The Silent Crisis: Rising Rates of Pediatric Kidney Failure Alarm Health Experts in Indonesia

Kidney failure has long been perceived by the general public as an ailment exclusively affecting older adults. However, a concerning epidemiological shift is unfolding across Indonesia, where chronic kidney disease (CKD) is increasingly plaguing children and adolescents. Driven largely by non-communicable diseases (NCDs) such as hypertension and diabetes—conditions that were once rare in pediatric populations—this modern health crisis is compounded by limited parental awareness and delayed medical intervention. The real-world implications of this trend are reflected in the harrowing journeys of young patients like Agistina Kamila and M. Rahmat, whose stories illuminate a broader public health vulnerability demanding urgent systemic reform.

The Human Toll: Lives Interrupted by Dialysis

For 17-year-old Agistina Kamila, known to her loved ones as Agist, the weekly routine involves spending at least two days undergoing hemodialysis. A twelfth-grade vocational school student in Tangerang, her education has been put on indefinite hold. Without the blood-filtering machinery of dialysis, her failing kidneys are entirely incapable of sustaining her life.

Agist’s path to chronic kidney failure was marked by a terrifying medical emergency. Last year, she slipped into a coma that lasted approximately a week before physicians officially diagnosed her with advanced chronic kidney disease. Her mother, Lisna, recalls the agonizing days when her eldest child was unresponsive and admitted to the intensive care unit (ICU). During her coma, Agist underwent emergency hemodialysis. Initially, her physical fragility limited these life-sustaining sessions to just two hours, far short of the standard three-to-five-hour duration.

"On Sunday morning during visiting hours, she had regained consciousness—she could call out for Mother and communicate," Lisna recounted. "By Sunday night, however, she had slipped back into unconsciousness." Fortunately, a subsequent hemodialysis session the following Monday proved life-saving, pulling her back from the brink.

Reflecting on her daughter’s medical history, Lisna notes that Agist was historically more delicate than her peers. Childhood ailments, including recurrent tonsil issues, initially deflected medical attention away from deeper systemic risks. However, the trajectory shifted when Agist was diagnosed with kidney stones during her first year of vocational high school. Following a course of treatment, her condition temporarily stabilized.

The situation deteriorated sharply in September of the previous year due to a severe urinary tract infection (UTI). Recurrent kidney stones blocked her urinary tract, fueling the infection. Before the underlying stone issues could be fully resolved, Agist plunged into her week-long coma. Only through exhaustive subsequent medical evaluations did Lisna discover the root cause: chronic, uncontrolled hypertension had severely damaged her daughter’s kidneys over time, rendering them permanently non-functional.

A Parallel Struggle in Makassar

A strikingly similar narrative unfolds in Makassar, South Sulawesi, where M. Rahmat faces his own grueling battle with renal failure. Diagnosed at the tender age of 15 during his first year of high school, Rahmat’s lifestyle habits from early adolescence laid the groundwork for catastrophe. Since his first year of junior high school, he frequently stayed up late, consuming commercially packaged beverages and excessive amounts of salty snacks.

"As soon as I entered the first year of high school, I suddenly experienced severe nausea, vomiting, paleness, and lethargy. I also had a seizure, prompting my parents to rush me directly to the emergency room," Rahmat shared.

Laboratory diagnostics revealed a terrifying reality: his blood creatinine levels were thirty times higher than the normal range for his age group, and his blood pressure had skyrocketed to 172/93 mmHg. Subsequent evaluations determined that Rahmat’s residual kidney function had plummeted below 15 percent. Attending physicians concluded that his renal failure stemmed from years of unmanaged, undiagnosed hypertension that had quietly degraded his organ function without triggering early warning signs.

Why the Silent Killer Goes Unnoticed

The phenomenon of children developing hypertension and subsequent kidney failure points to a dangerous gap in public health awareness. Historically categorized as geriatric ailments, hypertension and diabetes are creeping into younger demographics. According to estimates from the Indonesian Ministry of Health, only about one-third of hypertension cases nationwide are properly diagnosed.

