Elaine Chen, penned an article in the June 25 2023 STATNews.com titled “ADA says all diabetes patients should be screened for nonalcoholic fatty liver disease.” As you might surmise, I have never heard of this malady. The article starts off with “The American Diabetes Association said Sunday that all adults with type 2 diabetes or prediabetes should be screened for nonalcoholic fatty liver disease, an increasingly prevalent condition that can lead to serious liver damage.” If you have been reading this blog, you know that I am a diabetic exacerbated by exposure to Agent Orange in Vietnam.
Fatty liver, also known as hepatic steatosis, is a condition where there is an accumulation of fat in the liver cells. The liver is responsible for processing fats, but when there is an excess of fat, it can build up in the liver, leading to fatty liver disease.
There are two types of fatty liver disease: alcoholic fatty liver disease and non-alcoholic fatty liver disease (NAFLD). As the name suggests, alcoholic fatty liver disease is caused by excessive alcohol consumption, while non-alcoholic fatty liver disease is caused by factors such as obesity, high cholesterol, and type 2 diabetes.
Fatty liver disease often has no symptoms, but it can lead to more serious liver damage, such as cirrhosis if left untreated. Treatment usually involves lifestyle changes such as losing weight, exercising regularly, and avoiding alcohol.
If you suspect you may have fatty liver disease or are a diabetic for certain, it’s important to see a doctor for proper diagnosis and treatment. I’m going to bring this concern up with my GP next visit. The reason this is so important to those of us on dialysis is that on the order of 47% of us are also diabetic. So it figures that we are also the heavy half of people with NAFLD. For the record, my BMI is less than 24 which rules out the obesity factor, and I do not have high cholesterol.
I am using the Abbott Libre Freestyle 3 as I have often noted herein, and paying for the same out-of-pocket. Recently I had a bad sensor, called Abbott’s customer service, and they replaced it and requested I send the defunct one back which I immediately did. Today I received a formal letter from Abbott which stated they had not received the return and requested the same. The letter went on to state if it had already been returned to disregard their request. Before the letter went in the bin I read the small print.
On the back of the letter under Warnings/limitations, it states: ” The FreeStyle Libre Pro System does not provide real-time results and patients should adhere to their blood glucose monitoring routine while using the system….Patients with high levels of ascorbic acid (Vitamin C) or salicylic acid (used in Aspirin) or severe dehydration or excessive water loss may experience inaccurate results with this system. The FreeStyle Libre Pro System is not approved for pregnant women, persons on dialysis, or recommended for critically ill population….” All emphasis is mine.
The first sentence, “patients should adhere to their blood glucose monitoring routine while using the system” directly states to keep doing old fashion finger pricks while using the Libre system. Doesn’t this totally beg the issue of why even use it then?
The second group excludes Orange Juice which I am drinking for breakfast since my dialysis dietician took me off tomato juice because of potassium, and I have also been taking glasses of orange juice to stave off low glucose readings. I take a baby aspirin every day to appease my cardiologist. I have noted that I have been receiving lots of low glucose readings from my Libre 3 while at the same time having no physical presence of being low. Having been at this game for about 40 years I know what a low feels like.
The last statement precludes persons on dialysis from using their CGM in no uncertain terms, no ifs ands, or buts.
I turned to my ChatGPT AI with the following prompt and response in an attempt to dig deeper into this subject with the following results:
Prompt: I just received a letter from Abbott concerning the use of the Libre 3 CGM system. It states in Warnings/Limitations that the Freestyle Pro system is not approved for persons on dialysis or with high levels of ascorbic acid (Vitamin C). Why is this?
ChatGPT provided the following response:
The Freestyle Libre 3 Continuous Glucose Monitoring (CGM) system, like many glucose monitors, works by measuring the level of glucose in your interstitial fluid. This is the fluid that surrounds the cells of your tissues, and it generally mirrors the glucose levels in your blood.
For people on dialysis, there could be a few reasons why the device isn’t approved. The body’s fluid levels can fluctuate significantly during dialysis, and this might affect the accuracy of the CGM system. Additionally, dialysis patients often have other health complications that might affect the system’s performance. However, without more specific information from the manufacturer, it’s difficult to say for sure.
