Reducing the need for dialysis


One pitfall of some of the incredible medical advances over the last century is that we too often forget what it was like before.

Before penicillin in the 1940s, thousands died of simple infections. Before a cure for polio in the mid-‘50s, tens of thousands were sickened, killed or disabled.

And before outpatient dialysis became widely available in 1972 – 40 years ago this year – 100,000 Americans died of kidney failure every single year.

Until 40 years ago, a diagnosis of kidney disease meant only a difficult, certain death.

Dialysis isn’t easy, and it’s not a cure – but today about 450,000 U.S. adults with kidney failure survive each year because of outpatient dialysis.  For 450,000 people in this country, dialysis offers the gift of life this year.

It’s a tremendous medical success story – and a larger public policy success story as well, since 40 years ago this year, Congress enacted a Medicare benefit for end stage renal disease (ESRD), ensuring that those needing dialysis would not be barred from it by financial obstacles.

During March – National Kidney Month – and throughout this year, the 40th birthday of outpatient dialysis, we should all recognize and celebrate the millions of lives saved by dialysis over the last half-century.

Then all of us in the health care community – physicians, health care professionals, and patient advocates – should rededicate ourselves to making dialysis better and preventing the need for it as much as possible.

When it comes to making dialysis better, we have done a great job, but there are plenty of areas where we can continue to improve.

Mortality rates, particularly for first-year patients, are too high, and research shows that we can reduce these rates through focused, integrated care.  Infection rates, often due to continued use of a neck catheter rather than the safer fistula access in the arm, are unnecessarily high as well.  Too often patients don’t take their medicines at the right time, in the right way, or at all, causing a wide variety of health issues – better medication management can help. In short, we don’t have to look far to find ways that the care of kidney patients could be better.

Of course, the best solution of all is to prevent the need for dialysis in the first place.  It’s not always possible to prevent kidney failure, but perhaps for the majority of dialysis patients, more knowledge about their risks and better care of underlying diseases could have made all the difference.

Unfortunately, understanding the risks of kidney disease is abysmal in some of the populations most at risk.  For example, a 2003 study by the National Kidney Disease Education Program found that among African Americans who had high blood pressure, only 10 percent identified kidney disease as a negative consequence of not treating their condition.  Among those with diabetes, only 29 percent knew that kidney disease was a risk.

Our task as health care providers is clear – we must not only treat our patients, but do a better job of educating them as well.  Reducing the need for dialysis in this country could significantly reduce health care spending and eliminate untold suffering.

Allen R. Nissenson is the Chief Medical Officer of DaVita, Inc. and blogs at Allen’s blog.  

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