Seven hundred new patients a year. That’s the count of Hawaii residents in need of kidney dialysis treatment. In cases of end-stage renal failure, unless a transplant is an option, a patient becomes dependent on dialysis — essentially a kidney substitute, filtering toxins, waste and excess fluid from the blood — for the rest of his or her life.
The average life expectancy for patients on dialysis is five to 10 years. However, many patients live well while undergoing treatment for two and three decades. Sadly, in the islands, the clamor for more clinics is going to get much louder before a significant drop in patient count is even a possibility.
Diabetes is the leading kidney-
disease culprit, with prediabetes and type 2 diabetes now affecting nearly 600,000 people here — roughly 1 in 2 Hawaii residents. Native Hawaiians and other Pacific Islanders are two times more likely to have diabetes than other ethnic groups in the islands.
While Hawaii is hard hit, we’re not alone. On a global scale, health officials predict that by 2030 some 366 million people will have the disease, marking a doubling of diabetes cases since 2000.
The state has more than 30 dialysis clinics, with four still awaiting certification — needed for reimbursement of Medicare and Medicaid patient treatment, which covers as much as 85 percent of the dialysis population. Without certification, a clinic is typically limited to treating patients with private-pay insurance.
In the short term, to keep pace with the demand to open more dialysis facilities, the state must accelerate its certification process, which is now taking up to three years. The state Department of Health, which has blamed delays on too-tight staffing and resources, must work with state lawmakers to loosen up purse strings and establish a more efficient and timely process as a top DOH priority.
Last year, the DOH resorted to spending $140,000 to contract a half-dozen Arizona inspectors to complete delayed certifications for 11 dialysis centers. It’s a sure bet that more of that sort of stopgap funding will be needed until the state puts in place a viable certification process. Without one, it’s also a certainty that more low-income residents having difficulty booking regular clinic appointments due to short supply of certified clinics will turn up at at emergency rooms, where treatment is three to four times more expensive.
Research searching for answers to questions about why people become prediabetic and why roughly 25 percent later become diabetic is underway at the new Center of Biomedical Research Excellence in Diabetes at the University of Hawaii’s John A. Burns School of Medicine. Here’s hoping that scientists can quickly connect the dots — with a strong understanding of the molecular complexities underlying the disease.
For many of us, type 2 diabetes, which occurs when the body cannot use insulin properly, is preventable. And in cases in which it is challenging to avoid — due to genetic makeup, for instance — the disease can be delayed and later effectively managed to diminish the need for the kidney stand-in that is dialysis.
According to the Centers for Disease Control and Prevention, 86 million Americans now have prediabetes — that figure includes 1 in 3 adults. Without intervention, many could develop type 2 diabetes within five years. Risk factors that cannot be controlled: aging, being age 45 or older; and the presence of diabetes in family history. Factors that can be tweaked with intervention: being overweight and physically inactive. So, lose weight (if that’s what your doctor advises), eat healthfully and step up your aerobic fitness.
Meanwhile, the state Health Department, in tandem with the Legislature, must find a way to quickly improve the clinic certification process as the state’s two dialysis operators, Liberty Dialysis and U.S. Renal Care, are planning to open as many as a half-dozen new facilities annually over the next five years.
