Dialysis success dependent chiefly on patients
More people in Lubbock may be on dialysis for a longer period of time, now that both kidney transplant centers in the city have closed.
Posted: July 8, 2011 - 6:12pm | Updated: July 9, 2011 - 12:14am
The mortality rates of dialysis patients in Lubbock come close to national statistics, and the United States has one of the highest mortality rates of dialysis patients in the industrialized world.
Quality reports The Avalanche-Journal obtained from the Centers for Medicare and Medicaid through the Freedom of Information Act for Lubbock’s four dialysis clinics, from 1999 to 2011, show it’s likely the mortality rates aren’t the result of high infection rates or careless medical staff, despite a handful of complaints from patients over the years.
Some medical records were incomplete at Lubbock Dialysis Center-Redbud, the Kidney Center of Lubbock and South Plains BMA Dialysis Center of Lubbock.
Mold was found growing under the sinks at Fresenius Medical Care Lubbock.
Dried blood was found on the chairs at South Plains BMA Dialysis Center of Lubbock.
In each incident, the complaint was recognized by both the clinic and CMS and corrected.
But dialysis clinics’ mortality rates often attract attention and criticism. The four clinics’ rates average 21.5 percent, more than the state average of 18 percent and just barely over the national average, 20 percent.
Dialysis is not a curing process, but a life-sustaining one. Whether patients take charge of their care often determines the quality of life they experience on dialysis, according to medical officials.
“There’s a lot of stereotypes when it comes to dialysis,” said Dr. Joel Starnes, a Covenant Medical Group nephrologist. “But they’re just not true.”
Not just numbers
Operators of dialysis clinics can control some things and some they can’t control. The Centers for Medicare and Medicaid maintains dialysis care clinic operators can control the quality of patients’ care and the quality of instruction given to patients on how to care for themselves.
The operators of dialysis clinics cannot control patients’ medical complications, whether patients follow their instructions or patients’ unexpected deaths.
“When you’re comparing clinic to clinic, it’s not like comparing apples to apples,” said Jane Kramer, vice president of public affairs and communications of Fresenius Medical Care North American, a company operating thousands of dialysis clinics, including South Plains BMA Dialysis Center of Lubbock, Fresenius Medical Care Lubbock and Lubbock Dialysis Center-Redbud.
A Fresenius Medical Care statement said the mortality reports could not be used alone when considering the quality of dialysis care.
Most of the deaths of dialysis patients cannot be attributed to kidney disease. In most instances, those patients die from heart attack or stroke.
National Kidney and Urologic Diseases Information Clearinghouse reports 43.8 percent of the people on dialysis experience kidney failure because of diabetes, and diabetes causes the problems leading up to their deaths.
Patients are not dying of infections, as some would assume, Starnes said and statistics supported. The infections result primarily from the way the dialysis is administered.
Fistula first
When kidneys fail and only function at a 10 percent rate, patients can no longer sustain life. Those patients and their physicians must consider options.
The preference is a transplant. But not all patients are good candidates for a transplant. Dialysis is a second option. The average patient lives seven years on dialysis, Starnes said.
Dialysis does not help failed kidneys begin to function. Instead, the process cleans the blood, just as kidneys do.
Typically, dialysis is performed three times a week for four hours. During that time, the blood exits the body through a needle and enters a machine that washes the blood 20 times, and then the blood returns to the body through another needle.
Dialysis is administered in two common ways, either through a catheter or a fistula.
A catheter is a tube inserted into a vein in the patient’s neck, chest or leg. It has two chambers to allow a two-way blood flow, necessary for dialysis.
But this process has issues. The catheter can become clogged or cause infection.
On the other hand, a fistula is created during outpatient surgery. A physician connects an artery to a vein, usually within the forearm. This connection causes more blood to flow into the vein and causes it to expand. The larger vein makes inserting needles easier. This process also decreases the risk of infections.
“We just don’t see infections in fistulas,” Starnes said.
The National Kidney Foundation suggests with fistulas, the rate of infection should not exceed 1 percent.
Within the last decade, the medical community has pushed to increase the number of fistulas performed.
But there’s a catch.
A fistula takes a while for the vein to become larger. In most cases, the vein takes 30 days to expand, Starnes said.
This means a patient must wait 30 days before beginning dialysis.
If a patient comes to the emergency room and physicians discover kidney failure and need to administer dialysis immediately, this removes a fistula as an option.
Physicians can lay the groundwork for one, but in the meantime, they’ll have to rely on a catheter.
Prevention
For many patients, kidney disease is preventable. The disease is caused by diabetes, high blood pressure, smoking, high cholesterol and long-term use of medication that can harm kidneys.
The National Kidney Disease Education Program points out early kidney disease has no signs or symptoms. The only way to know if a patient has kidney disease is to get checked for it.
According to the foundation, two tests are used to check for kidney disease. A blood test demonstrates how well kidneys are filtering the blood. A urine test checks for albumin, a protein that can pass into the urine if the kidneys are damaged.
Diabetes and high blood pressure are the two main causes of kidney disease. About seven out of 10 people with kidney failure have one or both of these conditions.
“If you have any risk factors for a kidney disease, you should be screened,” Starnes said.
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