Unmitigated good news

[Bill Peckham]

"Between 2002 and 2012 (most recent data available), the adjusted rate (or incidence) of new ESRD cases (which includes patients of all types of health coverage who initiate dialysis or receive a kidney transplant) decreased by 0.7 percent per year, from 378 per million people to 353 per million people (United States Renal Data System 2014). Since 2009, the adjusted rate of new ESRD cases has declined by 2 percent per year. This decline is seen across all races and ethnicities (White, African American, Asian Americans, Native American, and Hispanic) and all age groups.4 In 2013, we estimate that approximately 82,000 FFS dialysis beneficiaries were new to dialysis, and nearly half (46 percent) were under age 65 and thus entitled to Medicare based on ESRD (with or without disability)."

http://www.medpac.gov/documents/reports/chapter-6-outpatient-dialysis-services-%28march-2015-report%29.pdf


"Unadjusted mortality rates for patients followed up to 1 year fell for both new and continuing dialysis patients from 2003 to 2011, said researchers at a poster session here at the National Kidney Foundation's spring clinical meeting."

http://www.medpagetoday.com/MeetingCoverage/NKF/50690


It is a curiosity that the dialysis patient census stays in balance even as the inflow of new patients changes. It would seem that the surest way to improve outcomes of existing dialyzors is to stem the flow of replacement dialyzors.

[Hemodoc]

Absolutely Bill, especially with a large part of ESRD cases from preventable diseases including HTN and diabetes. While there is a genetic component with diabetes and perhaps HTN, better control of these illnesses would reduce that number progressing to ESRD even more.

If the prevalent ESR: population is stable, would that suggest ESRD patients are living lomger?

[Rerun]

That is unexpected since they kept saying it was to double because of obesity and diabetes. 

[kristina]

That is unexpected since they kept saying it was to double because of obesity and diabetes.

Newspapers in the UK keep saying that the need for dialysis is going up because of obesity and diabetes.
... I have been wondering whether the increase of diabetes and obesity is in some way connected
to our food quality being compromised due to the fierce competition between food-conglomerates?

[jeannea]

Interesting news. I have no idea what it means but thanks for sharing.

[Bill Peckham]

The number of people using dialysis - the prevalent dialysis population - had been going up as much as 6 and 7% a year in the late '90s and early '00s. I remember the articles predicting that by 2010 there would be over 700,000 people using dialysis in the US - here for example http://www.nature.com/ki/journal/v67/n94s/full/4496031a.html  In fact in 2010 there were about 420,000 people using dialysis in the US, that's quite a feat - 300,000 people who are not in the chair. It isn't entirely clear what happened, which is too bad. When the news isn't good it gets analyzed from every angle, but when the news is good it goes by almost entirely unremarked.

The prevalent dialysis patient population at the end of the year is the product of everyone who started the year dialyzing, less the number who die or are transplanted, plus the number who begin treatment. If fewer people died or were transplanted the number of people dialyzing would be even greater, just as if many more people transitioned into needing treatment the number in the chair would be greater. What has happened instead, it appears, is that fewer people died, but at the same time many fewer people have needed to start dialysis. Even with more people living with diabetes and hypertension fewer are transitioning into needing renal replacement. I don't think there is any one explanation but I think we should try to figure out what has been working and do more of it.

[jeannea]

Very smart last sentence Bill.