To bridge this diagnostic gap among youth, the government launched expanded health screenings through school-based programs known as Cek Kesehatan Gratis (CKG) Sekolah. Data compiled through July 31 reveals the scope of the issue: out of 14.64 million children and adolescents screened, approximately 2.21 million—roughly 15 percent—exhibited blood pressure readings above normal parameters. While these elevated readings do not automatically translate to a formal hypertension diagnosis, they serve as a critical red flag.

Medical experts emphasize that pediatric renal failure is not solely driven by lifestyle-induced hypertension. Congenital conditions, genetic factors, autoimmune-related inflammations of the kidney’s filtering units (glomeruli), and nephrotic syndrome also contribute significantly to the caseload. However, a lack of parental supervision and incomplete medical treatments drastically accelerate disease progression, turning manageable anomalies into irreversible chronic organ failure.

The Public Health Crisis and Institutional Responses

According to the Indonesian Children’s Kidney Foundation (Yagina), a primary driver of the epidemic is widespread societal misunderstanding regarding non-communicable diseases.

"What really needs to be improved first is the awareness of parents, followed by education reaching remote communities, because many people there remain laymen to these risks," explained Agustia Sumariati, Chairperson of Yagina.

Over the past decade, Yagina has become a vital support network for young renal patients, currently aiding approximately 80 children. Clinical records from the foundation indicate a steady climb in pediatric kidney failure cases across the Jakarta, Bogor, Depok, Tangerang, and Bekasi (Jabodetabek) agglomeration over the last ten years.

This upward trend underscores a broader epidemiological transition across Indonesia. The nation has experienced a definitive shift from infectious diseases to non-communicable illnesses that develop insidiously over time, earning them the moniker of "silent killers."

Indonesian Deputy Minister of Health Dante Saksono Harbuwono highlighted the deceptive nature of these conditions. "People with hypertension often do not know they have hypertension. Individuals with diabetes frequently do not realize they have diabetes either. Therefore, we cannot rely solely on active patient complaints. Routine screenings like CKG are essential to detect risks early before complications manifest," Dante emphasized.

Preventative Strategies and Moving Forward

Recognizing that treatment facilities and dialysis units face immense strain, health authorities and advocacy groups agree that preventative measures must take precedence. Expanding the reach of school-based health screenings remains a cornerstone of the national strategy.

While the initial target for the 2026 CKG Sekolah initiative was set at 16.9 million children spanning preschool to high school, actual participation has surpassed expectations, reaching over 25 million children nationwide. Similar over-target achievements have been recorded among adult demographic screenings, signaling a growing public willingness to engage in preventative health checks.

To amplify preventative education, advocacy groups are pushing for practical, systemic interventions. Yagina has urged the government to reinvigorate public campaigns promoting simple habits, such as encouraging children to carry reusable water bottles to school and strictly limiting access to high-sodium, ultra-processed snacks.

"Reading nutritional labels on packaging is currently difficult because the print is too small. We need larger, bolder fonts detailing the sugar, salt, and fat content on food and beverage packaging. It is vital not just for the children, but equally important for their parents to understand this," Agustia noted.

Amidst systemic advocacy, individual resilience continues to shine a light on the crisis. Despite his fragile health, frequent hospitalizations, and reliance on intravenous lines, M. Rahmat utilizes his TikTok platform—@pejuangdialisis, boasting over 10,000 followers—to campaign for healthy lifestyle choices among his peers. Even when physical weakness forces him to reschedule interviews, his commitment to raising awareness remains steadfast.

As Indonesia grapples with this shifting health landscape, the convergence of early screening, enhanced nutritional labeling, and heightened parental vigilance will ultimately determine whether future generations can escape the silent progression of pediatric kidney disease.