Diabetes Association Renal Unit (DARU)
The first kidney dialysis procedure was performed in the USA in 1948 at the Mount Sinai Hospital in New York. However, it was not until 1970 that the first procedure was performed in Jamaica at the Kingston Public Hospital (KPH). Later, in 1971, the first kidney transplant was performed in Jamaica also at the Kingston Public Hospital. These procedures which were performed by Dr. Lawson Douglas and his urology team, assisted by Dr. Sam Street, were not only ‘firsts’ for Jamaica, but also ‘firsts’ for the Caribbean and the countries of the Third World.
Because diabetes causes nearly 50% and hypertension nearly 30% of kidney failures worldwide and the high incidence of these diseases in Jamaica, the Diabetes Association made a decision to offer dialysis services.
Diabetes Association Renal Unit (DARU) was founded in 2001 with five units and intends to plays its part in keeping more ESRD patients alive at a reasonable cost per treatment.
DARU is a welcomed addition to health care delivery in the island particularly as it pertains to patients with kidney failure. We are well aware that the demand for long-term renal replacement therapy outstrips supply. The landscape in renal care in Jamaica has improved tremendously over the last decade and we trust the continued interest of charitable organizations and partnerships between Government and the Private Sector of foster renal care will bring further advancements in this arena.The Unit offers first world quality kidney treatment and overtime, at present we have, as planned, increased the number of machine in our unit from five to ten.
We estimated that about 400-600 new cases per million population of chronic renal failure occur in Jamaica per year and Diabetes Mellitus contributes significantly to this burden. The University of the West Indies Diabetes Outreach Project (UDOP) has done a tremendous job in educating the public about Diabetes Mellitus and its complications. The Nephrology service at the Department of Medicine, UWI included the development of DARU as part of its continuing outreach project to the community. This new unit may also be seen as an out post reaching service for training specialists. This unit must therefore be a part of the public education drive in the renal disease, service to patients, training of health care personnel and research in association with the Nephrology division of the Department of Medicine, UWI.
There are currently fifty (50) dialysis machines in Jamaica treating approximately two hundred and fifty (250) patients. The math is simple, even at the lower estimate of 780 new cases per year, hundreds of people are dying because there are not enough machines to offer treatment to everyone who needs it. Kidney failure does not discriminate, it strikes rich and poor, old and young alike. Kidney failure is a debilitating disease that affects the entire body. There is no substitute for a good kidney, but while we can, we must work together to help those who suffer from ESRD to enjoy a better quality of life.
What is Hemodialysis?
Hemodialysis is a process in which a dialyser or artificial kidney is used to remove waste and excess fluid from the body. The result of this process is similar to that of the ‘Irish Potato’ test done by students in school to demonstrate the theory of osmosis (the movement of solubles across a semi-permeable membrane). A mixture, called ‘dialysate’ is prepared, made up of selected chemical substances in the same proportions as those found in normal blood.
One way to describe the importance of dialysis in the treatment of kidney disease is to liken it to the importance of filters to a car’s engine. Without filters the care’s engine will close up and cease to function optimally. Similarly, without dialysis treatments a diseased kidney will eventually cease to function, resulting in death.
How does it work?
For haemodialysis to be carried out, access to the patient’s blood circulation is needed and this must be able to yield up to 400ml (or little of the blood per minute). The patient is connected to a dialysis machine by tubing which pull and return blood to the patient at the same time. This blood passes through a hollow “capsule like” tube, which is called the dialyzer, fiber, or artificial kidney. The blood and dialysate do not mix; they are separated by the semi-permeable membrane of the artificial kidney. Fluid and solubles passes through the semi-permeable membrane out of the patient’s blood and into the dialysate, thereby removing the waste and excess fluids.
A session of dialysis can last between two (2) hours at the first treatment to four and a half (4½) hours according to the physician’s prescription. Ideally, patient are treated three (3) times per week but some patient can only afford once or twice.
What Causes End-Stage Renal Disease (ESRD)
A person who is diagnosed as having End-Stage Renal Disease (ESRD) or kidney failure would require haemodialyis or a kidney transplant. Possible causes of kidney failure are uncontrolled hypertension, diabetes mellitus, trauma from motor vehicle accidents, longstanding kidney infection due to untreated Urinary Tract Infection, congenital diseased, and Lupus. Current statistics shows an increased incidence of type 2 Diabetes Mellitus worldwide, being one of the major causes of kidney failure. In fact, 50-60% of clients in Diabetes Association Renal Unit (DARU) are diabetic. Statistics in the US shows that Diabetes 31% and Hypertension 24% are the leading cause of all cases of End-Stage Renal Disease (ESRD). A kidney or any human organ for that matter is not readily available for transplant and there are a lot of factors which have to be taken into consideration, especially, the question of a perfect match to reduce the risk of organ rejection. In light of this, haemodialysis is the preferred treatment modality.
Cost for Dialysis
Haemodialysis is a very expensive procedure. It involves the use of hundreds of gallon of water and kilowatt-hours of electricity to operate the machines. Most of the supportive materials and equipment used are disposable (one-time use only).
The cost to patient is tremendous, seeing that a vast majority of these clients do not have adequate health insurance, have no health insurance or are ‘uninsurable’ by insurance companies. The cost for dialysis plus medications is burdensome. The government health insurance companies, should make a concerted effort to do something substantial for these patients.