Wednesday, November 19, 2008

Chronic Kidney Disease: America's Malady

Kidney disease is on the rise in the United States, yet it still gets less attention than other diseases such as cancer. Many factors, such as high blood pressure or even carbonated beverages, contribute to the disease. Regardless of the cause though, the burden of dialysis treatment takes a toll not only patients but on the healthcare system as a whole. For many, awareness of chronic kidney disease comes too late:

In February 2005, Rita Miller, a party organizer in Chesapeake, Va., felt exhausted from what she thought was the flu. She was stunned to learn that persistent high blood pressure had caused such severe kidney damage that her body could no longer filter waste products from her blood.

“The doctor walked over to my bed and said, ‘You have kidney failure — your kidneys are like dried-up peas,’ ” recalled Ms. Miller, now 65, who had not been to a doctor or had her blood pressure checked for years.

“The doctor said, ‘Get your family here right away,’ ” she said. “They were telling me I might not make it. I was in shock. I started dialysis the next day.”

Ms. Miller, who has since moved to Connecticut to be with her children, was one of the millions of Americans unaware that they are suffering from chronic kidney disease, which is caused in most cases by uncontrolled hypertension (as in her case) or diabetes, and is often asymptomatic until its later stages. The number of people with the disease — often abbreviated C.K.D. — has been rising at a significant pace, thanks in large part to increased obesity and the aging of the population.

An analysis of federal health data published last November in The Journal of the American Medical Association found that 13 percent of American adults — about 26 million people — have chronic kidney disease, up from 10 percent, or about 20 million people, a decade earlier.

It is clear why CKD has a great impact on patients' lives, but why does chronic kidney disease have such a large impact on the system?
In 2005, more than 485,000 people were living on dialysis or with a transplant, at a total cost of $32 billion. Medicare pays for much of that, because it provides coverage for patients needing dialysis or transplant even if they are not yet 65. In fact, kidney disease and kidney failure account for more than a quarter of Medicare’s annual expenditures.
In other words, unlike almost any other disease, the federal government fully covers treatment for nearly everyone requiring dialysis, due to a quirk in the law. Therefore, moreso than any other condition, CKD becomes a disease that society as a whole must grapple with, especially as its incidence rises.

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