The Growing Need For Dialysis Could Lead To Paralysis

2010-07-10 | |
Last updated: 2010-07-10
Kidney Dialysis Needs Increasing

Without going out on a limb, it is fair to say that waste management is never going to be on the top of anyone’s list of sexy, exciting topics. Whether it be in the world we live in or within our bodies, managing waste is simply an unpleasant necessity. We generally will not think about it at all until the systems responsible for waste management break down. In daily life, this occurs when the garbage and recycling collectors go on strike and garbage piles up in the streets. In our bodies, this can occur when the kidneys fail.

When the kidneys are no longer able to filter out the waste materials from the blood, the result is chronic kidney disease (CKD) and the treatment for this is either a kidney transplant or regular dialysis treatments. Without functioning kidneys, untreated individuals can die within weeks from the accumulation of waste material and fluid in their system. While a kidney transplant is the best option at this stage, poor overall patient health and a shortage of organ donors can limit the possibilities for such a transplant.

Because transplantation is often not an option, many patients must make use of frequent dialysis. In the US, Canada and the UK there are roughly 350,000, 18,500 and 19,000 people respectively on dialysis. In the case of the US, African Americans have 4 times the risk of Caucasians for developing kidney failure and requiring dialysis. Hispanics have twice the risk of the rest of the population.

In general, the two most common causes for developing kidney failure are poorly managed diabetes and high blood pressure. In some cases, the poor management of these diseases comes simply from a lack of early diagnosis.

Once a doctor determines that dialysis is required, however, most patients will have 2 to 3, 4-hour duration dialysis treatments each week in a dialysis center. Some of the more fortunate will receive daily nocturnal dialysis which involves staying most of the evening in dialysis center, but receiving up to 8 hours of treatment per day. A rare few will be able to receive dialysis treatment at home.

Dialysis treatment typically involves one of two common approaches. The first, called hemodialysis involves directing a patient’s blood through a dialysis machine to filter out the waste products. The patient essentially sits next to the machine attached to it and waits while the machine cleans the blood as the blood circulates.

The second approach involves injection of a filtering fluid directing into the space around the intestines, stomach and liver. In this case, the fluid pulls the waste products out of the blood over a number of hours before the fluid is extracted and discarded. While this approach sounds better in terms of patient quality of life, numerous studies have found that no one approach is universally better for all patients.

Unfortunately, while it is an immediate lifesaver, dialysis is generally not very effective. In terms of costs, the US Medicare system spent $8.6 billion in 2007 on dialysis alone. The UK National Health Service (NHS) spends 2% of its budget on treatment of dialysis patients; roughly $3 billion US annually. This is despite those being on dialysis only representing 0.1% of the UK population.

In terms of patient quality of life, dialysis fairs very poorly in this regard as well. Less than 25% of patients on dialysis are able to go to work. As well, roughly 20% of patients on dialysis each year in the US die. Overall, the life expectancy for patients on dialysis is between 66% and 83% less than the general population.

Though dialysis performed at home is somewhat more effective for both health care systems and patients because treatments are more frequent and patients do not have to leave their home and use hospital space, it is still relatively rare. In the US, only 8% of patients receive dialysis at home and in the UK the number is less than 20%.

With these sorts of numbers, the relative ineffectiveness of current dialysis techniques and use of these techniques is definitely a problem for patients and health care systems. Unfortunately, the problem is getting worse and not better.

According to a study by the Canadian Institute For Health Information, the number of people with complete kidney failure rose by 114% between 1995 and 2004 in that country. Looking to the future, the UK National Kidney Federation is projecting the number of people requiring dialysis in the UK to double within the next 10 years. It quickly becomes clear that the number of people needing dialysis needs to be reduced.

One extremely important approach to reducing the number of people who need dialysis is prevention. This can come in the form of screening for obesity, cardiovascular disease and for high blood pressure followed by treatment programs for each. Weight loss is a very effective means of reducing these major causes of kidney failure. Treating these conditions and retaining even reduced kidney function is significantly better than reaching a point of complete kidney failure.

The second important approach to reducing the need for dialysis is for those who have reached a stage of near total kidney failure to receive a kidney transplant. Unfortunately, the availability of organs is limited due to public willingness to part with them. Kidneys, in particular, are in high demand, with one study in Canada showing that roughly 70% of people on the waiting list for organs were waiting for kidneys. To address this need, governments must take steps to improve organ donation rates. Kidney transplants are very important because they triple the life time of those who have suffered kidney failure.

With the rates of kidney failure increasing significantly due mostly to preventable conditions, many more people will require costly dialysis treatments simply to stay alive. However, the quality of life on dialysis is significantly lacking and it is in the interests of every government and every individual to take steps to minimize the risks of kidney failure, to maximize the availability of kidneys for transplant and to reduce the subsequent need for dialysis treatments. If we do not take action, the increasing burden of dialysis will paralyze the lives of many individuals and health care systems.

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