I was reading an article published by an old friend.  (No, he’s not old- I am.)

He, like I, has been involved in dialysis for most of his life.  He, unlike I, decided that he enjoyed working for a large firm and has become the Chief Medical Officer for one of the largest dialysis providers in the world.

His article reminded me of how recent dialysis treatments really are. And, upon reading his article, one of the long-lasting questions in my life was answered.

Why would an 8-year-old kid decide that he wanted to invent an artificial kidney?  When not a soul in his family (or friends) had kidney disease or diabetes (at the time).  When not a soul in his family was a physician.  (That fact changed long ago.)

Because the need was expressed that kidney failure was killing people, and maybe if we opened up special clinics, those that only provided dialysis, we could change that situation dramatically.  And, it was those discussions that I must have read (by this time, I was reading the New York Times, the Herald Tribune, The New York Post, and Newsday every day) that piqued my interest.  (Or, maybe, there was a discussion on the evening news.)

Over the years, I did invent my dialyzer.  I did perfect a method (back when water treatment was not the norm for dialysis patients) that removed chlorine from the water, which was hemolyzing patients’ blood. I did develop instrumentation to improve the dialysis regimen.  And, I did invent the first all-liquid bicarbonate dialysate- the same buffer that works in our body, rendering treatment to be far more physiologically compatible than it had been since the mid-1960’s.  (Back when dialysis first started, the solution was prepared in batches; that was replaced by automatic delivery [especially when it was found that the batches allowed bacterial growth and contamination- and the automatic delivery system couldn’t deal with the relatively insoluble bicarbonate ion, until my discovery.)

Back in the 1960’s, dialysis revolved about four folks.  Drs. George Schreiner, Willem (Pim) Kolff, John Merrill, and Belding Scribner.  Pim had developed his washing machine kidney system back during World War II, but when he came to America, he kept perfecting it.  Dr. Scribner invented a procedure that afforded dialysis patients vascular access- which meant dialysis could be effected almost any time- and chronicled the successful long-term therapy (dialysis was an acute procedure, not for long-term care until then). for three patients in Seattle.  Dr. Merrill of Harvard and Peter Bent Brigham Hospital ran the premier kidney transplant center (the first transplant ever was done in 1950), and Dr. Schreiner (who began his dialysis work during the Korean War) headed up one of the best nephrology training programs at Georgetown.  Dr. S also started the American Society for Artificial Internal Organs back in 1954 (a group that let me become a member less than two decades later) as well as the American Society of Nephrology in 1967.

It was these folks- and a few more- who worked hard to get dialysis to be covered by Medicare.  That law, HR-1, came about two years after the first attempt failed, in 1972.

Dialysis is one of the few health care programs in the US that has seen the annual cost of care decrease over the years.  (Yes, while no one anticipated some 700,000 folks to be covered by ESRD [End Stage Renal Disease] programs, the regulatory system has managed to keep the price per treatment per patient extremely stable.)

But, as I’ve written, not many new development have come about in dialysis over the past three decades.  That’s why the KidneyX program was developed.

That was a start.  Now, Senators Ben Cardin (Maryland) and Roy Blunt (Missouri) have introduced bipartisan (yes, you read that correctly) legislation to further advance kidney care.  The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019 (S 1676).

From the title, you can see that the bill proposes to address the education and preventive care for those who are “pre-diabetic” or showing impaired kidney function.  The concept is to increase awareness and improve care to help BEFORE patients need dialysis. (Like introducing a ketogenic diet.)

In addition, the bill hoped to improve palliative care, the training of more nephrologists to provide care in underserved areas, developing additional programs for Medigap policies (age-independent), and better dialysis clinics and quality programs.

Hopefully, things are changing.