Dialysis is the process in which artificial means are used to replace the blood filtering function of the kidneys. There are two main types of dialysis: hemodialysis and peritoneal dialysis. These centers are needed when a person's kidneys cease functioning properly. This process presents itself primarily as Chronic Kidney Disease (CKD), where the kidneys are damaged and will no longer filter effectively, and End Stage Renal Disease (ESRD), where the kidneys cease functioning altogether. The below map shows the locations of Kidney Care Clinics across the US.

As with multiple sectors of American healthcare, treatment of ESRD is not equitably distributed: Primary care, which has been identified as the principal factor in avoiding the conversion of chronic renal insufficiency into ESRD, is not equitably distributed and this has been known for decades (primary care shortage areas). Dialysis treatment centers cluster as well, creating vast areas where dialysis care is either nonexistent or hard to reach. The Map below shows the count of Kidney Care Clinics per County Across the United States.

Effects of These Disparities and the Future

Beyond the ballooning costs and increased morbidity and mortality of ESRD in the American population, the inequitable distribution of ESRD treatment resources has several deleterious effects onto our society:

  • Increased mortality:
    • It goes without saying that decreased accessibility to life saving modalities such as dialysis treatments increase overall mortality from ESRD and its associated effects on the human body.

  • This mortality will also reflect the social economic and racial inequities present in the inequitable distribution of these resources.

  • Increased costs:
    • Decreased treatment will lead to more complications and more illnesses, which will lead to more costs to the taxpayer.

  • Increased use of emergency and hospital services:
    • Missed dialysis appointments, usually due to difficulties in transport to a nearby facility, is a common ED admission complaint.

  • The greater the barriers to accessing dialysis centers, such are present in dialysis center deserts, the greater the numbers of ESRD patients we will see reporting to local EDs and hospitals in need of costly, emergency care.

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