These are not the best times to be a permanent kidney failure patient. Sometimes it seems like we’ve come a long way in the past 30-odd years when death squads decided which patients were deserving of dialysis (and would live) and which were sent home with a handful of morphine to die in a narcotic stupor. But then a wave of news comes along to indicate that we’re not that much further along after all.
Consider Kaiser Permanente’s San Francisco Medical Center. It was criticized by the national Organ Procurement and Transplantation Network for mismanagement of its transplant program. The Medical Center, according to the network, “effectively denied patient access to kidney transplantation and threatened safety for patients on its waiting list.” Last May the Medical Center announced it would close down its transplant program “following accusations that patients’ lives were endangered by botched paperwork and administrative errors.”
Meanwhile New York was found to have the worst dialysis patient outcomes in the US according to government records. New York’s dialysis market is dominated by small providers, “many of them run by people with little background in medicine who entered the business to meet the surging demand,” according to Richard Perez-Pena writing in the New York Times:
“Newly released patient data show that people who receive their dialysis from a national chain generally fare better than those treated by an independent provider.”
New York, in a well-meaning initiative with unintended consequences, prohibits publicly traded corporations from owning health care facilities.
The New York Times piece provides an alarming overview of the rising tide of dialysis patients in the US:
“In 1980, fewer than 50,000 people in the United States needed dialysis to do the work of their kidneys; today, there are more than 350,000, including roughly 24,000 in New York. In 1980, diabetes was the primary cause of kidney failure for fewer than 6,000 dialysis patients; today, the figure is about 150,000.”
One glimmer of progress is news that Boston’s largest hospital system, Partners HealthCare, has announced it plans to reduce epoetin doses in dialysis patients. The move comes in response to studies indicating that aggressive use of epoetin increases the risk of fatal heart attack and stroke.
Epoetin is a drug widely used in end-stage renal failure patients to treat severe anemia.
Partners HealthCare’s announcement is a first in the US (epoetin doses are generally much less aggressive in Europe). The large for-profit national dialysis chains have said they have no intention of changing their epoetin dosage levels. After all, Medicare guarantees dialysis providers a minimum profit of six percent on epoetin.
Last November, the US FDA strongly urged the medical community to stay within its epoetin dosage guidelines which clearly state that the drug should not be used to raise red blood cell counts above 12 grams per deciliter of blood. According to Medicare data, about half of US dialysis patients routinely receive epoetin doses that raise their red blood cell counts higher than the FDA’s recommended levels.
Finally, a recent study published in the Journal of the American Medical Association indicates that the risk of cancer rises after kidney transplant. Finding that patients’ risk of cancer—particularly those caused by a virus—was 3.3 times higher after kidney transplant, the researchers attribute the discrepancy to necessary immune system suppression rather than the actual transplant itself. Nonetheless, lead researcher Claire Vajdic of the University of New South Wales told Reuters UK, “the findings do not challenge the live-saving value of kidney transplantation for people with end-stage renal disease, noting the risk of dying is four times higher in patients remaining on dialysis than in those who get a transplant.”
Oh, happy day.
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