Understanding Cardio-Renal-Metabolic Diseases and Their Impact (with Exclusive Interview)
Chronic kidney disease (CKD), cardiovascular disease, and diabetes are driving a massive health and financial crisis in the Philippines, with CKD alone affecting an estimated 13 million Filipinos, about 1 in 10 individuals nationwide.
These conditions are deeply interconnected under the umbrella of cardio-renal-metabolic (CRM) diseases. A disruption in one organ system significantly accelerates complications in the others.
Driven by persistent gaps in early detection, low health literacy, and a lack of integrated care, the national economic burden of CKD has reached an estimated PHP 592.15 billion, with late-stage disease accounting for 56% of that total.
Because CRM conditions function as “silent diseases,” they frequently progress without any visible symptoms during their early stages. Many patients only receive a diagnosis when the damage is irreversible and requires aggressive, high-cost interventions like dialysis or an organ transplant.
The Escalating Cost of Delayed Care
Data from a recent Cost of Illness study reveals that the financial impact on Filipino families spikes dramatically as kidney function declines and complications manifest. On average, individual households spend between PHP 45,000 and PHP 120,000 annually to manage the disease.
The baseline annual costs of care scale significantly by stage:
- Early-Stage Care: ~PHP 42,000 per year (focused on lifestyle modifications and preventive medications).
- Late-Stage Disease: Over PHP 100,000 per year.
- Dialysis Treatment: ~PHP 560,000 per year.
- Kidney Transplant: ~PHP 1.9 million.
When CKD occurs alongside other CRM complications, additional annual management costs compound the existing baseline financial burden:
- Heart Failure: Adds PHP 214,000
- Anemia: Adds PHP 138,000
- Stroke: Adds PHP 84,000
- Heart Attack: Adds PHP 70,000
Severe Systemic Strains and Insurance Gaps
The healthcare ecosystem faces massive resource strains from advanced cases. In 2021, approximately 65,000 Filipinos underwent hemodialysis, which alone accounts for roughly 20% of all PhilHealth benefit claims. Conversely, only 319 patients received peritoneal dialysis between 2022 and 2023.
A primary driver of late-stage detection is that critical early screening protocols, such as the urine albumin-to-creatinine ratio (ACR) test, are not fully covered by health insurance. This leaves patients with out-of-pocket expenses that frequently cause them to delay testing.
The Biological Connection
Dr. Maria Greta Cortez, Head of Medicine at Boehringer Ingelheim, details how these conditions interact biologically, noting that diabetes directly damages the vascular system.
“Diabetes is a disease that affects our blood vessels,” Dr. Cortez explained. “And because diabetes affects our blood vessels, it also affects all organs that have roots. The heart is one of them. So that’s it. They say that diabetes is an equivalent for heart disease already.”
When the heart is compromised, the failure quickly cascades to other vital systems.
“Now, heart disease affects a lot because the heart is the core of our body,” Dr. Cortez stated. “It provides blood to the brain, to the kidneys, to all of our organ systems. So if your heart is already affected, then you can just imagine how it will affect other organs. The kidneys now come in as part of those organs that can be affected by problems in the heart.”
Historically, the medical field managed diabetes, heart conditions, and kidney failure through distinct specialist silos. A modern CRM approach consolidates treatment around unified pillars: structured lifestyle changes (such as smoking cessation and increased physical activity) and strict medication adherence to halt organ deterioration.
Confronting the ‘Silent’ Disease Stage
A major hurdle in long-term disease management is that many Filipino patients discontinue their prescriptions once their immediate physical symptoms subside. Dr. Cortez emphasizes that these are lifelong, incurable conditions that require continuous maintenance to prevent severe, compounding damage.
“So all three diseases don’t actually have any symptoms. You may have warnings, but not necessarily symptoms,” Dr. Cortez noted. “So that’s why we call the three, not just hypertension, not just diabetes, not just kidney, the three are actually silent diseases.”
Medical professionals advocate for regular diagnostic checkups precisely because early warning signs rarely manifest as obvious physical pain.
“There are signs, however, these are bordering on moderate disease when you feel those symptoms,” Dr. Cortez warned. “In reality, we physicians are very happy when patients, without feeling anything, undergo the annual checkup… Because the screening, the annual checkup, when you do screening, even if you don’t feel anything, that’s when you pick up the disease early.”
The Economics of Early Screening
From a healthcare economics standpoint, routine preventive screenings dramatically lower long-term medical expenditures. Basic annual checkup packages tracking blood sugar, cholesterol, and kidney metrics typically cost between PHP 1,000 and PHP 2,000.
Early detection from these tests allows clinicians to initiate immediate drug therapies, which cost significantly less than the thousands of pesos required weekly for advanced interventions like dialysis.
According to Dr. Cortez, a sustainable healthcare framework relies on a clear three-part economic chain: “Number one, screening, because screening helps early diagnosis, and early diagnosis leads to early treatment.”
Shifting Patient Behavior Without “Shock Value”
In response to the growing health crisis, Boehringer Ingelheim Philippines launched “IMPACT at Kapihan,” a capacity-building workshop organized alongside local patient advocacy groups. The program focuses on training participants in communication, public media engagement, and ethical storytelling to amplify patient perspectives on CRM conditions.
The educational initiative concluded with a collaborative forum timed with National Kidney Month titled Kapihan at Ugnayan: Usapang Kidneys, Puso at Metabolismo. The dialogue brought together patient organizations, media representatives, and healthcare professionals to map out structural solutions for integrated CRM care, focusing on expanding public diagnostic access and routine preventative screenings.
Addressing how to shift public behavior—particularly among younger generations who may ignore passive health warnings—Dr. Cortez argued that sustainable change relies on deep, systemic disease awareness rather than fear-based messaging or shock tactics.
“Rather than a shock factor, what we really lack, in my opinion, for any disease, I’m not just talking about CRM, people lack total awareness,” Dr. Cortez emphasized. “So, that lack of awareness, in my opinion, is where, if you know the disease and you know what you’re going to get because of that disease, you don’t need to get that shock factor anymore.”
Ultimately, the goal of modern CRM care is to foster a collaborative relationship between physicians and informed patients.
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ロイター（Reuters Japan）
