Aesthetics is not something that comes to mind when thinking about treatments for renal failure. But for Singapore General Hospital (SGH) renal medicine specialist, Dr Tan Ruyu, the practice of medicine must be holistic in that she wants a fuller understanding of a patient’s condition. As a specialist whose work largely revolves around creating a fistula — a life-saving artery-vein connection to allow for dialysis — Dr Tan does not want to just perform the procedure without having an idea of the patient’s overall medical condition.

For that reason, it is not enough to just think about better and more effective methods of dialysis and treatments for renal failure patients. She wants to also address other issues that her patients face while undergoing dialysis regularly. One of this is the embarrassment that some patients feel about their stigmatas or protruding scars that form from having a fistula created under the skin of their arm.

“That’s why some patients wear long sleeves all the time; they do not want people to know that they have a fistula or that they’re on dialysis,” said Dr Tan, SeniorConsultant, Department of Renal Medicine,SGH. “We make sure that emotionally they are okay, and that their vascular access is working, instead of just saying that the vascular access is not a renal issue, go see the (vascular surgeon who created the access).”

She is proud of a project that she participated in — together with colleagues from the vascular surgery, and interventional and vascular radiology departments — to create an endovascular arteriovenous fistula (endoAVF), which leaves no scars. More importantly, it is far less likely to lead to narrowing of the blood vessels and blockage. In traditional fistulas, patients need to undergo angioplasty (ballooning) frequently to unblock the veins to their fistulas, or even to create a new fistula. Feedback from patients has been positive. “Most are happy with endoAVF because — with no scar, no lump, no bump — it looks quite good cosmetically,” she said.

Not all dialysis patients are eligible for the endoAVF procedure, so creating fistulas by traditional methods is work that she finds meaningful. In this regard, Dr Tan is passionate too about research into the subject. One study involves using sirolimuscoated angioplasty balloons to help avoid the narrowing of blood vessels. Another project is a collaboration with the National Kidney Foundation (NKF) to train their community nurses to unblock their veins at NKF instead of having patients admitted to hospital renal wards for the procedure. “Doing research is an important part of our work because only through research are we able to discover new innovations, services or devices to help improve disease outcomes or patients’ lives,” she said.

Receiving a New Investigator Grant from the National Medical Research Council in 2021 to perform a randomised control trial studying the efficacy of the sirolimus-coated balloon, for one, was an important achievement for Dr Tan. She described the grant as notoriously difficult to receive. More significantly, receiving it is a recognition of the importance of the work for patients as well as her standing as a researcher. Independent research, she said, reflects medical professionals’ pursuit of evidence-based medicine. “It is up to people like us to try to find an answer to the efficacy of certain drugs, devices and procedures,” she said.

As a senior consultant, Dr Tan teaches younger colleagues and participates in biennial courses for general practitioners (GPs) and public forums, organised as part of celebrations for her department’s 50th anniversary in 2023. Dr Tan is quite unapologetic that her life revolves around her work in interventional nephrology, leaving little time or interest for anything else except watching the occasional film in cinemas or one of the streaming platforms. “If I perform a procedure successfully, I’m usually very happy,” she said, adding that she finds performing procedures an exciting challenge. Indeed, her work gives her a deep sense of fulfilment, she said.

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