As for high levels of ascorbic acid (Vitamin C), this is likely due to the fact that ascorbic acid can interfere with glucose monitoring systems. Many glucose monitors, including the Freestyle Libre, use a method called glucose oxidase to measure glucose levels. However, ascorbic acid can react with glucose oxidase, leading to falsely high glucose readings. This is a known issue with many glucose monitors, and it’s likely the reason why the Freestyle Libre 3 isn’t approved for use in people with high ascorbic acid levels.
At this point, I am flummoxed and speechless. No MD I have interfaced with has brought this up. No RN I have interfaced with has brought this up. No medical professional of ANY ilk has brought this up. I am going to continue underway as before and keep gathering data, such as it is. Stand by for another itshay!
I ran across a free new-to-me Ai site that purports to write essays for students. I plugged into the website, www.writeapp.co, and followed the bouncing ball to write the following blog on the basics of peritoneal dialysis (PD.) It did a creditable job. The graphic above is from Bing Illustrator.
Introduction
Peritoneal Dialysis (PD) is a treatment option for patients with end-stage renal disease that removes waste and excess fluids from the body. PD is an alternative to hemodialysis, which relies on the use of a machine to perform filtration. PD, on the other hand, utilizes the patient’s peritoneum as a natural filter. This essay will explain what Peritoneal Dialysis is, how it works, its types and their advantages and disadvantages, how it affects lifestyle changes, and conclude with recommendations for patients.
What is Peritoneal Dialysis (PD)?
Peritoneal dialysis is a treatment method used in place of hemodialysis for people who suffer from kidney failure or end-stage renal disease (ESRD). In PD treatment, the lining of your abdomen acts as a filter to remove harmful toxins and excess fluid from your blood. A catheter will be inserted into your abdomen through surgery; this will allow dialysate (a solution infused with minerals like sodium chloride) into your abdominal cavity where toxins present in your bloodstream enter it through capillaries in your peritoneum.
How does PD work?
Once dialysate enters the abdominal cavity via catheter tube implantation during surgery, wastes present in blood plasma pass across capillary walls into the peritoneum due to osmosis diffusion pressure gradients created by glucose present in the dialysate. The process occurs continuously over several hours while the patient goes about their daily routine.
Types of PD
There are two main types of Peritoneal Dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD), which requires no machine assistance; instead relies on manual exchanges five times or more every day by patients themselves without machines intervening; automated Peritoneal Dialysis also known as continuous cycling peritoneal dialysis 1(CCPD), allowing overnight treatments via an automated cycler at home providing 3-5 exchanges each night while the patient sleeps.
Advantages and Disadvantages of PD
PD has several benefits, one of which is that it allows patients more control over their treatment plans. The procedure can be carried out in the comfort of the patient’s home, allowing them to continue with their normal daily routine. This form of dialysis is also less invasive than hemodialysis since there are no needles involved. Some disadvantages include a high risk for infections due to catheter insertion and peritoneal membrane damage, requiring regular check-ups to prevent complications.
PD and Lifestyle Changes
Patients who undergo Peritoneal Dialysis must adjust their lifestyle accordingly. Patients should adopt healthy habits such as eating a healthy diet, reducing alcohol intake, taking medications regularly as prescribed by the physician, and avoiding strenuous activities that could interfere with catheter fluid movement within the abdomen whilst performing exchanges.
Conclusion
Peritoneal Dialysis (PD) is an effective mode of treating end-stage kidney disease compared to hemodialysis; however, it requires frequent monitoring and medical attention due to possible complications such as infection risks or peritonitis caused by incorrect techniques during exchanges or other factors discussed above. Physicians’ knowledge about this method plays an important role in whether they recommend it for patients over other treatment options; thus awareness campaigns should be created targeting clinicians on management protocols related to assessing suitability criteria for patients experiencing ESRD symptoms. More research needs to be conducted into examining how remote monitoring could improve patient care quality regarding long-term health outcomes after initial hospital discharge following PD commencement therapy.
As a Vietnam Veteran, I have a unique perspective on Independence Day, a holiday that celebrates our nation’s birth and its enduring promise of freedom. On July 4, we commemorate the passage of the Declaration of Independence in 1776, a momentous event where the Continental Congress voted in favor of independence from Great Britain.
