Tag Archives: kidney disease

Kidney disease kills thousands in sugar cane fields

In The Center for Public Integrity’s iWatch News, Sasha Chavkin and Ronnie Greene write that, “Little noticed by the rest of the world, chronic kidney disease (CKD) is cutting a swath through one of the world’s poorest populations, along a stretch of Central America’s Pacific Coast that spans six countries and nearly 700 miles. Its victims are manual laborers, mostly sugarcane workers.”

Each year from 2005 to 2009, kidney failure killed more than 2,800 men in Central America, according to the International Consortium of Investigative Journalists‘ analysis of the latest World Health Organization data. In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined.

Unlike in more developed nations, neither diabetes nor hypertension can be blamed for the widespread kidney ailments. Instead, the duo found, scientists suspect possible environmental toxins and strenuous labor conditions, both linked to the cane fields, as well as alcohol abuse and anti-inflammatory drug use. At present, researchers seem to be focusing on heat stress as the most likely culprit, and plantation owners seem to concur

Internal studies by Nicaragua Sugar, owners of one of Central America’s largest sugar plantations, provided by the company to ICIJ, show that the company has long had evidence of an epidemic tied to heat stress and dehydration. In 2001, company doctor Felix Zelaya conducted an internal study on the causes of CKD among its workers. “Strenuous labor with exposure to high environmental temperatures without an adequate hydration program predisposes workers to heat stress syndrome [heat stroke], which is an important factor in the development of CKD,” Zelaya concluded.

Nicaragua Sugar and other companies say they have acted voluntarily to protect workers by improving hydration, reducing work hours, and strengthening oversight of labor contractors.

Chavkin and Greene dig deep into the economic and political factors underlying the global response to the epidemic, as well as the day-to-day impact it all has on workers’ lives. For more, read their full investigation.

ProPublica releases ratings of 5,000 dialysis providers

On the heels of a successful FOIA request related to Robin Fields’ dialysis investigation, ProPublica has published a database evaluating dialysis clinics on 15 different measures. The information has been available to state health agencies for years, but this is the first time it’s been released for general public consumption, Fields writes.

Patients have long chosen dialysis clinics based only on location or physician recommendation, even though the data shows a wide variation in quality among the 5,000-plus such facilities nationwide.

In more than 200 counties nationwide, the data show, the gap between facilities with the best and worst patient survival, adjusted for case-mix differences, is greater than 50 percent. In areas such as Allegheny County, Pa., or Franklin County, Ohio, each with upwards of two dozen clinics, the differences are even more substantial, exceeding 200 percent.
There is also wide variability in how often patients at different clinics are hospitalized for septicemia. Although septicemia cases can be unrelated to dialysis, it is a significant risk for patients, who typically have their blood cleaned of toxins three times a week. Nationally, the rate was about 12 percent a year for 2006 to 2008. But in dozens of counties, the spread between facilities with the highest and lowest rates was more than 25 percentage points.

Like Dollars for Docs, this new database should provide plenty of ready localizations of of the story.

Dialysis program: Experiment in socialized medicine comes with high costs, risks

ProPublica’s Robin Fields has put together an artful examination of the nation’s Medicare-funded dialysis system. Part history and part investigation, it explains how this massive anomaly of government-run medicine came to be, and how it demonstrates the promise and peril of so-called socialized medicine.

The reporting has had an immediate impact, both upon the dialysis industry (read leaked plans for their response here) and upon the federal government. For health journalists, the federal response is particularly interesting, as it involves the disclosure of previously hidden data, and a classic government excuse.

ProPublica first asked CMS for the clinic-specific outcome data it collects — at taxpayer expense — two years ago under the Freedom of Information Act. The agency declined to say whether it would release the material until last week, as this story neared publication. It subsequently has provided reports for all clinics for 2002 to 2010. ProPublica is reviewing the data and plans to make it available for patients, researchers and the general public.

The reasons CMS has given for withholding the information until now is that some measures are disputed or lack refinement. Regulators and providers can put the data in perspective, officials had said, but patients might misinterpret the information or see it as more than they really want to know.

As befits something destined for publication in The Atlantic, Field’s piece might take more than one sitting to fully digest. And, if you haven’t yet had that second sitting, you’ll have missed some particularly nifty bits of comparative journalism, particularly where Fields compares the U.S. system to that in Italy, where the costs are significantly less and patients “got half the average dose of Epogen given to U.S. patients, perhaps because there’s no profit incentive to give them more.”

In Italy, about one in nine dialysis patients die each year. In the United States, that number is one in five. In dialysis treatment, there’s a trade-off between speed, cost and outcomes. And even high-rated Italy has had to make a few sacrifices, as evidence by comments from an Italian doctor:

“The decision to make dialysis faster wasn’t a scientific decision, it was a managerial decision,” he says. “It’s to allow you to do four shifts a day and make money.” He schedules just two shifts a day to accommodate longer treatment times.

Fields ends the piece on a high note. There’s hope for future efficiency in the dialysis system, thanks to a new program of bundled payments that will supplant the current system in which clinics see the actual dialysis as a “loss leader” and profit instead from heavy use of well-reimbursed drugs.

ProPublica promises more stories about this throughout the week, so be sure to check back its site for developments. Fields discussed dialysis on NPR today, as did Dr. Barry Straube, the chief medical officer at CMS.

Underinsured face higher bills, bankruptcy

In Time, Karen Tumulty used the story of her brother’s kidney problems and resulting medical bills to look into the plight of the nation’s underinsured, who she said may be even more vulnerable than the uninsured because, “until a health catastrophe hits, they’re often blind to the danger they’re in.”

In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance.

Tumulty’s brother, Patrick Tumulty, renewed a short-term private policy for about six years. When his kidneys failed, his insurance company refused coverage because his problems were, in terms of his latest six-month short-term plan, a pre-existing condition. Even with the help of a country program for the uninsured, Patrick struggled to pay the resulting bills.

A paradox of medical costs is that people who can least afford them — the uninsured — end up being charged the most. Insurance companies, with large numbers of customers, have the financial muscle to negotiate low rates from health-care providers; individuals do not. Whereas insured patients would have been charged about $900 by the hospital that performed Pat’s biopsy (and pay only a small fraction of that out of their own pocket), Pat’s bill was $7,756. For lab work — and there was a lot of it — he was being charged as much as six times the price an insurance company would pay.


Talking Health: Covering the Underinsured – This webcast explores the growing problem of the underinsured.

The program, moderated by AHCJ board president Trudy Lieberman, features Continue reading