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Living Day to Day with Kidney Dialysis

As he has for the last seven years, Tony Robinson, 47, heads straight from work on Monday, Wednesday and Friday afternoons to a nearby hemodialysis center in Orlando, Fla.

A nurse gives him a checkup, then Robinson settles into one of the recliners circling the room. Propping his left arm up, he allows a technician to slip two needles into blood vessels near his wrist. The needles -- one to capture the blood and the other to return it -- are attached to plastic tubes leading to a dialysis machine beside the chair.

For the next three hours, this device, which looks like a tall, narrow, automated teller machine, removes wastes and extra fluid from Robinson's blood. He passes the hours by reading, watching the evening news, and sometimes dozing.

Robinson was born with only one kidney. It failed when he was in his 30s, as did a kidney transplant. For now, dialysis keeps him alive.

Except for the initial needle stick, the procedure doesn't hurt. "You never get used to the needles, you just learn to handle them," he says with a laugh. "Sometimes I feel sick on my stomach if my blood pressure drops, but other than that, it's not bad."

Robinson is one of approximately 217,000 Americans who receive ongoing dialysis, at an annual cost of $11.1 billion nationwide. Since the late 1960s, the procedure has been used in place of kidneys lost to disease, birth defects, or injury. It can be used temporarily until the kidneys resume function or the patient receives a transplant, or for years if those options are not available.

With dialysis, Robinson and many others like him can live full and active lives. In fact, Robinson works full-time as an investigator with the Food and Drug Administration's Orlando office. His job requires him to walk distances through production plants, climb ladders, and lift boxes to inspect products. He travels to cities all over Florida to conduct inspections. The overnight trips are not a problem as long as he schedules dialysis ahead of time in the cities he visits.

"If a dialysis patient is otherwise healthy, they should be afforded the opportunity to work," says Robinson. "No one should say you're disabled or restricted to certain areas. I travel, go to training, do inspections -- and I have since 1990. I've gotten adjusted to arranging things around the treatments."

Dialysis Under Scrutiny

Since the 1960s, surveillance studies have consistently shown that American dialysis patients do not live as long as those in other countries -- the U.S. mortality rate for dialysis patients is about 23 percent, twice the rate of patients in Western Europe or Japan.

A number of factors seem to be the cause. As a whole, American clinics perform hemodialysis treatments for a shorter length of time than in other countries, both because reimbursement doesn't increase for lengthier treatments and patients don't want to sit for five or six hours, according to Dr. Garabed Eknoyan, president of the National Kidney Foundation and professor of medicine at Baylor College of Medicine in Houston, Texas. "If you talk to any of the patients, you'll find it's hard to convince them to stay five hours. They come in late and want to leave early."

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