Independence Day is a day of patriotism, of pride in our nation and its foundational principles. Yet patriotism, as we understand it, is not about blind loyalty or uncritical support for a country or its elected officials. As veterans, we know the difference between true patriotism and hollow nationalism. True patriotism lies in the continued quest to find a more perfect union, a commitment to the ideals encapsulated in the Declaration of Independence and the Constitution of the United States.
The principles that bind us as a nation—freedom, equality, justice, and opportunity— are what we, as veterans, have been prepared to defend. It is about loving our country not for its power or wealth, but for its selflessness and idealism. This sense of devotion to country is not about misleading slogans and empty gestures but about ideals and the hope that this nation can serve as an example to the rest of the world.
Yet, as we celebrate, we must also remember the responsibility that comes with this freedom. Our forefathers knew that the union they were forming was not perfect, but they believed in the possibility of making it “more perfect” with each passing year. They envisioned a nation that belonged to “we the people” – not to the government or political parties.
Independence Day serves as a reminder of our duty to protect this vision and to correct our nation when it strays from its path. In the words of Martin Luther King Jr., “I criticize America because I love her. I want her to stand as a moral example to the world”. We acknowledge our nation’s imperfections, we admit our mistakes and strive to atone for them. This too, is a patriotic act.
As a Vietnam veteran, my experiences have taught me to value freedom, to understand the weight of service, and to appreciate the continual pursuit of a more perfect union. On this Independence Day, let us not just celebrate our freedom but also remember our responsibility to uphold the ideals of our nation and to continue striving for that perfect union our forefathers dreamed of so long ago.
As we celebrate the Fourth of July this year, let us remember the courage, the sacrifice, and the vision that birthed this nation. Let’s continue to strive for a more perfect union, for ourselves, for our children, and for the generations yet to come. For we are not only celebrating a moment in history but a promise, a promise of freedom, equality, and the pursuit of happiness that has been the beating heart of our nation for nearly two and a half centuries.
Happy Independence Day to you all, and let freedom ring! But for individuals on dialysis reading this, NEVER RING THE BELL!
Medicalpress, on June 14, 2023, reported on a new and novel approach to the manufacture of insulin for potential use involving lettuce, yes, lettuce. The article by Lauren Rebecca Thacker, University of Pennsylvania titled “A plant-based, oral delivery of insulin regulates blood sugar levels similar to natural insulin: Study.” A summary of the article follows:
A groundbreaking study led by Henry Daniell of Penn’s School of Dental Medicine has introduced a new, affordable insulin delivery method that could revolutionize diabetes treatment and dramatically lower the risk of hypoglycemia compared to current methods. Insulin, a lifesaving medication for the estimated 537 million adults living with diabetes worldwide, has traditionally been delivered via injection, which can cause hypoglycemia due to insulin reaching the bloodstream too quickly. Although automated insulin pumps can minimize this risk, they are expensive and only accessible to a small portion of diabetes patients globally.
Daniell’s study, published in the journal Biomaterials, presents a plant-based, oral delivery of proinsulin that addresses these drawbacks. The new plant-based insulin contains all three peptides found in natural insulin, which clinical insulin lacks. The plant cell walls protect the insulin from stomach acids and enzymes until gut microbes break it down. The insulin is then delivered to the liver through the gut-liver axis. In trials with diabetic mice, this oral insulin-regulated blood sugar within 15 minutes of ingestion, similar to naturally secreted insulin, and without causing hypoglycemia, a common risk with traditional insulin injections.
The production of this plant-based insulin, using lettuce in this case, involves blasting human insulin genes through plant cell walls using a “gene gun.” The insulin genes then integrate into the plant’s genome. The lettuce is freeze-dried, ground, and prepared for oral delivery following FDA guidelines. This method eliminates the need for expensive fermentation, purification, and cold storage/transportation, significantly reducing production costs. The final product is shelf-stable at room temperature, eliminating the need for cold storage and reducing post-production costs.
