Hemodialysis Home End Stage Renal Disease
(ESRD) Principles
Dialyzers Modeling
Hemodialysis Therapy Demonstration History
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)
Hemodialysis Home End Stage Renal Disease
(ESRD) Principles
Dialyzers Modeling
Hemodialysis Therapy Demonstration History
Copyright ©
2001, John F Patzer II
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