Chronic kidney disease takes heavy toll in Hawaii

It took the loss of a limb for Bobby Pedro to finally give up Big Gulp sodas.

The former district chief of Honolulu’s Emergency Medical Services drank the sugary beverage almost every day over his 38-year career. Three months ago, part of his left leg was amputated above the knee, a casualty of a slow but silent chronic disease that often ends the lives of its victims or leaves them dependent upon a dialysis machine to survive.

Pedro, 64, a Type 2 diabetic who retired from the ambulance system in 2010, is among the growing number of kidney dialysis patients in Hawaii. That number jumped 42 percent to 3,305 in 2014 from 2,328 in 2006, according to Western Pacific Renal Network LLC.

“I neglected myself. I took care of everybody else except myself,” said Pedro, the father of four grown children, while receiving dialysis treatment with about 50 other patients earlier this month at DSI Honolulu Dialysis on North Kuakini Street.

Pedro, sporting his old faded gray EMS shirt, sat up in his chair while his blood was pumped into a machine that cleans it before funneling it back into his veins.

“I gave everything I had to my children. I was involved in their activities. I worked very hard, but I did not take care of myself and that’s why I’m sitting in this chair,” he reflected.

With a blanket, he covered a freshly bandaged wound on his missing leg.

“First they started with the foot, then they went up below the knee and then above the knee,” he recalled. “Through the years … you eat all the wrong foods and too many sodas. I always had a soda in my hand. The sugar in that made me become a diabetic.”

In Hawaii each day on average, one new person starts dialysis, said Pedro’s nephrologist, or kidney specialist, Dr. James Ireland, assistant clinical professor at the University of Hawaii John A. Burns School of Medicine. The rates of chronic kidney disease, also known as CKD, which can be caused by diabetes or high blood pressure, are projected to soar over the next 20 years, with more than half of those 30 to 64 years old at risk, according to a study published in the March issue of the American Journal of Kidney Diseases.

“It really is a public health crisis,” said Ireland, who used to be Pedro’s employee at EMS, and later EMS director. “Every year we’re seeing more and more patients. The line is still going up. We’re not even plateauing. We are seeing new dialysis centers open in Hawaii at an alarming rate. At this point they probably outnumber fitness centers.”

The state has 25 renal dialysis centers, 18 of which opened just in the past decade. Most operate three shifts a day and are full with the old, young, sickly and the outwardly healthy.

“Some people, they appear to be very healthy, and other people they have to be carried in here,” said Pedro, who also suffers from congestive heart failure, a condition more prevalent in diabetics. “The dialysis is what keeps us alive because without the dialysis we would pass on.”

New dialysis centers are planned for Salt Lake near Target, Hawaii Kai at the old Blockbuster site, Mililani Mauka, Kapolei in the former Simply Organized building, Waterfront Plaza and South Beretania Street. In recent years dialysis facilities have opened in Waipahu, Aikahi in Kailua, Kaimuki, Kaneohe near Temple Valley and on Kapahulu Avenue.

“The solution to address the issue of chronic kidney disease cannot be building more dialysis centers, but unfortunately that seems to be the track we’re on,” said Glen Hayashida, president and chief executive officer of the National Kidney Foundation of Hawaii. “It’s just too expensive of a solution, so we really need to look at prevention. That’s really the key for chronic disease.”

It costs roughly $80,000 a year to treat a dialysis patient, he said, or $264 million annually in Hawaii alone.

“That’s how much we’re spending just on kidney failure,” Hayashida said. “But here’s really a more frightening statistic. More patients die before they can actually get to dialysis. Patients on dialysis can be seen as survivors.”

There are 168,053 Hawaii residents with chronic kidney disease. The damage that kidney disease does to a person’s body makes other illnesses such as hypertension and cardiovascular disease much worse and often fatal, Hayashida said.

“Just like several other types of diseases, it has no symptoms,” he said. “By the time you feel symptoms, it’s too late. Your kidneys are already failing.”

Symptoms include swollen fingers, hands and feet, and eventual nausea, vomiting and the inability to eat.

The National Kidney Foundation is working with primary care doctors on earlier detection through blood tests. One indicator that the kidneys are not functioning is protein in the urine.

The group also is seeking to work with physicians to develop dietary intervention programs. Its latest project is starting a teaching kitchen to show patients how to prepare healthier meals.

Diabetes is the No. 1 cause of kidney disease, which is rising because “people don’t eat the foods they should, eat too much of the foods they shouldn’t and don’t exercise enough,” Ireland added. Nationally, 45 percent of kidney failure is a result of diabetes. In Hawaii 63 percent of kidney failure is attributed to the disease.

“The knife and fork is to blame,” he said. “We have to invest in healthy lifestyles and healthy choices way earlier. It’s growth, and it’s not the kind of growth you want. There’s a cost to all this, too, in both lives and what insurance has to pay to reimburse this.”

Ireland estimates dialysis costs range from $500 to $1,000 per treatment. Most patients typically need treatment three times a week, or 156 times per year. In 2010 the cost to Medicare for end-stage renal disease was $32.9 billion, while the price for earlier stages of the illness totaled $48 billion nationally, according to the study in the American Journal of Kidney Diseases.

Medicare pays roughly $300 per treatment, while private insurance covers between $500 and $1,000, Ireland said.

Hawaii has one of the highest rates of diabetic kidney failure and is among the top 10 states in the nation for new dialysis patients each year, with a disproportionate number of Native Hawaiians and Pacific Islanders affected by the disease, said Dr. Ramona Wong, a Honolulu-based nephrologist who offers free classes on how to make healthy choices at alohakidney.com.

“Everybody says eat healthy and exercise,” she said. “It’s easy to ignore that advice because you hear it all the time. But you can make a difference in your daily choices. If you adopt lifestyles that nudge you toward healthy versus chronic disease, there’s a better chance you can avoid chronic diseases or delay them. But if you go with the flow of the American way, it nudges you toward chronic disease. Our society is not health-oriented. It’s so economically oriented that they market to your taste buds, not your health.”

Patients can get off long-term dialysis with a kidney transplant, but only about 50 surgeries are done per year, with hundreds of people on the waiting list. Approximately 450 people are on the organ waiting list, and more than 90 percent of those are waiting for kidneys.

The number of adults older than 30 years with kidney disease is projected to reach 28 million in 2020, and nearly 38 million in 2030, the national study shows. The disease affects nearly 1 in 7 adults in America, and according to the latest research, CKD-related deaths have doubled in the past two decades.

“It’s a matter of being mindful,” Wong said. “So many of us eat mindlessly. It’s OK to enjoy, but if you want more time in this body, then you have to know how to take care of this body.”