Daniell plans to test this plant-based insulin in canine and human subjects in the future. He has previously conducted canine studies and believes this method could significantly alter treatment for diabetes and other diseases. In addition to its advantages in efficacy and affordability, plant-based insulin aligns with Daniell’s commitment to making healthcare globally accessible and affordable. He emphasized that this new method could provide patients with a superior drug at a lower cost.
For readers of this blog, we should take solace in that current research, while still in the animal-testing stage, appears to indicate that oral-based insulin may become available in some of our reader’s lifetimes!
A month or so ago I suffered an Orthostatic Hypotension incident in front of our home while talking to a neighbor. I sensed it coming on and gently fainted onto the payment with his kind help. I recovered quickly and with input from my dialysis nurse Cindy, we altered my dialysis solution mix and it has not occurred since. This is the “why” I’m interested in this malady.
On June 13, 2023, CNBC ran an article announcing a startup, Stat Health was coming out with a wearable device that is placed in the ear per the above picture that gives a warning to the user well in advance of an event such as orthostatic fainting. The CNBC blurb states;
‘When users stand up, the earpiece automatically tracks changes in their heart rate, blood pressure trend and blood flow, which are useful insights for patients who commonly experience dizziness and fainting spells as a result of illnesses like long Covid and postural orthostatic tachycardia syndrome (POTS), among others.
Users can track their metrics in an app on their cellphone and glean insights into how their lifestyle choices affect their symptoms. The STAT earpiece has also proven to predict fainting minutes before it happens, according to peer-reviewed findings published in Journal of the American College of Cardiology this year.”
I followed the bouncing ball and arrived at Stat Health’s website and signed up to be eligible for the device. They charged $1.00 to signup which puts me in the queue to receive the device and pay $50 a month to use the device and their software. More to follow as more is known.
Recently (June 17-18, 2023. P. A5), The Wall Street Journal ran a piece by Betsy McKay titled “Testosterone Therapy Shown Not to Increase Heart Risks.” At first blush, this does not appear to have much impact on those of us on Dialysis. But wait. The fifth paragraph states, “While the study found no risk of major cardiovascular events such as heart attacks, researchers did report a few cases of pulmonary embolism, or a blood clot affecting the lungs; atrial fibrillation, a heart-rhythm disorder; acute kidney injury; and small blood pressure increases among men who received testosterone treatment. (Emphasis provided.)
I am and have been for years on Testosterone Therapy and the “acute kidney injury” got my attention. What is this all about?
McKay’s article cited the study upon which her article was based as being published in the New England Journal of Medicine. It was based on a new clinical trial of about 5,200 men funded by AbbVie et al. With the information, I did a Google, found, and created the original report in searchable PDF format. I then searched for the word “kidney.” This is where things get interesting!
Buried in the body of the report is the following statement: “There were more cases of nonfatal arrhythmias warranting intervention, atrial fibrillation, and acute kidney injury among patients who received testosterone than among those who received placebo; these adverse events were not expected.“ (Again, emphasis provided.) And this is pretty much where it was left for this study – EXCEPT.
Refer to Figure 3 at the end, a screen capture from the report. To impart a little more understanding to what is shown, a little about “p” values in statistics is merited. In this study, it was assumed that there are no differences between the two groups of men, ie, those taking testosterone and those who do not. This is called a null hypothesis in statistical testing. The “p” value, or probability value, describes how likely the data support the null hypothesis, in this case, no difference between the groups. A “p” value of 0.05 or less is generally accepted as a strong indicator that, in this case, THERE IS A DIFFERENCE. 1-p is the inverse, that is, there is a difference rather than there is not. For acute kidney injury, 1-p=1-.04=96% probability that there is a difference in the groups. In layman’s terms, we can be 96% certain that the administration of testosterone therapy adversely affected those from a kidney perspective who took it compared to those who did not.
Like analysis holds true for Atrial Fibrillation, only even stronger, that is, the probability is 98% that those who were on testosterone therapy were adversely affected in this regard compared to those who were not on the therapy.
To me, these are stupendous findings. I recognize that the researchers were investigating therapy as related to cardio aspects, but to state “these adverse events were not expected” is a vast understatement and a disservice. You can see from the table below that 60 men on therapy suffered acute kidney injury compared to 40 not on therapy who did not. Let’s put this into perspective! Full 50% more men on therapy suffered acute kidney injury compared to the 40 men in the control group. That’s right, half again as many. Have your attention yet?
