Why Does US Have Worst Fatality Rate From Kidney Dialysis?

Just about anyone diagnosed with kidney failure can get their kidney dialysis fully covered under Medicare. So why are taxpayers paying $20 billion a year for a program that lets 25% of the patients die within a year, the worst fatality rate of the first world? Why do only two chains run 2/3 of all clinics? And why won’t the government release important data that could improve the quality of care? An investigation in The Atlantic probes this issue in depth.

“God Help You. You’re on Dialysis.” [The Atlantic]


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  1. pop top says:

    For a first-world country, we also have bad infant mortality rates, high rates of women dying during and after childbirth, terrible STD rates, the list goes on. It’s pretty sad really.

    • lordargent says:

      Infant mortality rates are calculated differently depending on the country. The reason the IMR is so high in the US is that they count more premature births as live births than other countries do.

      “The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5]

      The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size,”

      • healthdog says:

        That is so interesting. Thanks for the info!

      • jenjenjen says:

        The US still has numbers higher than both Germany and Sweden. Even when you move past the straight neonatal mortality onto something less prone to apples/oranges like risk of death before age 5, we’re not doing as well as we should.

      • mythago says:

        Which means that the US is still doing poorly compared to countries like Germany and Sweden, which report premature births the same way we do.

        Also, if you’re going to quote somebody else, please put in a link to your source. You cited the Wikipedia article on infant mortality, which has a lot of things to say about the causes and significance of infant mortality other than ‘they count different than we do’, and the text you quoted goes back to a US News and World Report article by USNWR’s health columnist, who, according to links in her own Wikipedia article, thinks there may be a link between vaccines and autism that the government is deliberately refusing to study.

  2. eturowski says:

    Maybe the quality (inadequacy) of our dialysis centers is a result of the high demand for dialysis in the US. If we as a nation could shape up, we would have reduced rates of obesity –> diabetes –> diabetic nephropathy –> renal failure. As it stands, we are pushing the limits of an overworked system, which inherently leads to error.

    • RosevilleWgn says:

      Or, quicker testing by physicians. In my wifes case, Bacterial infection -> Renal failure. Three (failed) transplants later, back on dialysis.

      • ninabi says:

        I’m so sorry to hear about your wife’s situation Has her experience with dialysis been like those described in the article? I surely hope not.

      • Jedana says:

        And my husband. The nephrologists have yet to come up with a definitive reason why his kidneys failed (although the adrenal cancer on his right kidney certainly didn’t help that one). We do home hemodialysis, and have had only 2 infections, both of which came about after my husband had to go “in-center” to do a treatment.

    • Loias supports harsher punishments against corporations says:

      Don’t forget alcohol abuse. Honestly I don’t know the numbers so I’m postulating. But since college-age binging is much more prevalent here, one could argue that as a contributing factor to future demand as well.

      • HideYaKidsHideYaWife says:

        I don’t really but that considering every other country in the world has much lower drinking ages than ours.

      • HideYaKidsHideYaWife says:

        I don’t really buy that considering every other country in the world has much lower drinking ages than ours.

    • Anonymously says:

      If there’s such a demand for dialysis, maybe I should open up some clinics and steal a piece of that pie.

    • LadyTL says:

      You know not every diagnosis of “obesity” ends up with diabetes and not every case of diabetes ends up with kidney failure.

      • eturowski says:

        You’re right. My bad, there’s no link between obesity and (Type II, I’ll clarify while I’m at it) diabetes.

        • eturowski says:


        • CBenji says:

          Actually there is a link to being overweight and diabetes, but if you get older you will also get it too. So if you don’t get killed in a car accident, or get cancer, by the time you are in your 80’s there is a good chance you will get diabetes. My father has it and was never overweight. It also didn’t run in his family, but cancer did, and so did fighting in wars. Maybe I should do something about him getting old…

          • terribletony says:

            You’ll find that sex runs in the family too. If your parents didn’t have it, there’s good chances you won’t either.

