The Barnes/Jewish Dialysis Center is an unassuming square gray building on Forest Park Avenue in St. Louis. It is part of the Barnes Hospital complex that sits a few blocks up the street on Kingshighway. Inside the center are approximately 50 “pods.” A pod is what the technicians call a kidney dialysis machine and the chair that sits next to it.
On most days, the pods are filled to capacity with patients whose kidneys no longer function enough to keep them alive. Your kidneys perform the important function of filtering the toxins that accumulate in your blood and discharging them as urine. They also help regulate blood pressure and electrolytes like sodium, potassium, and phosphorous.
There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is where the patient’s blood is basically put through a filter, just like the oil in your car. The excess water and waste metabolites end up in the filter after the dialysis session. In peritoneal dialysis, the patients own peritoneum is used.
A bag of fluid is introduced in the peritoneal cavity by way of a permanent catheter. Then it is drained after several hours carrying the waste materials with it. Or sometimes a machine is used to circulate the fluid while the patient sleeps. Hemodialysis is used far more than peritoneal dialysis.
In the dialysis center, patients undergoing hemodialysis are put in the reclining chairs for 3-4 hours three days a week. Two large needles are inserted into either a fistula (a vein and an artery sewn together) or an artificial shunt that is placed in the patient’s arm. Two tubes are attached to the needles.
One carries blood from an artery out to the machine and another carries the blood back into the body through a vein. The patient’s entire blood supply is circulated through the machine many times during a session.
The dialysis center is a noisy place. You hear the constant whir and click of the machines as well as piercing alarms going off every few seconds. The alarms usually mean that one of the patient’s tubes has been blocked, the pressure in the machine has dropped, or the patient’s blood pressure has dropped. Low blood pressure is a frequent problem and some patients may develop severe cramps and scream out in pain.
Most of the patients are poor and on Medicare and Medicaid. I’ve noticed that most of the patients in the hemodialysis section are ethnic while most of the patients that do the peritoneal dialysis at home are white. Whether this is a national trend, I have no idea. I also have no idea why.
Some of the patients are wheeled in from nursing homes and a few remain unconscious and unresponsive while they are there. Sometimes a patient has to be rushed to the hospital.
Hemodialysis is by no means a pleasant experience and oftentimes leaves the patients dizzy and weak from the loss of fluid from the procedure. After the treatment, the patients weigh themselves to see if they have attained their “dry” or ideal weight. Many are very thin and emaciated looking. One technician commented that “at first they come in walking under their own steam, then they come in using a walker, then a wheelchair, then they no longer come in.”
The only option to dialysis is a kidney transplant, but the list is long and may take several years. Many of the patients at the center don’t want the transplant. Some won’t pass the physical that you have to go through to qualify for the operation.
Life is hard for these dialysis patients. There’s always the risk of infection. The machine does some of the work of the kidneys but not all of it. There is always the danger of cardiac problems and an accumulation of too much potassium or phosphorous, both of which can be fatal.
Recently the Missouri legislature slashed funding for the Missouri Kidney Program (MOKP) by 48%. That’s almost half. Many of the services provided by the kidney fund will be slashed or eliminated. Nutritional supplement program: eliminated. Transportation assistance: eliminated. Help with Medicare premiums: eliminated. Insurance premium assistance: eliminated. Transplant/donor grants: reduced. Patient/staff education: eliminated.
The budget cuts that eliminated all of these important services amounted to about $2 million, a drop in the bucket as far as the state budget is concerned. And what makes it even worse is that since the program is part of the University of Missouri, they can’t solicit private donations.
And the way that the legislators (mostly Republican, of course) went about it was to put it in the University’s appropriations bill so the general public wouldn’t be aware of it. Kind of underhanded I would say. I went to the website of the Missouri House of Representatives and even that is kind of confusing. The website says that the bill was sponsored by Icet, Allen, but when you click on his name it takes you to the web page of Republican congressman Don Gossen??
I think that some of the people who voted for these budget cuts to the kidney program should have to go through a few dialysis sessions themselves and see what it’s like. The patients have it rough enough as it is without having more burdens placed on them by these budget cuts.
House Bill 3
MO House of Representatives
201 West Capitol Avenue
Jefferson City MO 65101 Legislative Assistant:Lauren Meschino Phone:573-751-1247 E-Mail:[email protected]