Kidney disease places particularly heavy burdens on people in rural communities. Congress can take action to help them.
For the roughly 800,000 Americans living with kidney failure, there are many hurdles to overcome, from receiving life-saving dialysis care three days a week to finding someone willing to be a living organ donor.
But for patients with kidney failure who live in rural areas, there can be additional struggles, such as needing to travel 75 miles to see a specialist or not being able to find renal-friendly foods at the local grocery store. For those living outside of major metropolitan areas, it also can be nearly impossible to maintain a job while spending hours in the car traveling to and from dialysis and medical appointments.
On top of these challenges, Americans living in rural areas are more likely to be uninsured and tend to have less access to primary health care services.
The disproportionate burden faced by people with kidney disease and kidney failure who live in rural communities is a prime example of how social and community factors can contribute to inequities in care. In fact, research has shown that patients who live more than 100 miles away from a dialysis center are more likely to die than those who live less than 10 miles from a treatment facility.
Sadly, the kidney disease crisis in America is only getting worse. Data indicates chronic kidney disease has been the fastest-growing noncontagious disease in the country, with 37 million adults living with it and millions more at risk. From 2010 to 2020, the number of people with kidney failure, or end-stage renal disease, increased by 35%.
And, although kidney transplant is considered the best treatment option for patients facing kidney failure, the number of people needing an organ is great – more than 100,000 are on the waiting list, and about 85% need a kidney. Many people will die before they receive a transplant because of the dire shortage of kidneys from living or deceased donors.
This is why lawmakers need to reintroduce the Coordination, Accountability, Research and Equity (CARE) for All Kidneys Act in 2023, a bipartisan bill put forward previously in Congress to help address this crisis. If enacted, the bill would spur research into geographic, socioeconomic, racial, ethnic and other factors that may fuel poor kidney outcomes among rural and other underserved communities. Officials also would develop an action plan to fight kidney disease in the U.S.
The CARE for All Kidneys Act is a vital first step in addressing the inequities that exist for people with kidney disease who are underserved by our health care system. We need every American – regardless of the neighborhood where they live – to have access to comprehensive and affordable kidney disease diagnosis and treatment options.
Two patient experiences further illustrate the struggles faced by patients in rural communities and, at the same time, offer hope.
Consider Amy Staples, a farmer in a small town in Missouri, who was traveling to a dialysis clinic 35 miles from her home for seven months.
“It’s an all-day thing. There’s no way you can have a full-time job unless you work overnight,” she said. “I would be dizzy after treatment, so my husband would drive me home. It’s not just the time and effort. It’s the wear and tear on the vehicle, the scheduling with your spouse if they have to work. … It’s a lot of logistics to try to get through and manage.”
Amy eventually switched to home dialysis, an option that works much better for her life on the farm but is often overlooked.
“There’s a general lack of education among regular doctors about dialysis. When I’ve had to go to the hospital for other health issues, my primary care doctor didn’t understand the process of dialysis and how it impacted my care. Also, hospital workers didn’t know that home dialysis was an option,” Amy said.
Increasing awareness of home dialysis and improving access to this option for patients with kidney failure could help address some of the challenges that patients in rural communities face.
Another tool that has the potential to improve health outcomes and reduce costs among rural populations is telehealth. Erin Heaberlin, a resident of a rural community in Oregon, was born with kidney disease and her family couldn’t afford to live closer to the city.
“It’s difficult to live in a rural community with medical issues. There are little to no resources to support you, stores often don’t carry the food you need and time in the car feels endless,” she said. “It was too expensive to live in the city close to the hospitals, but arguably it was just as expensive to drive all the time.”
Erin recently found some relief after getting a kidney transplant in 2019 and becoming stable enough that she can use virtual appointments with her nephrologist instead of driving in every time.
However, while telehealth has been crucial to care for many people during the pandemic, the absence or spottiness of broadband access in rural areas and a lack of adequate marketing and communication about telehealth offerings to rural patients can still hinder its use.
Improving access to home dialysis and telehealth services are just two examples of how the CARE for All Kidneys Act can help close the gaps for those underserved by our health care system and burdened by kidney disease.
We are hopeful that the CARE for All Kidneys Act will be reintroduced in Congress in 2023, and we urge all policymakers to support this bipartisan bill to help address the kidney crisis in our country. It is time for lawmakers to take the necessary steps to battle this disease by ensuring that all Americans have equitable access to the health services they deserve.
Source: US News