          • u1itn0w2day says:

            Overweight is definately a problem. But so is lifestyle young or old. A more fit body through exercise will have more stamina and higher metabolism to not only burn fat but to boost the immune system. If you can keep your immune system fit things like infections don’t have the catastrophic effects on the body.

            And are alot of the problems associated with old age actually a accumulation of a lifetime or long period of not exercising. Odds aren’t with you as you age but a have to remember the current generation of seniors are about the last ones that didn’t have the access or knowledge to stay fit as a young person(not that it’s helping 10 year gamers today) or as a older adult. The current philosiphy of the medical industry on senior care is still basically just keep them comfortable and functioning and not working on their fitness.

            A fit nation is a healthier nation.

      • eturowski says:

        Diabetes IS the leading cause of renal failure in the United States, by the way. You can take it up with NIH if you have issues with that statement.


    • Bladerunner says:

      You realize that’s bad logic, right? We’re talking about statistics here. Our percentage is worse than theirs. So you’re saying that despite the fact that these centers make a profit (and they do), they’re ‘overburdened’… so in other words, they’re cutting corners to maximize profits, and it’s killing people? That’s not a need for us as a country to ‘shape up’ (although, honestly, you’re right, I wish people WERE healthier), but a need for OVERSIGHT to prevent the natural greediness of corporations from killing the people they treat.

      One thing about your argument that makes sense is this: since there are SO MANY people in need of dialysis, these companies don’t have to care about their death rates, because new people will come right through the door.

      • eturowski says:

        I’m not saying that they’re cutting corners, I’m saying that it’s easier to miss a vein/not read a chart carefully/forget about a patient when the center is completely booked (or overbooked) than when they’re only 50% booked.

        They don’t need to cut corners… Uncle Sam is paying whatever they ask.

        I didn’t think about death rates. Interesting point! That alone argues for better regulation, I agree.

        • Loias supports harsher punishments against corporations says:

          RTFA. They aren’t paid whatever they ask for. There’s a flat fee that Medicare pays the clinic, regardless of the quality of care, mortality rates, etc.

          The for-profit clinic has no incentive to provide good care, but every incentive to cut corners as much as possible, because they are paid the same amount regardless.

          • tiatrack says:

            You clearly have zero understanding of the medical system.

            • MaxH42 thinks RecordStoreToughGuy got a raw deal says:

              Actually, Loias described very accurately and concisely the problem with our current method of administering medical care on a cost basis rather than as a necessary service. It is you who do not seem to understand health care systems and policy.

            • mythago says:

              How so? This seems like simple economics. If a for-profit business is paid a certain fee to perform a service, then the business has every incentive to keep the cost of that service low, because profit = fee – cost. This is particularly so when there is no possibility of raising the fee (for example, by charging customers more).

              What changes that model for the medical system, in your opinion?

    • Bob Lu says:

      My home country Taiwan has the highest dialysis in the world, while our five year survival rate is still higher than the two year survival rate in US.

    • Bob Lu says:

      Read some real research paper. Here is an interesting one:


    • kmw2 says:

      If you’d actually read the article, you would find that poor results are seen regardless of individual patient factors. Sorry, your attempt to blame it on the fatties fails this time.

  3. SimplyStating says:

    It’s all Obama’s fault!

  4. kt says:

    this is what happens when healthcare is run like a business. Profit margin is all that counts, not quality of care. When dialysis started it was to buy time until a donor could be found, now to increase profits people who would never qualify for a transplant are put on dialysis all the time. If you took the profit motive out you would have a lot less people receiving it.

    • TuxthePenguin says:

      Wait, so your argument is that a certain percentage of people who are receiving dialysis do not need it?

      There are two major flaws in that logic. First, if that were true, you would expect that we would have a LOWER rate of death as a bunch of people are receiving treatment for something that they do not need. Second, insurance companies review things like this – if its not medically necessary, they won’t pay. Now you’re getting into fraud territory – the doctor would have to make up stuff to get it past.

      • Mom says:

        Actually, I think you read the previous poster wrong. I think he’s saying that there are people on dialysis that aren’t eligible for transplants, so we should just let them die.