I didn’t stop here. I turned to my faithful AI subscription and asked, “What is the tie, if any, between testosterone-replacement therapy and acute kidney injury?”
The AI summarized findings thusly: “However, the evidence in humans is limited and somewhat mixed. Some observational studies have found higher testosterone associated with lower mortality in CKD patients and higher estimated glomerular filtration rate (eGFR), a measure of kidney function. However, a clinical case report showed testosterone therapy induced renal impairment, and a small randomized controlled trial in 48 men showed that 6-month testosterone treatment lowered eGFR. The lack of large-scale randomized controlled trials makes it difficult to assess the long-term effect of testosterone on CKD definitively.”
So, I’m sitting here thinking, Oh crap, or stronger words, what’s next to crawl out from the woodwork?
In the realm of healthcare, it’s not uncommon for us to focus primarily on the main conditions that affect a patient, such as kidney disease or heart conditions. However, the often overlooked aspect of patient health is how these conditions can affect other areas of a person’s life. For men on dialysis, one such issue is erectile dysfunction (ED).
Understanding the Problem
Erectile dysfunction (ED) is a medical condition where a man cannot get or keep an erection firm enough for sexual intercourse. It’s a common problem, particularly among older men, but is rarely talked about, even in medical consultations, due to the stigma and embarrassment associated with it.
For men on dialysis, the issue is particularly prevalent. Dialysis, a life-saving treatment for kidney failure, can, unfortunately, lead to ED for a number of reasons. First, the underlying health issues necessitating dialysis, such as diabetes or hypertension, are often risk factors for ED. Second, the physical and psychological stress of dialysis can also contribute to the problem. It’s estimated that as many as 70-80% of men on dialysis experience ED to some degree, a far higher rate than in the general population.
The Impact
The impact of ED on men on dialysis is profound. It goes beyond just the inability to have sexual intercourse. Men with ED often experience low self-esteem, depression, and anxiety. It can also strain relationships, creating a significant amount of emotional distress for both the patient and their partner.
Moreover, ED can be a sign of more serious underlying health issues. Cardiovascular disease, diabetes, and kidney disease, among other conditions, can all lead to ED. It’s essential to bring up this topic during medical consultations, as it can provide valuable insight into a patient’s overall health.
Addressing the Issue
The first step in addressing ED among men on dialysis is to break the silence around the issue. Encouraging open and honest discussions between patients and healthcare providers can help to alleviate the embarrassment associated with ED and lead to more effective treatment strategies. Thus this blog entry.
Treatment options for ED in men on dialysis do exist. These can range from medication to lifestyle changes, psychological counseling, or even surgical interventions. However, it’s important to remember that treatment should be tailored to each individual’s situation, considering their overall health, the severity of their ED, and their personal preferences.
The Future
Research is ongoing to understand the connection between dialysis and ED better and to develop more effective treatments. Already, there have been promising developments in the field of regenerative medicine and stem cell therapy that could potentially revolutionize the treatment of ED. This blog will report on a new entry in this field.
To conclude, while dialysis is a life-saving treatment, its impact on a man’s sexual health is undeniable. I
But wait, it is not just a male problem!
Women’s Sexual Health and Dialysis
While the conversation around dialysis and sexual health often focuses on men, it’s crucial to recognize that women on dialysis also experience significant sexual health challenges. A decrease in sexual desire, or libido, is a common issue among women undergoing dialysis treatment.
The reasons behind this decline in sexual drive are multifaceted. First and foremost, the underlying health conditions that necessitate dialysis, such as diabetes or hypertension, can negatively impact sexual drive. Dialysis can also lead to hormonal imbalances, including decreased estrogen, which can further lower libido.
In addition to these physical factors, the psychological toll of living with kidney disease and undergoing dialysis can be substantial. The stress, fatigue, and anxiety often accompanying dialysis can dramatically affect a woman’s mental health, leading to depression in some cases. All of these factors can contribute to a decrease in sexual drive.
