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Tag: Kidney Failure

  • Can Innovation Fix Kidney Failure?

    Kidney failure is a serious problem in the United States.  Nearly 800,000 Americans were living with end-stage renal disease (ESRD) in 2018.  That same year, the total Medicare spending on ESRD patients reached $49 billion.  While the industry has tended to focus on the needs of their active, middle-aged dialysis patients, the reality is that 80% of ESRD patients are older than 65.  Many of them are nursing home residents.  Nursing home residents need tailored dialysis care. It’s time to change the game and innovate to fix kidney failure.

    The best treatment for ESRD is a functioning kidney transplant, but only 30% of ESRD patients are able to receive one.  The rest undergo regular dialysis.  Despite the convenience that in-home dialysis would provide, 86% of dialysis treatment still occurs at outpatient clinics.  This arrangement is hard on nursing home residents for several reasons.  Outpatient treatment poses an extra infection risk to older, vulnerable patients.  Traveling to a dialysis clinic is disruptive, confusing, and time consuming for nursing home residents.  Transportation is especially hard for older folks who can no longer drive or whose nursing home does not provide them with transport to a dialysis clinic.  Finally, acute residents can struggle to find placement at outpatient clinics due to their extra needs.  

    Both nursing homes and their residents would benefit from the provision of on-site dialysis.  On-site treatment frees up hours of time the resident would have spent traveling to a clinic.  Having dialysis on-site also results in better collaboration of care, fewer readmissions to the hospital, and stronger relationships with hospital partners.  Nursing homes that provide transportation for their residents can cancel the cost of up to $411 every round trip their residents would have made.  Homes with on-site dialysis can also accept higher acuity patients than those which lack the service.

    In choosing what type of dialysis to provide innovation for kidney failure for nursing home patients, 3-day dialysis is preferable by far to the daily option.  98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis.  Switching them to daily treatment requires changes in prescription, leading to confusion and potentially disrupting the continuity of care.  Daily dialysis carries greater risk of potentially leading to hospitalization or surgery.  This is because the risk of complications like difficulty surrounding the blood-access site, blood clots, and aneurysms are more common in daily dialysis.  While 3-day dialysis can occupy 9-12 hours of a patient’s time per week, daily requires a time commitment of anywhere between 10 and 21 hours.  Those who opt for 3-day dialysis have more time for other therapies and social activities.

    Though the quality of care is first priority, it is understandable that nursing homes must also be wary of the cost of their services.  The truth is that 3-day dialysis is more cost effective than daily dialysis as well.  For the same initial investment, on-site dialysis provided every 3 days gives treatment to 3 times more patients than daily dialysis does.  The same 6 chairs can serve 36 patients in 3 day dialysis compared to 12 patients in daily treatments. 

    Dialysis in Nursing Homes

  • Man Claims P90X Sent Him To The Emergency Room

    As if we needed more of a reason to avoid working out, one man claims that just a single session of the high intensity workout system P90X sent him to the emergency room with kidney failure.

    Matt Lombardi, an internet entrepreneur, just wanted to get back in shape after putting on twenty pounds while launching the sports website College Spun. After completing the first day of the P90X regimen, which is the “Chest & Back” portion, Lombardi experienced pain and discomfort. He chalked up that initial discomfort to the intensity of the workout. However, as he writes in his first-hand account published on College Spun, things soon took a terrifying turn:

    “Thursday morning, things got real. When I got up to go to the bathroom, I noticed that my urine looked like Coca-Cola. In an attempt to self-diagnose (usually a bad idea), I Googled my symptoms. Ten seconds later, I knew I had “rhabdo” and that I was in serious trouble.”

    The condition that Lombardi discovered is known as rhabdomyolysis, which occurs when skeletal muscle tissue breaks down and releases toxins into the body. The increased level of toxins can lead to kidney failure if not treated promptly.

    While the condition often occurs after “crush” injuries, as often occur during building collapses, the round of P90X was apparently intense enough to trigger it. However, that is not to say that the exercise program alone is to blame. As Lombardi himself mentions, it is not uncommon for even well-honed collegiate athletes to develop the condition if they engage in strenuous exercise following a prolonged hiatus.

    Regimens such as P90X have become fitness fads with their promise of quick and obvious results. While the idea of sporting the perfect beach body is often enough to lure the average joe from the couch, cases like Lombardi’s suggest that a more measured approach may be the better option. His story is one to keep in mind before trying to bust out 50 chin-ups when your normal routine includes lifting the remote to change the channel.