      • Scud89 says:

        No. Please read his post further. He states a certain percent of people on dialysis NEED it but are to old or to sick to ever get a donor kidney. Dialysis is not a treatment but a way to prolong death. He is saying if people cannot be cured with a donor kidney then they shouldn’t be on dialysis because its wasting money that could be used for people who need it. I don’t know if i agree but its a valid argument.

        • Cameraman says:

          Oh, I understood his point just fine. I was just horrified at his suggestion that we withhold dialysis from people for… and not really sure why…. and was covering my horror with sarcasm.

    • Cameraman says:

      So, your argument is that people who in kidney failure who are not candidates for a transplant should not get dialysis either? Well, I suppose that would cut down on fatalities of people on dialysis, although it seems that would increase the overall number of people dieing of renal failure. And it would kill them more efficiently, freeing up parking spaces and so forth for the rest of us! Good plan. From now on, you’re in charge of the death panels.

  5. jesirose says:

    I would wonder if it’s because in some other countries, if the patient is that likely to make it, they don’t even get put on dialysis. Here, they can get it if the doctor thinks they have even a shot of surviving. So more people who aren’t as likely to make it, get a chance. Some of them still don’t make it.

    I’d be interested to see if compared to a country with a lower fatality rate, we have a higher rate of giving a kidney failure patient the treatment.

    • MrEvil says:

      Those other countries have nationalized healthcare so of course the same types of people are getting Dialysis there that they are here. In fact, those Mortality rates are regardless of other patient factors.

  6. LabanDenter says:

    any of those blaming the private sector read the article?

    most of dialysis money comes from the feds. IE its basically universal health care. The kind of quality you can expect when goverment runs it.

    • Evil_Otto would rather pay taxes than make someone else rich says:

      And if the government was running the dialysis centers, you might have a point. But, since they’re not, I think you need to re-analyze your statement.

      Government-funded is not the same as government-run.

    • dolemite says:

      So…it’s provided by a system that isn’t set up to provide healthcare in the first place? BECAUSE the private sector can’t be bothered with it, since it doesn’t rake in enough profits?

      Face facts, US ranks 37 out of all countries in providing healthcare for our citizens. THIRTY SEVEN. People can gripe about the government all they want, but the vast majority of countries that rank above us have….oh….my….god…SOCIALIZED MEDICINE!

      • Mike says:

        But my talking point is that government run anything is bad. How am I supposed to respond to you if my talking point is invalid?

        Government is bad OK? Just accept it, nod in agreement and move on.

      • JonBoy470 says:

        I call Shenanigans. Cite the source of this #37 ranking, and the criteria used to arrive at it.

        • jenjenjen says:

          It was the World Health Report rankings of health care systems, but it was in 2000. http://www.who.int/whr/2000/en/index.html So it’s old and they don’t do this exact type of ranking anymore. However, despite the fact that we have made gains in the intervening 10 years, many other countries have made even bigger gains, so I really don’t imagine we would be in the top 5 if they were to run this again now. If you look through the indicators section of the current World Health Organization’s statistics, we’re definitely good, but it’s surprising the countries that beat us out in certain areas, including places like Chile, Lithuania, and so on. Just shows that if we really WANTED health to be a priority, it could be. But we have more important things like toner cartridges on airplanes to deal with, right?

      • VeganPixels says:

        That’s precisely it! If it were only run as a business, like all government should be, it would be wildly profitable! The only hitch in the plan is that government-business (let’s just call it “goviness” from now on, kinda like “truthiness” only truthier…) has a quite unique model in that it’s mandated to take in less and less revenue YOY, sell fewer and fewer products and services, and never make a dime over expenses.

    • kmw2 says:

      Try re-reading. The care is provided by private firms (mainly, two of them) who are incentivized to push as many patients through as they can, rather than provide quality care. It’s precisely the same problem that plagues the rest of the US health care system, the only difference is that Medicaid is footing the bill.

    • ARP says:

      Government funds doesn not equal government runs. Since they’re private, they have the maximizing profit motives that all other businesses have. Sorry, you just proved the opposite.

