IStock Photo 11829313 © Daniel Mirer

As the United States as a nation has gotten fatter and the prevalence of diabetes has grown exponentially, more and more people are suffering kidney failure. From 1980 to 2006, the likelihood that an American had End Stage Renal Disease (ESRD) increased over 5 times from 1 in 3,461 to 1 in 614.9. Not coincidentally, the odds a case of ESRD was caused by diabetes increased almost 4 times over that same time period—from 1 in 10.75 to 1 in 2.76.

Of people suffering from ESRD, 70% are on dialysis. Dialysis is a treatment which does the work of failing kidneys by filtering harmful toxins and excess salts out of the blood. Currently, Medicare covers dialysis for any ESRD patient who is eligible for Social Security benefits, even if they are under the age of 65.

Among Medicare recipients in 2006, less than one half of one percent were being treated for ESRD, yet they accounted for 2.3% of total Medicare spending. This is because, on average, patients with ESRD cost over 5 times as much annually as a typical Medicare recipient—$43,335 compared to $7,862. In 2006 the total amount spent by Medicare on dialysis patients was close to $18 billion.

Dialysis patients have a few options when it comes to their method of treatment. The vast majority (92%) receive in-center hemodialysis, and Medicare typically covers 3 treatments a week. These 4-hour sessions are time-consuming and exhausting, but they are also an inferior substitute for the work performed by healthy kidneys. While a healthy person’s blood is filtered by their kidneys all 168 hours a week, those receiving hemodialysis are only filtered 12 hours a week (7% of the time).

The other option for dialysis patients is home treatment, which 8% of patients choose. Home treatment is between 3-15% less expensive than in-center hemodialysis; it also allows for many more hours of dialysis per week, resulting in a healthier patient and a higher quality of life. Additionally, the indirect costs of in-center treatment, including transportation and work loss, make staying home a very attractive alternative for those who can manage it.

So why do so few patients choose to have home dialysis? A large part of the answer may be the lack of a friend or family member—or affordable paid help—who can act as a nurse, a requirement for home dialysis. Some of it may have to do with limited space—a dialysis unit is the size of a refrigerator, an issue for patients living in tight surroundings. And finally many may simply be unaware that home dialysis is an option.

Even with all the money spent by Medicare on dialysis, 20.1% of US patients died in 2006. That is the highest dialysis death rate in the world. Part of the reason for that rate lies in the fact that the US offers the treatment to anyone who needs it, unlike other countries with more selective systems. But many other countries encourage home dialysis, and it is possible our mortality rate could be significantly cut if we followed suit.

Of course, prevention is the best answer for both saving lives and controlling costs. The number of people with ESRD in 2006 was 506,000, with about 183,000 of the cases resulting from diabetes. And the number of cases caused by hypertension was over 120,000. Estimating how many of those cases of diabetes and hypertension were preventable is difficult, but even a 50% decrease to a total of 150,000 ESRD diagnoses would reduce the number of patients on dialysis by 105,000 (150,000 x 70%). This reduction could potentially lead to a reduction in direct dialysis costs of $4.5 billion (105,000 x $43,335) while saving over 20,000 lives a year. Neither is an insignificant number by any stretch of the imagination.