Furthermore, body image issues can arise due to changes in physical appearance related to kidney diseases or dialysis treatment, such as weight gain, skin problems, or surgical scars. These changes can significantly affect a woman’s self-esteem and, in turn, her sexual desire.
In conclusion, just like men, women on dialysis face significant sexual health challenges that often go unaddressed due to the focus on treating the primary disease.
The US FDA recently (June 2023) approved an Over-the-Counter solution to ED for men. The following was gleaned from various websites and is provided without attribution. Do a Google, and you can find out more about the subject on your own. I have included a video at the end that describes the product in more detail.
US FDA Grants for Over-the-Counter Marketing Authorization to Futura for Fast-Acting Topical Gel, MED3000, to Treat Erectile Dysfunction
June 12, 2023, 03:39 AM Eastern Daylight Time
GUILDFORD, England–(BUSINESS WIRE)–Futura Medical plc (AIM: FUM) (“Futura” or the “Company”), a pharmaceutical company developing a portfolio of innovative products based on its proprietary, transdermal DermaSys® drug delivery technology currently focused on sexual health, today announces that the US Food and Drug Administration (“FDA”) has granted over the counter sale (“OTC”) Marketing Authorisation for MED3000, the Company’s breakthrough, topical gel formulation for the treatment of erectile dysfunction (“ED”) as a De Novo Medical Device.
MED3000 can now be legally marketed in the USA as the first topical treatment available OTC without needing a prescription. MED3000 is approved as an effective, clinically proven treatment for ED with a 10-minute onset of action. Oral medications (“PDE5i’s”) such as Cialis and Viagra require a doctor’s prescription in the USA and typically are required to be taken at least 30 minutes in advance. The US represents the largest ED market in the world.
The prevalence of ED disrupts the lives of at least 1 in 5 men globally1, with around 22 million men suffering from ED in the US. There has been little innovation in ED treatments for over a decade, and many patients continue to suffer dissatisfaction with current therapies and have limited access to safe and effective treatments.
MED3000 has already been approved as the first pan-European clinically proven topical treatment for ED available OTC and is now available in Belgium and the UK, with multiple commercial agreements in key markets including the European Economic Area, UK, Switzerland, South Korea, Latin America, and the Middle East. Futura continues to establish and expand a network of licensing and distribution partners with strength in brand building, pharmaceutical credibility, regional infrastructure, and marketing expertise for the long-term distribution of MED3000 across the globe. Initial launches commenced under the brand name Eroxon® in March 2023, with further launches planned through 2023 and beyond.
Previously I used Content Analysis to gain insights into the 63 responses to the Frensenius-sponsored forum for dialysis patients moderator’s question “What is the number one problem you face in dialysis?” Recall the data collection spanned four years. See the 6/22/2023 blog post for this nine-factor analysis. For this blog, I posed two different questions in the Prompt to the AI housing the data as follows:
Prompt: Based on the dialog provided, from a patient’s viewpoint what is the number one problem faced in dialysis; from the provider of dialysis services, Fresenius, what is the number one gripe?
From a patient’s viewpoint, based on the dialog provided, the number one problem faced in dialysis can be identified as the various physical and emotional challenges associated with undergoing dialysis treatment. This includes issues such as sleep disturbances, discomfort during treatment, dietary restrictions, weight management, infections, complications, emotional distress, and lifestyle adjustments.
Regarding the provider of dialysis services, Fresenius, the number one gripe mentioned in the dialog is the inefficiency and perceived lack of responsiveness in their supply chain and pharmacy division. Patients express frustration with the difficulties in obtaining supplies, encountering defective products, and the need to actively manage and coordinate their own orders. The lack of adequate communication and support from Fresenius personnel is a recurring complaint.
From my perspective dealing with Fresenius in Granbury, Tx, I have not experienced ANY of the situations documented in the replies to the moderator’s question EXCEPT with the Cycler throwing alarms on the drain cycle. Fresenius personnel across the board have been kind, responsive, earnest, and helpful. I couldn’t ask for better support, especially from my dialysis nurse Cindy. There is only one of her caliber period. Thanks, Cindy for your kind care. We’re hanging in there! I will never ring the bell!