    • Gulliver says:

      Government PAYS, but has nothing to do with RUNNING it. Two MAJOR for proffit corporations RUN the thing.
      If you want to see what government RUN health care looks like, check out the VA system. It is consistently voted best by the people who actually use it, and it’s outcomes are better than any insurance company.

      • LabanDenter says:

        goverment sets the rules. the others play by them.

        please think before just using the tired old line of ‘goverement run = good’ ‘private run = bad’ logic.

        the private company only operates within the the rules the goverment gives them. If theres fault its with those rules. But you and most others on this site are so blinded by faith in goverment that nothing short of total goverment control is good enough.

        • Anonymously says:

          Your vitriol is out of proportion with the comment you’re replying to. Or as the Joker said “Why so serious?”

        • th3v6cann3val0s3 says:

          Your right; the rules of ‘free enterprise’ or more accurately the special ‘corporation rules’ they get to play by.

          We do need to change them. We need to change them by actually enforcing the market controls in place. You sound like you’re healthy enough to complain though – good health insurance?

    • LabanDenter says:

      you people need to read better. And get over your bias that goverment = good, and goverment run = good. Your the same as all the people that claim everything goverment does is bad.

      Dialysis is a goverment run program. They set the rates, standards, payments, etc etc. The only ‘private’ involment is who is the end provider.

      If it was truely ‘goverment run’ under these same rules the outcome would be the same. Goverment pays too little for the actual treatment. Then it cuts pay outs because paying less means treatment costs less? And fails to account for inflation.

      Then instead of adjusting payment schedules, it pays out more for giving out drugs. The outcome of which is obivous… more drugs being given out.

      So the dialysis games rules and ref’s are goverment. The players are the private sector. Yet instead of blaming the rules you blame the player.

      ‘Dont hate the player, hate the game’

    • th3v6cann3val0s3 says:

      With their hands tied behind their backs. With lackluster funding and manpower and trying to do more with less due to a gov’t situation too much in favor of private enterprise. Was that the situation you were trying to paint? O right, the TRUTH would hurt your agenda, so just blame it on some bs ‘bureaucracy’.

      Remember that line you dumbass conservatives always spout? – ‘Personal Responsbility’ ? Maybe step back and really take stock of everyone ‘taking responsbility’ not only the gov’t but your precious private sector also.

  7. Dr.Wang says:

    I’ve been in a few in my years and it’s generally due to shrinking reimbursement for medicare/medicaid forces the for-profit owners of the dialysis centers to pay minimum wage or close to it, which attracts a less professional grade of employee, short cuts and bad practice occur, infections happen, and people die.

  8. Nigerian prince looking for business partner says:

    “…Social Security Act that granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income. “

    Couldn’t this also play a role as to why there are such high failure rates? I imagine different countries have different policies regarding rationing of care, which makes direct comparisons difficult.

    • OnePumpChump says:

      What? I didn’t know I’d get free dialysis if I had kidney failure! Well, shit I’m gonna go buy 30 pounds of sugar and eat it all tomorrow!

      See, I’ll be getting something for nothing, so I’ll be better off than I was!

      (What’s sad is, while I’m being sarcastic, I have met people whose thought processes aren’t that far away from that.)

  9. BethM says:

    Is it the quality of the dialysis centers or is it the fact that people aren’t going like they’re supposed to? Usually you have to go for 3-4 hrs at a time and about 4 x per week… I’m sure the compliance rate is not so hot. Not doing dialysis correctly = rapid death.

    • colorisnteverything says:

      But why would the compliance rate be low?

      My guess is that it is because people may not be able to afford it.

      • hansolo247 says:

        No, because it sucks.

        Death is often perceived as the best solution, especially when you can’t get a transplant.

        And before anyone flames…I’ve been on dialysis.

      • Master Medic: Now with more Haldol says:

        I am constantly being called to peoples homes, often the same ones who need dialysis and choose not to go. It’s a lot of factors but the #1 is always “I just don’t have the time”. Those that claim that often are on SSI and are busy watching TV.

