Kidney disease is hitting at an earlier age, but there are more options

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Monday, November 10, 2008
Life on dialysis
Kidney disease is hitting at an earlier age, but there are more options

Kimberly Hayes Taylor / The Detroit News

Starting kidney dialysis felt like a death sentence for Jason Thurmand.

His kidneys began failing when he was 16. Three years later, his doctors said his kidneys no longer functioned well enough to remove toxins, minerals and excess fluids from his blood on their own.

"I figured my life was over," says the 22-year-old Detroiter. "I refused it at first. I told the doctor I would rather die than be on dialysis. I was just furious because I can't go on trips and I can't find work. But I don't sob and I don't whine; I put my life in the hands of God."

Thurmand is among a growing number of younger people who can be found in kidney dialysis centers across Metro Detroit. Medical experts say health issues that attack the kidneys -- primarily high blood pressure, obesity and diabetes -- have caused the trend. As a result, about 26 million Americans, an estimated 6 million more people than a decade ago, are experiencing chronic kidney disease and end-stage renal disease.

The impact is devastating. For example, experts say chronic kidney disease is the second-highest killer of African-American men, after trauma.

Chronic kidney disease doubles the risk of heart attack, stroke and early death, even among young and middle-aged adults, according to results of a national screening program researchers at Beaumont Hospital conducted. The study, reported in the August edition of the American Heart Journal, provided the nation's first proof that the dangers of chronic kidney disease are not restricted to people older than 65.

To address this need, dialysis centers, hospitals and other medical facilities offer people alternatives to sitting in dialysis centers on a rigid schedule, four to six hours at set times three days a week. Because of the high demand in Metro Detroit, hemodialysis, most often done in dialysis centers, is offered through more flexible scheduling. For instance, people can come during the day on Monday and then return on a Wednesday night or a Friday morning. They are offered do-it-yourself techniques at home and an opportunity to sleep while dialyzing for eight hours at night through new nocturnal programs offered at DaVita dialysis centers, the largest provider of dialysis in the nation, with 25 centers in Metro Detroit.

After 15 years in the business, Kelley Eelnarme, group facility administrator for DaVita's Cornerstone Dialysis in Southfield, never imagined seeing so many kidney dialysis patients with young faces -- until five years ago. That's when she first recalls noticing so many people ranging from their early 20s through 40s, where previously patients were 60 or older.

"We have more diabetes and people with high blood pressure, and that's why we're seeing so many young people," says Eelnarme, who runs a nocturnal program starting at 6 p.m. that allows patients to have dialysis during the night.

"Anytime we have anybody who's young and vibrant and ends up on dialysis is a shocker for us. You hope you don't have to deal with that in your 20s, 30s or even in your 40s. It's a very, very hard diagnosis. You see a lot of denial in the beginning -- anger, lashing out."

Another reason for a noticeable increase in younger kidney patients is that pediatric (younger than 18) kidney patients are living into adulthood, says Dr. Tej Mattoo, chief of nephrology at Children's Hospital of Michigan.

"A good job done with newborn babies (on dialysis) gives us more children who need dialysis when they get older," he says. "A good job with pediatric patients will give us more patients in their 20s and 30s. And then to add to that, people are getting diagnosed at all ages because there is more awareness."

Dr. Rachel Donaldson saw an example of that recently when she got word to welcome an 18-year-old who had outgrown his time as a pediatric patient.

"I have seen 21-year-olds and 23-year-olds. But for him to be 18, that's something new for me," says Donaldson, who owns and operates State Fair Dialysis in Detroit. "Younger people on dialysis are on the rise. Because of that, younger people need to be diligent about seeing their doctor. They need to talk about diabetes and high blood pressure in school, and young people need to stop eating potato chips and drinking pop, and learn to eat something healthy and nutritious."
A life-altering situation

No matter their age, being on dialysis is a stark reality for people with chronic kidney disease. Common knowledge is, short of a miracle, the only way to get off dialysis is to have a kidney transplant -- or die. And life on dialysis is not an easy one. The treatments can result in occasional nausea, muscle cramps or dizziness. The day after treatment, people complain about being wiped out, and up to 90 percent of dialysis patients report experiencing intense itching, according to the American Association of Kidney Patients.

It's also expensive. Fortunately, almost all kidney patients are covered by some form insurance, including Medicare and Medicaid.

Despite all the issues surrounding it, people like Thurmand eventually take dialysis in stride.

Around the room in the Southfield dialysis center where he gets treatment, Thurmand joins about 25 people, most younger than 50, every Monday, Wednesday and Friday night. Relaxing in peach-toned vinyl recliners with a television attached, they come equipped with pillows, blankets, iPods, books and magazines.

It's obvious why they need to occupy themselves. Most of them will sit for eight hours -- longer than it takes to fly from New York to London -- while their blood flows out of their body through a tube, a few ounces at a time. Most people in the room are younger than 50.

On a recent night, Thurmand sat beside Tracey Lofton, a 42-year-old Detroiter. While Lofton went over her budget, homework and other lists she says she must complete to feel a level of control in her life, she chatted with Thurmand until he dozed off, something he usually does during the night.

Lofton, on dialysis since December, says her kidneys failed because of lupus, but she still works as a business manager for a restaurant franchise. Nocturnal dialysis allows her to study for her master's-level classes at Wayne State University and be well-rested enough to work part time during the day. She tried peritoneal dialysis, a do-it-yourself home treatment that allows the blood to be treated inside the body. Such treatment is offered through programs at several Metro Detroit hospitals, including St. John Hospital and Medical Center and Henry Ford Hospital, but it didn't work for Lofton. So she opted for the nocturnal treatment instead.

"I live with dialysis, but it doesn't control me," Lofton says. She has a great support system with the help of her husband, who does the cooking, cleaning and chauffeuring.

Still, on second thought, she admits it's pretty tough.

"Dialysis isvery controlling," says Lofton, who is desperate for a kidney transplant. "We used to go on vacation at the drop of a hat. I can't eat chocolate, potatoes, cheese or any dairy products.

"But it's not like your life is ending or anything. I do feel depressed. Sometimes, I cry and have to take a few minutes for myself. Sometimes, I ask God why I have something I can't control."
Addressing patient needs

Lofton isn't the only one who realizes dialysis is beyond her control. Dr. Robert Provenzano, chief of the department of Nephrology at St. John Hospital and Medical Center in Detroit and vice president of medical affairs for DaVita, says medical officials are well aware that kidney dialysis patients feel a loss of control in their lives, and it requires an adjustment physically, emotionally and spiritually.

That's why an increasing number of dialysis centers began offering flexible hours, he says, and then added nocturnal programs and home dialysis. He also says nocturnal dialysis is used more in Detroit than elsewhere in the nation.

One reason for that is the number of young African-American men who are homeless and on dialysis. It provides them a safe, comfortable place to sleep during the night, he says.

"We are trying to be more sensitive to the needs of our patients," Provenzano says. "Part of what we do is work to get away from the paradigm that everybody who gets dialysis gets it three times a week in a center during the day. You can come on a morning or a night, and we're trying to allow more a concierge service where patients can design their dialysis around their lifestyle."

You can reach Kimberly Hayes Taylor at (313) 222-2058 or ktaylor@detnews.com.
 
 
 
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