Interestingly, adjusted for inflation, government dialysis treatment reimbursements have declined since the 1970s. When the program began, the federal government paid $135 per treatment (approximately 80% of the cost). In 1995, that number (adjusted) had fallen to just $122. Why is that important? It leads to a peculiar observation. As the federal government’s largess, as measured in per patient dialysis treatment funding, dried up; the dialysis industry witnessed an enormous, sustained boom in business.

How could this be? Only two possibilities can explain this:

1. The number of ESRD patients grew at an increased rate;

2. The dialysis industry minimized the costs of care to scoop out extra profits.

It turns out that both of these explanations have merit.

Taken in this broader context, it is easy to understand why Fresenius opted to use a cheaper dry acid (i.e. sodium diacetate) instead of the more expensive acetic acid in GranuFlo. “Going cheap” was just a native part of the dialysis industry’s culture. On some level, it didn’t matter that the dry acid solution might be less than ideal for patients; if a strategy improved the bottom line, it was likely to be adopted. That attitude was the legacy of Dr. Hampers’ business philosophy.

The Second Reason for the Dialysis Industry Boom

There is a second, more disturbing explanation for the increase in industry profits: the geometric growth in the prevalence of ESRD. According to National Institutes of Health statistics, ESRD cases in the United States have skyrocketed over the past three decades. In 1980, there were approximately 290 case of ESRD per million people. By 2009, that number had climbed to over 1,700 cases per million people. The United States Renal Data System’s annual data report from 2011 found that, by the end of last decade, 871,000 patients were receiving care for end-stage renal disease, 571,000 of whom used Medicare funds to subsidize their treatment.

What Caused the Spike in ESRD? (An Examination of the Saccharine Disease Theory)

So why has ESRD spiked so dramatically?

The story gets even more peculiar… and disturbing.

Kidney disease is associated with a cluster of metabolic diseases, commonly known as metabolic syndrome or syndrome X. These illnesses include type 2 diabetes, obesity, hypertension, heart disease and cancer. Sometimes, researchers cause these problems “The Diseases of Civilization” or “Western Diseases,” since they typically only occur (in large numbers) in industrialized societies that have been exposed to the “Western” diet and lifestyle. In fact, in diverse non-Western societies — including the traditional Inuit in the Arctic Circle, the Massai Warriors in Africa, and the Kitavans in Polynesia — the Diseases of Civilization are incredibly rare.

We will explore the fascinating relationship between the diseases of civilization and diet in the next post. For help with your GranuFlo case, call Davis & Crump at 800-277-0300 for a confidential case evaluation.