Here are some actual numerical statistics related to the preponderance of dialysis among blacks and other minorities in the USA:
Prevalence of Chronic Kidney Disease (CKD):
According to the National Kidney Foundation, black Americans are almost four times more likely to develop kidney failure than white Americans.
The prevalence of CKD is higher among Hispanics, Native Americans, and Asians than non-Hispanic whites.
Approximately 15% of the adult population in the USA, which is around 37 million people, are estimated to have CKD.
End-Stage Renal Disease (ESRD) and Dialysis:
The ESRD prevalence rate for black Americans is about three times higher than for white Americans.
As of the latest available data (2019), black Americans represented 32% of the ESRD population, despite comprising only around 13% of the total US population.
Hispanics and Native Americans also have higher ESRD rates than non-Hispanic whites.
ESRD patients require dialysis or a kidney transplant to sustain their lives. In 2019, over 550,000 Americans were receiving dialysis treatments.
Healthcare Disparities:
Black Americans are more likely to experience disparities in healthcare access, quality, and outcomes. They have higher rates of uninsured or underinsured individuals compared to white Americans.
Access to early detection, screening, and preventive measures for kidney disease is often limited within minority communities.
Studies have shown racial disparities in kidney transplantation rates, with black Americans facing longer waiting times and lower rates of receiving kidney transplants than white Americans.
Economic Impact:
The cost of dialysis is substantial, with an estimated average annual cost of over $90,000 per patient in the USA.
ESRD disproportionately affects low-income populations, and individuals from minority communities often face financial challenges, leading to increased financial burdens related to dialysis treatments.
Reduced workforce productivity due to dialysis treatments can result in income disparities and economic strain within minority communities.
These statistics provide a glimpse into the disparities and impact of dialysis among blacks and other minorities in the USA. Let’s now look beyond the statistics.
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) disproportionately affect these communities, leading to a myriad of social and economic challenges. In this blog, we will now delve into the factors contributing to the preponderance of dialysis among blacks and minorities and explore the profound social and economic implications it entails.
Understanding the Disparity:
Health Disparities: Blacks and other minority groups face a higher risk of developing CKD due to a combination of genetic predispositions, socioeconomic factors, and healthcare disparities. Conditions like hypertension and diabetes, which are more prevalent in these populations, contribute to the development and progression of kidney disease.
Socioeconomic Factors: Socioeconomic factors such as limited access to quality healthcare, inadequate insurance coverage, lower income levels, and educational disparities are pivotal in exacerbating the prevalence of dialysis among minority communities. Lack of awareness, cultural beliefs, and language barriers may also impede early detection and treatment of kidney disease.
Inequities in Healthcare: Systemic biases within the healthcare system can contribute to the disproportionate burden of dialysis on minority populations. Implicit biases, unequal treatment, and racial disparities in healthcare delivery can hinder timely access to preventive measures, screening, and early interventions, thus leading to a higher incidence of ESRD.
Social Impact:
Diminished Quality of Life: Living with CKD and undergoing dialysis treatments can significantly impact an individual’s quality of life. Dialysis requires substantial time commitments, often several times a week, leading to decreased productivity, limited employment opportunities, and restricted social interactions. These challenges can lead to feelings of isolation, depression, and diminished overall well-being.
Psychological and Emotional Burden: The emotional toll of managing chronic illness and relying on dialysis can be overwhelming. The stress associated with financial burdens, family strain, and uncertainties about the future can adversely affect mental health within minority communities. Moreover, disparities in mental healthcare access can compound these challenges.
Economic Impact:
Healthcare Expenditures: The economic burden of dialysis is substantial, with costs ranging from medication and equipment to dialysis treatments and follow-up care. Individuals from minority communities, who often face financial constraints and limited insurance coverage, are disproportionately impacted by these costs. Moreover, higher rates of dialysis utilization strain public healthcare programs and contribute to rising healthcare expenditures.
Workforce Productivity: The prevalence of dialysis among minority populations leads to decreased workforce productivity. Frequent dialysis sessions and medical appointments make it difficult for individuals to maintain regular employment, resulting in income disparities and perpetuating socioeconomic inequalities.
Summary: As the above shows, in the USA, minorities are at the short end of the stick regarding dialysis and CKF.
