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The Trouble with Dialysis

patient helped during dialysis session in hospital

According to research from the National Institute of Diabetes and Digestive and Kidney Diseases, around 14% of Americans suffer from Chronic Kidney Disease (CKD). CKD refers to any disease that reduces your kidney function over the course of time. If CKD develops, it could lead to end-stage renal disease (ESRD), which represents permanent kidney damage and the need for dialysis or a kidney transplant.

America and Dialysis

It is fair to say that dialysis is not a particularly pleasant procedure. Patients have three sessions a week, and each one could last up to four hours. They spend the time hooked up to a machine with needles inserted into their AV fistula, although some clinics tape the needles into place.

An estimated 100,000 Americans start dialysis each year, but 25% of them die within 12 months. This figure represents one of the worst rates in the developed world, yet the process costs more in the United States than it does anywhere else. The entire dialysis program was America’s first attempt at a sort of universal care, yet it has descended into chaos in recent years.

The program launched in 1972 cost just $135 million per annum and helped up to 11,000 people. Not only did the program cover dialysis and kidney transplants, but it also paid for all of the medical needs of those on it. Fast-forward 40 years; the program now costs taxpayers almost $20 billion per annum, a figure that equates to $77,000 per dialysis patient.

Why Is the Mortality Rate so High?

It makes little sense that the nation spending the most on dialysis has one of the worst mortality rates. It is puzzling that the issue of dialysis has remained away from the spotlight given the fact it is potentially a lifesaver for up to 400,000 Americans at any given time. Finally, ProPublica took the mantle and interviewed hundreds of patients while reviewing thousands of inspection reports.

Its findings were discouraging,to say the least. ProPublica found that patients received dialysis treatment in unsanitary settings, with dangerous lapses in care a disturbing regularity. Medical supervision is minimal, and while clinics must hire board-certified physicians as medical directors, clinics don’t have to have a doctor on site, and few bother paying for one. Even the lenient federal requirement of having one qualified nurse on-site is beyond some clinics.

The dialysis treatment field has long since relied on technicians to do most of the work. It is possible to become a technician with nothing more than a high-school diploma and an in-house test of some sort. Neither Medicare nor individual states set minimum staffing ratios in dialysis centers.

It is unfair to tar all clinics with the same brush, as some are of premium quality with clean facilities, trained doctors, and top-notch facilities. However, plenty of centers operate like factories. The only goal is to boost profit by any means necessary, which means patients are shuttled in and out of the center as fast as possible. The result is that staff doesn’t follow proper hygiene precautions. In fact, the pace at these clinics is so intense that patients are encouraged to soil themselves instead of taking a bathroom break.

From 2002 to 2009, ProPublica examined the inspection records of approximately 1,500 clinics in several states, including Ohio, California, and Pennsylvania. Researchers noted “filthy” or “unsafe” conditions in almost 50% of the units. In some locations, the blood of patients was on the walls and even on the treatment tables. In one unit in North Carolina, a patient complained about an infestation of ants in the center. An employee allegedly handed him a can of bug spray.In addition, hundreds of clinics received citations for breaches in infection control,while others had toshut down.

A Monopoly Is Causing a Breakdown in Standards

British comedian John Oliver, now a talk show host in the United States, had a feature on dialysis on his Last Week Tonight show in the middle of May 2017. In the segment, Oliver pointed out that two providers dominate the dialysis treatment industry: DaVita and Fresenius. Between them, the two companies record operating profits of around $2 billion a year.

Oliver stressed that Fresenius was just as culpable as DaVita, but he focused on how the latter company operated. The organization has allegedly broken a variety of rules. For example, it throws out drugs with the sole purpose of billing Medicare for more money. In addition, it apparently cuts dialysis treatment off early to ensure more patients receive treatment in a day.

There is no question that a kidney transplant is the best option for the vast majority of people suffering from ESRD. As well as improving your quality of life, a kidney transplant potentially adds 10 years to your life. While dialysis is a life-saving treatment in its own right, it is not an ideal replacement for a human kidney. One of the issues with dialysis is that it causes damage to the body, which potentially results in serious conditions such as heart disease.

The vast majority of kidney transplant patients begin on dialysis; the negative effects of the treatment stop once you receive the new organ. If you have a transplant, you no longer need thrice-weekly treatments, nor do you have to worry about side effects such as vomiting, low blood pressure, and itchy skin, among other issues.

Despite the obvious benefits, DaVita either fails to provide patients with information about transplants or else its staff discourages people from getting on the waiting list. Shockingly, an estimated 40% of people eligible for a kidney transplant are not on a list.

Final Words

Dialysis is a necessary treatment for hundreds of thousands of people, but the standards for centers providing the life-saving measures must improve dramatically. Some states are taking these warnings to heart. For example, the New York State Living Donor Support Act is under review; it would make the donation process a lot easier for willing donors. Additionally, the Act would ensure that centers must provide patients with information on kidney transplants, so there is no longer a repeat of what happens in DaVita centers.