Profit and Loss: America on Dialysis

In the U.S., a third of Americans are at risk of chronic kidney disease, and age is a major factor. More than half of Americans older than 75 are thought to have some sort of kidney damage. Here is what happens when you have it.

Read the full five-part series in partnership with Undark: “Profit and Loss: America on Dialysis.”

Treatments that reduce suffering and incorporate patient values aren’t common in kidney disease care. That’s changing

Demand for healthy kidneys has long outstripped supply. But better testing and treatment are expanding the donor pool

Minority patients are diagnosed later, stay on dialysis longer and are added to transplant lists less quickly. Why?

Joint ventures between nephrologists and dialysis centers have expanded treatment. Critics ask: At what cost?

Kidney disease affects millions of Americans, but corporate capture of dialysis, along with disparities in treatment and transplant access, mean that not everyone's journey is the same.

On this Science Talk podcast, we speak with Carrie Arnold, lead reporter in an ambitious, year-long reporting project into the current state of chronic kidney disease treatment in the U.S., from diagnosis to dialysis, and from maintenance treatment to transplant (for those who are lucky).

You can read the first part in the series here.

It's a story of technological and procedural advance, but also one that has seen just two large, for-profit enterprises come to dominate the market for dialysis delivery. It's a story of expanding access, but also one still marked by racial and ethnic disparities. And it's a tale of medical innovation and adaptation, but also one beset by conflicts of interest and an inability to adapt to holistic modes of care that other disease specialities, from cardiology to oncology, have long ago embraced. 

For the 37 million Americans navigating the corridors of kidney disease, these are likely familiar issues. But for the third of Americans at risk for renal disease — and for anyone who cares about how the nation's health care dollars are spent — this five-part collaboration between Undark Magazine and Scientific American pulls back the curtain and provides an unflinching look at what's working, and what's not. 

A new California law aims to curb what sponsors say is profiteering by dialysis centers. But are there any easy answers?