What Is Chronic Kidney Disease, and How Might It Affect You?
An overview of how kidneys work, how they do much more than just make urine, treatments used when kidneys fail, disparities, and how when a large corporation comes in hospitalizations go up and treatment quality goes down.


Kidney Dialysis Is a Booming Business—Is It Also a Rigged One?
This article sheds light on how the dialysis companies found a loophole in the Affordable Care Act where dialysis patients can be funneled into private insurance with the help of the AKF (American Kidney Fund), who helps pay the patients premiums.  Here the health insurance companies can be gouged by the dialysis companies with impunity, bypassing the lower rates paid by Medicare.  And who are major donors to the AKF?  The for-profit kidney dialysis companies Davita and Fresenius who are getting an excellent return on their investment!  (while driving up health insurance rates for the rest of us)  One question that has to be asked why the AKF isn't helping with things like Medigap policies to help cover the 20% Medicare doesn't cover.

Also highlighted in the article is the expensive, low-quality care offered by the dialysis companies.

Part 1 -- The Market

Should Your Kidney Doctor Have a Financial Stake in Dialysis?

Read about nephrologists discussing the pros and cons of joint ventures - doctors and dialysis companies sharing ownership in dialysis clinics.  Joint ventures are normally not allowed by the Stark Law but dialysis got an exemption.

Notable quotes:
"If you really look at the corporation's obligation to shareholders and you take that seriously, and you take the obligation to patients seriously, I think they're fundamentally incompatible."

"With six-figure medical school debt and facing a specialty choice with long hours and relatively low pay, owning a piece of a dialysis clinic is a lifeline, he (Nelson Kopyt) says."

"an ESCO is a partnership between dialysis clinics, physicians, and hospitals to innovate and improve the care of patients in kidney failure."

"Berns outlined some of his ethical concerns about the hospital system entering a joint venture ESCO. Even if the hospital didn’t deliberately steer patients towards receiving care at Penn’s own ESCO, employees could feel subconscious pressure to do that."1

1This article mentions ESCOs and the University of Pennsylvania.  This reminds this writer of a pioneer in home and clinic nightly dialysis (aka slow nocturnal), Dr. Robert Lockridge.  He was bought out by the University of Virginia.  It would be interesting to find out if he had a joint venture with the University of Virginia and what he thought of ESCOs.

Part 2 -- Conflicts

For Black and Brown Kidney Patients, There Are Higher Hurdles to Care
Case studies help illustrate what minorities have to overcome for better kidney care: things like getting diagnosed later, on dialysis longer making it harder to get a transplant, less quick getting on the transplant list, problems with diabetes and hypertension, less likely to get a preemptive transplant, victims of misinformation, dental problems, and even a test that discriminates against them!

On a more uplifting note, meet a doctor who helped change the racial landscape of kidney donation!

Part 3 -- The Disparities

The Lifesaving Potential of Less Than Perfect Donor Kidneys

Some great news for a change about how better hepatitis C drugs have allowed the use of formerly rejected kidneys!  That and better immunosuppression drugs have expanded the number of kidneys available for transplant.  It was also pointed out none of the patients in UPenn and Johns Hopkins studies had developed any signs and symptoms of hepatitis C.  In South Africa HIV infected kidneys have been transplanted into HIV infected patients with great success!

Part 4 -- Less than Perfect Kidneys

Few Kidney Patients Can Access Palliative Care or Hospice—Why?

This story tells how dialysis patients have problems accessing hospice and palliative care while on dialysis.  It also includes a case study of former police officer Bob Swain who chose hospice care over dialysis due to other problems he was dealing with.

Part 5 -- Alternatives

America on Dialysis

Carrie Arnold, lead reporter of this series, is interviewed by Jeffery DelViscio

America on Dialysis interview