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Sheila Silva said it was a struggle getting her boyfriend to dialysis treatments after his kidneys failed him a couple of years ago. They had been going to Liberty Dialysis Waianae, but the only time slots available were in the evening.
“We had been going to Waianae trying to get a seat out there at 4 or 5 at night and coming out at 11 p.m., and I would have to work the next morning. So it was rough,” said Silva, speaking Tuesday at a blessing ceremony for a new clinic in Nanakuli operated by Liberty Dialysis.
She’s now able to take her boyfriend to Waianae Coast Nanakuli Dialysis Clinic early in the morning, go to work and come back and pick him up.
Dialysis is a life-sustaining treatment for people suffering from end-stage renal disease, the point at which kidneys can no longer function on their own. Dialysis acts as the person’s kidneys, cleaning their blood and filtering out dangerous levels of waste and toxins.
The treatment is done three times a week for about four hours during each appointment and can be draining.
The prevalence of end-stage renal disease in Hawaii jumped 38% from 2010 to 2018, according to data from the U.S. Centers for Disease Control and Prevention. Diabetes and high blood pressure are the primary contributors to kidney failure. The new clinic in Nanakuli was opened to help fill the growing need.
The Waianae clinic has been overtaxed, and area residents have had to travel to clinics in Ewa, Kapolei and Waipahu, said Dr. Arie Ganz, medical director at the Nanakuli clinic.
Double capacity
Liberty’s Waianae clinic serves about 120 dialysis patients. The new Nanakuli clinic has the capacity to serve about twice as many, said Aurora Archibald, clinical manager at the Nanakuli clinic.
Merrilee Oki, 71, has been receiving dialysis treatment for 2-1/2 years. She said the Nanakuli clinic is just five minutes from her home.
“It’s not easy,” she said of the treatments. “It takes a toll on your body. It stresses your heart.”
Ganz said that all dialysis patients are in need of kidney transplants, but the shortage significantly limits who can get them. Oki says she is not a prime candidate because of her age and medical conditions — though 48 years ago she donated a kidney to her brother, when he was 21 years old and she was 23. Oki said he lived with her kidney for 37 years before dying of an unrelated cause.
Oki stressed that donating her kidney is not what landed her at the dialysis clinic. She suffers from diabetes and high blood pressure. She urged people to get regular kidney screenings.
About 1 in 7 adults in the U.S. have chronic kidney disease, which often goes undetected until its reaches a severe stage. Late-stage kidney disease can cause a long list of symptoms, including itching skin, fatigue, swelling in the hands and feet and nausea.
Approval backlogs
Increases in kidney disease have put pressure on state officials in recent years to approve more dialysis centers and speed up their certification process, which could take three years, the Honolulu Star-Advertiser reported in 2018. At the time, three new dialysis facilities were sitting idle as they awaited an inspection by the state Department of Health.
The approval process can be difficult. An operator has to obtain a certificate of need from DOH, which sometimes gets challenged by a competitor. A new clinic also must be certified by the state and approved by Centers for Medicare & Medicaid Services in order to accept Medicare, the health insurance that serves the majority of dialysis patients.
Liberty was able to streamline some of those approvals in order to open the Nanakuli clinic. The original plan was to relocate the Waianae clinic and expand it, said Palani Smith, director of market development at Fresenius Kidney Care, the parent company of Liberty Dialysis. So the company transferred its 1994 certificate of need from the Waianae clinic to the planned Nanakuli clinic, but then decided it wanted to keep both.
“As time went on, we also had identified and realized that there was a large number of patients who actually still lived and resided in Waianae proper,” said Smith.
The clinic then applied for a separate certificate of need for the Waianae clinic, which didn’t require as rigorous a review process.
Liberty was also able to speed up what can be a lengthy government certification process by using a private organization, the National Dialysis Accreditation Commission. In 2019 the CMS approved the private accreditation process. While using NDAC can be costly, Archibald said that it’s faster.
“We don’t need to wait for the Department of Health,” she said, adding that the pandemic seemed to have slowed things down further. “Sometimes it takes years before they can come and do our survey.”
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