End Stage Renal Disease
End stage renal disease (ESRD) is a medically, socially and economically devastating reality for over 318,000 patients in the United States (U.S. Renal Data System, 1999). The average annual per capita cost of treatment was $52,200, for an aggregate total of $16.6 billion, in 1997 (the latest year for which statistics are available). Fortunately for those under Medicare, the program pays for approximately 80% of the treatment cost, which amounted to $11.8 billion in 1997. This, however, still leaves the patient with about $10,400 in costs which must be paid out-of-pocket or by private insurers.
The most common treatment modality for ESRD in the United States is hemodialysis in a dialysis center setting, accounting for about 200,000 patients in 1997. Patients undergoing such treatment lead a very restrictive and dependent lifestyle: typical treatment schedules require the patient to be at the center for upwards of five hours, three times per week. Opportunities for travel are limited because many dialysis centers in the United States are operating at or near capacity and are unable to accept a temporary patient. Social and economic prospects for patients are also limited: the total time involved in center hemodialysis precludes many opportunities available to those whose lifestyle is not so restricted.
The rise in the use of chronic ambulatory peritoneal dialysis (CAPD) attests to the desirability and acceptance of portable dialysis apparatus or, perhaps, the aversion to center dialysis with its inconvenience and alteration of lifestyle. Over the years, since its inception, the rate of increase in CAPD has tapered. While CAPD is a significant advance, there are many patients who are not able to receive its benefits, to which the modest rate of increase may be attributed, and who must remain on conventional hemodialysis. The development of complications causes many others to eventually return to hemodialysis.
Kidney transplantation is another alternative that frees the patient from the restrictive lifestyle imposed by hemodialysis. However, kidney transplantation is limited by the number of donor organs available in any given year, currently about 8,000. Kidney transplantation also has other considerations, such as lifelong need for immunosuppression drugs to prevent rejection, that potential transplant recipients need to consider.
More information on the nature and statistics about ESRD can be found at these websites:
www.usrds.org (US Renal Data System)
www.kidney.org (National Kidney Foundation)
www.unos.org (United Network for Organ Sharing)
Copyright © 2001, John F Patzer II
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