“USRDS” stands for the U.S. Renal Data System, a data registry system located at the University of Michigan in Ann Arbor. USRDS collects comprehensive data about patients with kidney disease across the United States and publishes the data each year in an annual report. The most recent report is relatively good news regarding kidney disease. The USDRS data tells us that kidney disease-related hospitalizations and deaths have incrementally decreased over the last twenty years.
Researchers compiling the report determined that more kidney dialysis patients now receive arteriovenous fistulas, lowering the risk of infection. More “paired” kidney donations are being made, and paired donations now constitute about 10 percent of all of living kidney donor transplants. Annual admissions to hospitals for patients suffering end-stage renal disease (ESRD) declined by about 19 percent in the decade from 2005 through 2014. From 1996 through 2014, mortality rates for patients undergoing kidney dialysis dropped by about 32 percent, and among kidney transplant patients in those same years, mortality rates fell a full 53 percent.
Dr. Rajiv Saran is a professor of internal medicine at the University of Michigan and the director of the USRDS Coordinating Center in Ann Arbor. Dr. Saran says the kidney disease numbers are improving for a variety of reasons. Primary care providers now provide more care to kidney disease patients, and “we are seeing healthier patients coming into the ESRD pool.” Dr. Saran also believes that falling infection rates among dialysis patients – because of better infection control in dialysis units – is another partial explanation of the overall improving picture for kidney disease patients.
WHY IS THE USE OF THE ARTERIOVENOUS FISTULA AN IMPROVEMENT?
The declining use of temporary dialysis catheters is an important and helpful development. Temporary catheters are prone to carry infections. Use of the arteriovenous fistula, a safer alternative to catheters that is also more permanent and provides better vascular access, increased from 32 percent to 63 percent among dialysis patients from 2003 through 2014. During the dialysis process, the arteriovenous fistula is also less likely to cause blood clots.
Kidney transplants still usually succeed for end-stage renal disease patients, but the number of patients needing kidney transplants still far exceeds the number of available kidneys. Wait times are long and are getting longer. At the end of 2014, the transplant waiting list numbered 88,231 candidates – 246 more candidates than the waiting list at the end of 2013 or about a 3 percent increase. Yet fewer than 18,000 kidney transplant operations were conducted in the U.S. in 2014.
Many healthcare professionals who work with kidney disease patients had hoped that the rise in paired kidney donations would help to alleviate the shortage of available kidneys and reduce waiting times. A paired kidney exchange – essentially a “kidney swap” – occurs when a living donor is incompatible with a proposed recipient, so the donor exchanges kidneys with another donor/recipient pair, resulting in two live donor transplants. In 2015, 552 paired transplants were performed in the United States. “We think it’ll increase over time,” Dr. Saran says.
HOW MANY IN THE U.S. STRUGGLE WITH KIDNEY DISEASE?
While the recent U.S. Renal Data System report is good news, chronic kidney disease continues to afflict approximately 15 percent of the adults in the United States. As 2014 ended, 678,383 dialysis and transplant patients were receiving treatment for end-stage renal disease in the U.S., a 3.5 percent rise from the end of 2013. High-risk groups for kidney disease include people over age 60, African-Americans, and anyone with a family history of kidney disease. The U.S. National Institute of Diabetes and Digestive and Kidney Diseases says that chronic kidney disease remains the ninth-leading cause of death in the United States.
About 20 percent of all Medicare spending – roughly $50 billion in 2014 – is dedicated to chronic kidney disease treatment. Thus, Dr. Saran is insistent that more work must be done. He said patients require better care as they transition into end-stage renal disease. “People aren’t getting the preparatory care they need in the transition to dialysis. That is a practice pattern that needs to change if we are going to continue reducing mortality,” Dr. Saran says.
Four out of five dialysis patients in the U.S., for example, still begin dialysis with a temporary catheter because an arteriovenous fistula is not made ahead of time, and too many patients still do not learn that they even have kidney disease until the condition is advanced. “Even though mortality rates are going down, there’s no room for complacency,” Dr. Saran told Medscape Medical News.
WHAT’S THE ADVANTAGE OF EARLY DETECTION?
Properly functioning kidneys are essential to everyone’s health. When the kidneys are not functioning as they should because of kidney disease, a patient is also at risk for a number of other serious medical conditions including heart disease, a life event and/or infertility. However, with early detection, chronic kidney disease is manageable – for most patients – with medications. If you belong to a high-risk group, you should see your primary care doctor and be tested regularly for kidney disease.
When a kidney disease diagnosis is early and accurate, a kidney disease patient’s life usually does not need to be entirely disrupted. Research author Dr. Chi-yuan Hsu, a professor of nephrology at the University of California, says that “Kidney disease takes years to decades to develop, and several decades ago, we started developing better ways of halting or slowing kidney disease. Control is much better than it used to be.” Still, with kidney disease afflicting approximately 15 percent of the adults in the United States, there are plenty of opportunities for medical mistakes and for injuries to patients due to medical malpractice.
Medical malpractice is the violation of the “reasonable standard of care” provided by most doctors, but if you are not a doctor, it’s genuinely difficult to know if you are a medical malpractice victim. Every malpractice case is unique, and every allegation of medical malpractice must be thoroughly examined from the legal perspective by an experienced medical malpractice attorney.
If you are a kidney disease sufferer and your doctor or your healthcare providers failed to diagnose your kidney disease early and accurately, or if you were given improper treatment or were prescribed the wrong medications, discuss your situation with an experienced medical malpractice attorney. If you were injured or if your health declined due to medical malpractice, you are legally entitled to compensation.