The Kidney Crisis
Chronic Kidney Disease (CKD) is a growing epidemic worldwide.
More than 8 million Americans suffer from CKD. It is caused by things like diabetes, high blood pressure, and genetic conditions. If kidney function declines too far, patients acquire kidney failure (also known as end-stage renal disease or ESRD) and must go on dialysis or have a kidney transplant to survive.
More than 8 million Americans are affected by CKD
Dialysis is not a long-term solution.
Today, approximately 450,000 patients are kept alive through dialysis. Dialysis is an extraordinary invention that provides a lifeline to ESRD patients by assuming duties normally performed by the kidney such as filtering waste and maintaining blood pressure. While life-saving in the short-term, dialysis is not a long-term substitute for a human kidney, performing only about 10% of kidney function, In the United States, dialysis is typically provided in about three sessions a week of about four hours each. Patients are tied to a machine, unable to travel easily and may find it difficult to participate in family life at the same level as before. It leaves many too weak to work. Over time, dialysis damages the body, leading to other complications such as infections, anemia, hypertension, bone disease, and heart disease. The longer a patient stays on dialysis, the greater the chances that they will become too sick to be transplanted. If transplanted, time-on-dialysis continues to be impactful by significantly reducing the length of time that the new kidney will continue to work (known as graft survival).
Every year 100,000 Americans start dialysis. One in four won’t survive 12 months, with a five-year survival rate of 33%, comparable to brain cancer. Heart disease is a leading cause. The risk of cardiovascular death for a patient between the ages of 25 and 34 on dialysis is the same as for an individual over the age of 75 in the general population. Reducing or eliminating your wait time on dialysis is the number one thing that you can do prior to your transplant to ensure that your new kidney will last a long time.
Reducing or eliminating your wait time on dialysis is the number one thing that you can do prior to your transplant to ensure that your new kidney will last a long time.
2. There is a chronic shortage of kidneys available for transplant.
There is a chronic shortage of kidneys available for transplant. The number of people in the United States with kidney failure has increased by nearly 20% since 2000 and there are currently over 109,000 Americans on the national waitlist for a kidney. Each year 17,000 patients receive a transplant, while about 35,000 new patients are added to the list. As many as 80,000 additional patients may be good candidates for transplant, but have never even been listed. (These unlisted patients tend to be of lower socioeconomic status and are less likely to have a college degree or private health insurance than listed patients. Issues with timely referral by primary care providers, dialysis facility practices, or the lack of appropriate patient education about transplantation may be a factor for these patients.)
Of those lucky enough to obtain a transplant, currently 65% will receive a kidney from a deceased donor. Despite the great efforts of HRSA (the federal agency that oversees transplantation) and organizations like Donate Life America to increase the pool of individuals willing to donate organs at the time of death, there is still a severe shortage of deceased donors. Deceased donation alone will never solve the crisis.
Deceased donations saw their highest numbers in 2006, but have since remained relatively flat. Because of the increased demand for kidney transplants, deceased kidney donation is not a sustainable alternative. Living donation transplants are the best option for many patients and provide the greatest opportunity to expand the growth rate.
3. Living kidney donation is in decline.
Living kidney donation is the best available treatment for kidney failure. Yet, the number of living kidney donors (LKD) has declined 13% annually since 2009. In fact, 2014 saw the lowest number of living kidney donors since 2000, when the waiting list was only half as long. There were 5,535 living kidney transplants completed in 2014 compared with 11,570 deceased donor transplants in the same year, despite evidence indicating greater outcomes and survival longevity is achieved from living donors. If only one in ten thousand Americans donated a kidney each year, it would be enough to end the shortage!
4. Cultural and economic disparities add to the crisis.
At every stage, people of color have worse outcomes than Caucasian patients:
- They are more likely to develop chronic kidney disease (CKD)
- Of those with CKD, more are likely to develop end-stage renal failure (ESRD)
- Of those with ESRD who are eligible for a transplant, fewer go on the waiting list
- Of those who are waitlisted , they wait longer and fewer receive a transplant
- Of those who receive a transplant, fewer receive a transplant from a living donor
In addition to cultural inequities, there are troublesome economic inequalities afoot. A 2014 longitudinal study of trends showed living donation rates over the past decade decreased in direct proportion to household income, indicating that people of lower socio-economic status donate less despite end-stage renal disease disproportionately affecting patients of similar status.These studies demonstrate the urgent need for culturally competent interventions to address these misconceptions and allay fears for this patient population to eliminate LKD disparities.
While African-Americans and Hispanics are 3.4 and 1.5 times more likely to develop ESRD, they are less likely to receive transplants from living donors.
|Relative Risk of Chronic Kidney Disease (USRDS, 2011)||3.4 times more likely than Whites||1.5 times more likely than Whites|
|Percent of ESRD patients receiving a transplant within 2 years
(adults 18-64 years olds)
|Greater than 20% poverty level (>20%) within patient’s zip code||7.9%||36.7%||37.1%|
|Waitlisted before dialysis||15%||6.6%||10.6%|
|Annual wait listing rates among dialysis patients||14%||8.1%||12.2%|
|Annual transplant rates||5.9%||2.8%||3.2%|
|Number of deceased donor transplants per 100 person-years on the waitlist||32.7||19.1||13.9|
Source: Hall, Y.N. (2011)
5. A growing wait list means a growing number of patient deaths.
A growing wait list means a growing number of patient deaths. On average, 12 people die each day while waiting for a kidney transplant.With the steady increase of individuals joining the waiting list and the shortage of available kidneys for transplant, average waiting time to receive a kidney has increased from 3 to more than 4.5 years. It can be more than 7 years in highly populated states, like New York and California. The longer a patient is on dialysis, the greater the likelihood a patient will die from kidney failure or develop other life-threatening complications, such as heart disease. The reality is that death has become an indirect method for managing wait list growth. In Alabama, more people on the kidney waitlist died in 2013 than received a transplant.
6. As the crisis expands, so do the costs.
As the crisis expands, so do the costs. Kidney disease cost taxpayers nearly $33 billion a year in the U.S. in 2012, a 6% increase from 2011. These are costs covered by the American taxpayer. Dialysis treatment is three times more expensive than transplantation. As longer wait times grow, the number of patients on dialysis increases, and mortality rates rise while many dialysis patients wait for a kidney transplant. This wait and increased care at dialysis clinics and intensive care units results in higher overall healthcare costs for those patients with end-stage renal disease. With the increased patient load, the cost of this care continues to soar with an average Medicare annual cost for dialysis treatment of $88,000 per patient per year. Transplantation and specifically, living donor kidney transplants are by far the most cost effective and safest treatment as an alternative to dialysis.
The difference each year between how many patients go on the waiting list and how many receive a transplant is 20,000. That’s about two-thirds of all auto accident fatalities in the entire country.