the college student cannot countenance the fact.

He says in a choked voice to Dr. Nguyen Van Thanh, deputy head of the department of nephrology and urology: “I’m only in my twenties. I don’t smoke. It’s just that my eating and sleeping habits are irregular. But so many others live like that too.”

Seeing the stunned look on the young man’s face, Thanh explains: “Because the disease was detected late and you did not follow treatment properly, your kidney function has been lost. Dialysis or a transplant is now the only way to save you.”

Duy was diagnosed with stage IV chronic kidney disease a year ago. But because he was busy preparing for graduation exams, he did not go regularly for check-ups or treatment and stopped taking his medication for two months.

Recently, when he began feeling exhausted and severely nauseous, he returned to the hospital and learned that his kidney function had deteriorated to the final stage.

These days, Duy lies in a hospital bed with a needle inserted into his vein and the dialysis machine humming beside him three times a week.

When his phone buzzes with group messages about hangouts and food gatherings, regret washes over him.

Milk tea, soft drinks, spicy instant noodles, and deep-fried food used to be his daily diet. It was normal for him to have a late-night meal and then stay up until two or three in the morning.

When a friend once warned him about “living a healthier lifestyle,” Duy laughed and replied “Come on, live life for the fun first.”

He says wistfully: “If I can turn back time, I’d take better care of my body. But now it’s too late.”

Another patient, Hoai, similarly, couldn’t believe the words coming from the doctor’s mouth: end-stage kidney failure. “But I’m only 20,” she stammered.

“I know,” Thanh nodded, all too familiar with this reaction.

He has met hundreds of similar young patients, all thinking “it’s early” until it’s too late, he says.

As a student, Hoai took a part-time job as a graphic designer and was known among peers as the “deadline queen.” Her life revolved around the cycle of studying by day and working by night, surviving on fast meals like bread, sausages and instant noodles. Strong coffee was always beside her laptop, and she only drank water when extremely thirsty.

“I’m young and chasing deadlines, sleep is for the old,” she used to tell herself.

When she first experienced painful urination, she assumed it was stress-related and bought antibiotics from a pharmacy. But as nausea, fatigue, insomnia, and changes in taste developed, she finally sought help at the Hanoi Medical University Hospital.

Thanh diagnosed her with end-stage kidney failure, with kidney function below 10%, and needs a replacement as soon as possible.

Vietnam currently has over 10 million people with chronic kidney disease, accounting for about 12.8% of the adult population.

Around 8,000 new cases are reported each year, with 800,000 patients requiring dialysis. But there are only 5,500 dialysis machines in the country which can serve only 33,000 patients, meeting less than 30% of demand, the Ministry of Health says.

Even more concerning is the clear trend of kidney disease affecting younger people.

At the artificial kidney department at Cho Ray Hospital in HCMC, the first three months of 2024 saw 450 patients on regular dialysis and 15% of them were under 35, with most diagnosed with end-stage failure.

At the nephrology and dialysis department at Binh Dan Hospital in the city, about a third of outpatients are under 40.

At Duc Giang General Hospital in Hanoi, doctors report that in the last five years the number of young patients with end-stage chronic kidney disease requiring regular dialysis has increased by 5–10%.

Thanh says the leading causes of kidney failure include glomerular disease, urinary stones and infections, but an unhealthy lifestyle is a major contributing factor—characterized by the lack of physical activity, sleep deprivation, poor hygiene, inadequate water intake, frequent urine retention, excessive alcohol and tobacco use, high salt consumption, excessive intake of meat, sugar, fried foods, and processed foods, and unregulated drug use.

The cost of treating end-stage kidney disease places a massive financial burden on patients and their families.

A dialysis session costs VND700,000 – 1.3 million (US$26.77 – 49.71). At three sessions per week a patient without health insurance has to pay VND9–15 million a month from their pocket.

The most effective treatment, kidney transplant, costs VND300–500 million without including the cost of immunosuppressive drugs needed afterward.

According to doctors, the biggest current challenge is how to prevent the growing trend of kidney disease among the youth.

Chronic kidney disease progresses silently, with no obvious symptoms in the early stages and so is often overlooked.

By the time warning signs like fatigue, nausea and loss of appetite appear, the disease has reached a late stage, making treatment difficult and less effective.

Vietnam is working to increase the rate of kidney transplants, but a shortage of organ donors and the high cost of transplantation are major hurdles to this.

Currently, only around 1% of end-stage kidney failure patients get transplants.

Doctors advise everyone to maintain a balanced diet, drink enough water, avoid salty foods, limit fast foods and alcohol, quit smoking, exercise regularly, and avoid self-medicating, especially with over-the-counter drugs and supplements.