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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on February 20, 2009, 11:29:29 AM
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February 20, 2009
Kidney disease costs state $5 billion
By Nanci Bompey
After 45 years of driving a truck for a living and eating unhealthy meals on the road, Larry Silver found himself with diabetes and high blood pressure.
Both of the conditions eventually led the 73-year-old Oteen resident to develop kidney disease, forcing Silver to spend four hours, three times a week on dialysis at the DaVita dialysis center in Swannanoa.
“It's not fun,” said Silver as his blood circulated through a dialysis machine. “I wasn't happy about it, but there's nothing I could do about it if I wanted to live.”
Silver didn't realize that his diabetes and hypertension could lead to end-stage renal disease or kidney failure, forcing him to be on dialysis for the rest of his life.
But the two conditions are the leading causes of people needing the treatment that flushes toxins out of the body when the kidneys are not functioning properly.
More than 40 percent of people who were on dialysis in North Carolina in 2006 had a primary diagnosis of diabetes and about 29 percent had a primary diagnosis of hypertension, according to the United States Renal Data System.
Experts predict that the numbers of people requiring dialysis will increase as the population ages and rates of diabetes increase, because more people will develop the disease as a result of being overweight and obese.
More than 23 million people in the United States, or about 8 percent of the population, has diabetes and the prevalence of the disease increased more than 13 percent from 2005-07, according to the American Diabetes Association.
“Diabetes is the No. 1 cause for people needing dialysis and as that number gets bigger the number dropping into dialysis gets bigger,” said Dr. Winfield Word-Sims, a nephrologist at Mountain Kidney Associates.
“There will be more need for dialysis, we assume, because that is the pool so many of our patients come from.”
In North Carolina, the number of people who visited a dialysis center for treatment increased by 78 percent from 1996 to 2006. In Buncombe County, the number of dialysis patients increased by 62 percent over the same time period.
Word-Sims said the increase can be attributed to an aging population and a greater prevalence of diabetes, combined with a greater availability of dialysis centers and acceptance of the treatment.
While the number of people on dialysis has started to level-off nationally and locally, Word-Sims said most people believe that the numbers will start to rise again as the population ages and more people are diagnosed and live longer with diabetes, complications that can take years to manifest themselves.
Nearly one in five people in North Carolina has diabetes or is at risk for developing the disease, and three out of five of those people are overweight or obese, according to the N.C. Diabetes Prevention and Control Branch.
“I think we are gradually coming around to the fact that this (obesity) is buying ourselves some really big problems,” Word-Sims said.
Dialysis takes physical, financial toll
Although less than 1 percent of people in the United States who have diabetes will end up with kidney failure as a result, for those who do need dialysis, the expense and burden of the treatment can be taxing, from limiting travel to making it difficult to hold down a full-time job, according to Word-Sims.
He said some people lose their jobs and their health insurance as a result of the time and burden of the treatment and that most people on dialysis are on Medicare or Medicaid.
The estimated medical costs of North Carolinians with chronic kidney disease, including those with end-stage kidney disease, is about $5 billion per year, according to the N.C. Institute of Medicine.
“It changes what you can do and how you live your life,” Word-Sims said. “It's really hard to function in what most of us consider a normal life.”
A high incidence of kidney failure means more communities are getting their own dialysis centers.
As of the end of 2008 there were 160 dialysis facilities in North Carolina providing a total of 3,841 dialysis stations, or machines. Western North Carolina has 10 of those centers. The state has approved an additional 145 dialysis stations and another 128 stations have been requested.
Transylvania County hopes to break ground on its new center later this year, providing treatment for existing patients as well as those who may need dialysis in the future, said Steve Smith, health director for the county's health department. The number of people on dialysis nearly doubled in Transylvania County from 1996 to 2006, according to the U.S. Renal Data System.
“The entire county has elevated diabetes rates so more folks are going to be needing dialysis at some point,” Smith said.
In communities where diabetes rates are high, like the Eastern Band of Cherokee Indians, the effects are already showing. Dr. Ann Bullock, medical director for the tribe, said that more than 60 people in the community are now on dialysis and nearly 100 percent of them require the treatment because of diabetes.
“In our population, unfortunately, people are very aware of it,” she said. “Hardly any family here is untouched by diabetes, and hardly any family here is untouched by chronic kidney disease … it seems so inevitable to people that they feel hopeless.”
Bullock said that while education about diabetes has improved, the number of new cases in Cherokee is continuing to rise, due in large part to high rates of obesity. She stressed however that proper management of the disease is critical for delaying or preventing complications.
“Improved treatment is prolonging the time between diagnosis and some of these complications, but we're up against a lot,” Bullock said. “I think, unfortunately, the reality is that it is going to continue to increase.”
Additional Facts
Number of people who visited a dialysis center by county:
Buncombe: 1996: 122,
2006: 198
Haywood: 1996: 15,
2006: 49
Henderson: 1996: 35,
2006: 77
Madison: 1996: N/A,
2006: 15
McDowell: 1996: N/A,
2006: 42
Yancey: 1996: N/A,
2006: 13
Source: U.S. Renal Data System
http://www.citizen-times.com/apps/pbcs.dll/article?AID=2009902200322