        The other factor is that yes, dialysis sucks ass. You go 3-4 days feeling like crap, dialysis, 2-3 days feeling OK followed by 3-4 feeling like crap.. May people do indeed want to die and are non-compliant with treatment.

  10. Scribblenerd says:

    I lost my husband to dialysis. I get it.

  11. JonBoy470 says:

    The fact is that people of means who live in countries with socialized medical systems very often travel to the US for major medical care (transplants, cancer treatment, etc) because such treatment is very much better in the US than in their native countries.

    Canadian-style socialized medicine is a great system, so long as you never have to use it. In Canada, if you’re too old, or have too advanced kidney failure, you’d not be able to get dialysis to begin with. Exclude the worst cases from the treatment, and it stands to reason said treatment will appear to have better outcomes.

  12. fortymegafonzies says:

    Our local paper had a story a few years ago about a woman who was mistakenly infused with cleaning fluid instead of recirculating her blood back into her during dialysis …not one of the better ways to die I imagine.

  13. hansolo247 says:

    First, Medicare does not cover dialysis fully. It covers 80%.

    The reason 25% each year die is that Americans don’t take care of themselves. In the US, kidney failure is most often caused by Diabetes and high blood pressure, which are things not as prevalent elsewhere.

    Medicare also has low reimbursement rates, which is the main reason for all of the consolidation in the industry. Due to the low reimbursement, it must be made up in volume. The non-profit center I went to struggled to break even, as many of the patients were uninsured (not citizens, and many not even legal). The for-profit centers wouldn’t take them.

    I did dialysis for 6 years, at a non-profit center. I have a transplant and it’s lasted 3 years, so I know literally everything about dialysis

    • KrispyKrink says:

      Congrats to you. I’m 8 years into transplant #2. First transplant lasted 4 years, followed by 8 years of dialysis before transplant #2. My ESRD is not diabetes related, it’s genetic.

      From my experience with various dialysis centers, it’s lack of training and extremely poor cleaning procedures that lead to many avoidable infections. One example that I witnessed was staff allowing the granddaughter of a patient to enter the facility while she had the chicken pox. It spread to almost every patient in the facility at that time leading to them acquiring chicken pox or it’s adult version, shingles. Three elderly patients died due to this one infection.

      • hansolo247 says:

        Awesome, congrats to you, too. I’m also on #2; #1 was pretty much DOA.

        Mine was caused by a strep infection that never presented symptoms. That’s the best guess at least.

    • Tarceinus says:

      The article isn’t really about the overall health of Americans. Of course, if we are healthier as a people, the rates of death would go down. The article is saying that the incidence of patients ending with “worse than expected” outcomes is frighteningly higher in the U.S. than most other places in the industrialized world. So yes, we need to get healthier, but we also need to find out how to get what we are paying for.

  14. eetonaee says:

    This can’t be right. John Boehner just said that the US has the best health care system in the world.

  15. Boberto says:

    It really has everything to do with the fact that America has become a third world country. We just haven’t accepted this truth yet.

    Frsenius and Davita are the Wal-Mart cost cutters of the medical industry.

    The prospective patients will generally have much poorer prospects than most, due to the high acuity. Good outcomes, are simply not in the cards for a lot of these new patients with ESRD. Rather than turning them away and referring them to hospice, these units will start them on chronic dialysis.

    They’ve simply never met a dollar they didn’t like. I’m talking about people of advanced age, disease process, etc.

    Get them on station and spin the pump. If they last on treatment past the first hour, it’s billable. Never mind issues of long term prognosis, or quality of life.

    The technology itself has become too ubiquitous. Too commoditized. More so, it’s simply not suitable for everyone.

    For some relegated to live out thier final days or weeks hooked up to dialysis, it can be a miserable awful end of life.

    The question is not, do we pull the plug, but do we put the plug in the wall to begin with.

    New ESRD patients must be given better information about the prospective outcomes and quality of life on dialysis, related to morbidities, possible complications etc.

    Social workers and Nephrologists (working for Fresenius and Davita) are under gag order and often never have the frank discussion needed at the start of the process.

