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Just listened to a fascinating Freakonomics podcast about the business of kidney dialysis. Kidney failure (often caused by diabetes) is such a catastrophic disease that Medicare covers treatment for anyone, regardless of age. Dialysis is 6-7% of Medicare's overall budget. The ACA (Obamacare) inadvertently created a loophole that the 2 dialysis industry players are gaming, to the detriment of everyone. The Trump administration was in the process of trying to solve this problem, but the incoming Biden administration has put it on hold.


One solution is home dialysis. In the US, only 12% of dialysis patients are on it, even though it helps keep people healthier, creates a better quality of life since it happens overnight while one sleeps at home, and would ultimately save money. Other countries like Guatemala have 50% of patients on home dialysis, and Taiwan has 80%. What's up with the U.S.? One take-away of this podcast is: maintain a healthy weight! You do not want to get diabetes and wind up on dialysis! This is such an interesting podcast with other take-aways.

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Medicare covers dialysis, but at 80%. The costs to the patient are high. On home dialysis that amount of space that is taken up is huge. The best prices for supplies are for one month. Your home ends up looking like a storage unit.
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Part of the reason I find the CKD topic of interest is because my hubs and I have a branding company and most of our clients over the past 38 years have been in med-tech (so, b to b not consumer or retail). There is a therapy for HBP called Renal Denervation, which ablates a certain nerve that regulates BP. So, when a patient has trouble getting compliance on controlling their BP, this is a very safe and effective option and more med-tech companies are getting into this field. My particular client's device disables the nerve through ultrasound, not heat. I'm not sure if this therapy is covered by Medicare or not, but if you or a LO is having problems getting your BP under control, this may be an option so ask your doctor. FYI I am not promoting anything for any client and get no compensation... I am just finally connecting the dots of why so many of our med-tech clients are keen on the HBP issue. The sheer size of the CKD issue is a revelation. Also an incentive to work to keep my health optimal.

Please keep your stories of at-home or clinic dialysis coming...I'm interested to learn more. Thanks, AC peeps!
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Kidney disease can be sneaky and major damage can have already occurred before you have any symptoms at all.Everybody worries about heart attack or stroke from high blood pressure but nobody talks about it damaging the kidney, if you already have any kind of heart disease your kidneys are at higher risk, and the reverse is also true because the kidneys regulate BP. When my BIL discovered he had a congenital malformation of his heart valves he also discovered he has kidney disease, a double whammy.
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Mom had no risk factors for CKD. She developed a kidney infection. After that her GFR numbers started down and eventually low enough to require dialysis. She had evaluations at both Cleveland Clinic and Ohio State. But no resolution.
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Somehow it does not comfort me to hold Guatemala up as a medical care role model.
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Peace, do you have any of these other factors?
- Family history of CKD
- Age
- Race/ethnicity (African-America, Hispanic, Native American, Asian)
- Other causes such as acute kidney injury, kidney cancer, autoimmune diseases like Lupus, other diseases

Bridger, what about your mom? Any of these factors?
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My mom was not a diabetic, no high blood pressure and very petite. But she ended up with CKD and on dialysis.
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Just recently I was diagnosed with stage 1 (bordering 2) CKD. I don’t have diabetes, btw. I do have high blood pressure (controlled) for several years. I’m now following a low salt , no red meat diet - strictly, plus exercising. My weight is good..could stand to lose a few pounds but not obese. So, I hope to delay the higher stages. If and when the time for dialysis comes, I probably won’t choose either home or center. Will opt for hospice instead.
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I listened to the podcast yesterday while doing yard work. It was very interesting and like you, Geaton, I was really struck by the importance of avoiding Type 2 Diabetes at all costs!

Diabetes patients apparently are just walking dollar signs to Big Pharma and the healthcare industry. One of the medical experts on the program stated that a third of all diabetics have some degree of kidney damage: ka-ching!
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Wow...the comments thus far are making me think about contacting the producers of the podcast and ask them if they actually interviewed anyone who has actually done in-home dialysis.
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You have had me reading up on home dialysis in Ontario, if dialysis is so costly in America then obviously it must be even more so here where the government bears 100% of the cost 🤔. My SIL is a social worker at a renal clinic (and is a type 1 diabetic) and coincidentally her husband's kidney function is at 30% so I am somewhat cognizant of many issues related to kidney disease, but up to now I haven't really been aware of the ins and outs of home dialysis.
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My FIL was on home dialysis. Everyone thought it sounded lije suchba great idea! You can travel, not be tied to inconvenient daytime appointments.

The schedule of care nearly killed my health MIL. FIL had CONSTANT infections in the line. Hospitalized every couple of weeks. Massive failure and I guarantee it cost more in the long run than dialysis in a center.

Very much like "age at home and pay your relative (a pittance) for being your 24/7 caregiver".

In medicine as in education, there is no free lunch.
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They give you all the same arguements About cost, convenience. Trumps plan was just another way to throw away those with major health problems. For a frail elder with poor coordination it’s horrible. My mom had great support -my dad and husband are doctors. I’m a nurse. But what happens in the middle of the night when the alarm goes off with air in the line. You have to sleep in one position to keep the catheter in place. At a center all is taken care of. Dialysis nurses are great. New Zealand actually has great outcomes because they dialyze longer and slower. And the equipment and supplies I. Your house are a mess.
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Bridger46164, I'm sorry disappointed to hear of your poor experience with it -- it seems like such a reasonable solution. Davita and Fresnius are the only 2 players in the dialysis industry. Did you listen to the podcast? I'd be interested to hear your thoughts.
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My mother was on dialysis for 6.5 yrs. She talked into going on home dialysis to save money for Medicare. IT SUCKS. No sleep, constant discomfort, port problems. We took her back to a Fresnius center. She had no problems, and good support and services. I would NEVER go on home dialysis.
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Thanks, I will check it out!
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