Know About Drugs with Chula Pharmacists: Extremely Salty Fish Sauce and Kidney Disease

    Recently, I had the opportunity to meet a senior executive from the pharmacy group of a large hospital in northeastern Thailand. During our conversation, I learned that one of the most widely used and high-cost drug categories is medication for treating hyperparathyroidism, a condition frequently found in patients with chronic kidney failure who undergo hemodialysis.

    It was revealed that this hospital treats a significant number of kidney failure patients. Even more concerning was the information that the Northeast region has an alarmingly high prevalence of chronic kidney failure, with some of the country's highest statistics for kidney transplants. This highlights how kidney disease is a major public health issue worldwide—and Thailand is no exception.

    According to statistics, the number of kidney disease patients in Thailand rose from 8 million in 2020 to 11.6 million in 2022. Among them, those requiring dialysis increased from 80,000 to 100,000 during the same period. These numbers place Thailand among the top five countries with the highest prevalence of kidney disease, with the Northeast being the hardest-hit region.

The Role of Kidneys and the Impact of Failure

    The kidneys are essential for filtering waste, balancing electrolytes, and producing vital hormones. They also regulate blood pressure, help produce red blood cells, and maintain bone health. When kidney function declines to the point of requiring dialysis, patients must rely on a variety of medications to sustain their quality of life.

    For those fortunate enough to receive a kidney transplant, dialysis is no longer necessary. However, their journey is far from over—they must take immunosuppressive drugs daily to prevent organ rejection.

    Kidney failure has multiple causes, including underlying conditions like diabetes and high blood pressure, lifestyle factors such as smoking, excessive alcohol consumption, and dehydration, as well as the misuse of painkillers, anti-inflammatory drugs, and herbal medicines.

High-Salt Diets and the Risk of Kidney Disease

    One major contributor to kidney disease is a high-sodium diet. Consuming too much salt—whether from salty snacks, processed foods, or traditional dishes—can significantly increase the risk of chronic kidney disease.

    In Thailand, the problem is exacerbated by regional dietary habits. People in the Northeast, for instance, often consume fermented and preserved foods high in salt. Popular dishes such as **som tam**, **jaew bong**, and **tom saep** frequently contain fermented fish sauce or other salty ingredients. These culinary practices have become so widespread that even restaurants outside the Northeast often include fermented fish sauce in their dishes.

A Call to Reduce Salt Intake

    It’s important to remember that excessive salt consumption directly impacts kidney health. While fermented fish sauce and other salty foods are beloved staples of Thai cuisine, reducing their use is crucial for long-term health.

Here are some practical steps to lower salt intake:

    1. Reduce salty seasonings and sauces**: Limit the use of fermented fish sauce, dipping sauces, and salty condiments in meals.

    2. Cook at home: Preparing your own meals allows you to control the amount of salt used.

    3. Cut back on salty snacks**: Opt for healthier alternatives.

    4. Be mindful of restaurant dishes**: Food prepared outside the home often contains higher sodium levels than recommended.

    The World Health Organization advises limiting sodium intake to no more than 1 teaspoon per day, but many people consume far more. By reducing salt consumption, we can protect our kidneys and overall health. Let’s take action today—our kidneys will thank us for it.

Assoc. Prof. Dr. Nattada Areepiam and Assoc. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University