    Doing so might pre-empt a cash cow of billings for a myriad of ancillary billings.

    Nephrologists and renal social workers really need to examine thier own ethical obligations in counseling patients and family members prior to advising them to even start the process.

    • Jedana says:

      New patients should also get information on the other ways they can do dialysis, other than in-center 3 days a week. PD, Home hemo, nocturnal.

      Clinics reuse filters (although they are labeled specifically for that patient, mix-ups do occur) until they are unusable.
      Home hemo, new filters each time.
      Clinics use batches of dialysate, that they mix. You don’t know if they are mixed correctly or with sterile fluid.
      Home hemo, we use sterile bags of dialysate, new each time.
      Clinics have 1 nurse/1 helper for 5-7 (and sometimes more) patients.
      Home hemo, I have one patient, my spouse.

  16. jim says:

    probably because people leave other countries to come to the US for free dialysis treatment. it certainly has driven a lot of companies to shut down their clinics because of the cost to provide treatment.

  17. BurtReynolds says:

    Because our health care system was perfect the way it was before this “reform” nonsense. Or at least John Boehner tells me that is the case.

  18. MrEvil says:

    Fresenius is/was a client of both Dell and Lexmark and I did service work in their clinics. Their smaller clinic in a rural community wasn’t so bad Only had about eight seats with 2 nurses and three techs on hand (at least when I was there) No doctor on hand though.

    Their clinic in Amarillo though was not a place I’d want to have to go to. It was crowded and for the entire room which had probably 2 dozen seats there were maybe 3 people suited up to watch patients. They had more staff in the administrative office than they did in the treatment room.

    So, tell me again how profit motivated medicine is so much better than socialized medicine?

  19. pot_roast says:

    In my EMS career, I have been in and out of more dialysis centers than I care to remember and I can recall quite a few unpleasant encounters with the staff not recognizing serious medical conditions.
    Another issue that we really should be addressing is the fact that most of the people on dialysis in the United States are African Americans, who are also suffering from rising obesity rates. (source: all over the NIH and CDC, and here’s a particularly interesting link – http://www.nkdep.nih.gov/news/campaign/african_americans.htm )

    What’s causing this? Why is this happening? It saddens me to see it happening.

  20. banmojo says:

    “So why are taxpayers paying $20 billion a year for a program that lets 25% of the patients die within a year, the worst fatality rate of the first world?”

    ANSWER: Because if they don’t pay, the IRS will fine the crap out of them and maybe even put them in jail. Yes, folks, we’ve taken this once great experiment and turned it into a kind of organized dictatorship. Think about it.

    “Why do only two chains run 2/3 of all clinics?”

    ANSWER: Because they got into it early on, with a strong start up capital pocketbook, and forged contracts with CMS that allowed them to force smaller startups out of business. This happens in all profitable industries, and should be ONE of the things the US Government should BE PROTECTING ITS CITIZENS FROM imho. Monopolies = BAD, healthy competition = GOOD in nearly all cases of business.

    “And why won’t the government release important data that could improve the quality of care? “

    ANSWER: $, $$, and more $$$. You think the Government hasn’t figured out a way to profit from this scam? Come on!! If certain higher-ups aren’t paid dirty money ‘under the table’ then campaign money is being doled out, or secret vacations are being had by all, or SOMETHING, SOME WAY those 2 big dialysis companies are keeping ‘Uncle Sam’ happy so that he allows them to keep their dirty monopoly without any quality control system in place.

    Our federal government has turned into a big stinkin’ monster that feeds on the tax payers and keeps growing growing growing. The system of checks/balances is not adequate to keep it from spiraling out of control (you KNOW it already is). Corruption is present at ALL levels of government in some form or another. Any unfortunately, what the Tea Partiers aren’t telling you, there is NO way the citizens of the USA can stage another successful revolution – the modern implements of war have given the US military the ability to keep the entire US population under house arrest if need be. Drones and satellites means the Wolverines will NOT be able to hide in the mountains for long (although we still haven’t caught Bin Laden, but then again he’s in a country that actively protects him at all times, so he has that going for him)