VALDOSTA – Quincey Roberts’ kidneys started failing while he was a fuel manager for the Air Force.

After retirement, he was hit with hypertension, diabetes and pancreatitis simultaneously. He gained 100 pounds in six months.

“The first time I was told I had kidney problems was when I went to Dr. Ven Chiang’s office (in Valdosta), and they said, ‘you have (kidney problems) and you have to go on dialysis,'” Roberts said. “I’d never heard of dialysis before. I think dialysis is one of those things that no one talks about. It’s looked at as a death sentence.”

Across the SunLight Project coverage area – Valdosta, Tifton, Moultrie, Milledgeville, Dalton and Thomasville, Ga. and Live Oak, Fla. – hundreds of people wake up before dawn, drive to a dialysis clinic and have their blood cycled through a machine to clean out toxins. 

The process can take three to four hours, three times a week.

Without treatment, the patients would die.

Roberts has been on dialysis for six years and has returned to a relatively healthy weight. He looks at his treatments as a job.

“I just come here, do my time, talk to the nurses and go home,” he said. “You can’t let it get you down, though. You can still live a productive life.”

But he had to make adjustments. 

After leaving the Air Force, the 66-year-old wanted to open a business; he gave up the dream because of dialysis. Still, he found a worthy occupation in helping veterans file claims with the Veterans Administration and helping them get benefits.

Roberts met with a veteran one time who was visibly upset. He asked him if he could help him with anything. The vet told Roberts he wouldn’t understand. 

The veteran said he was put on dialysis and his brothers wouldn’t give him a kidney.

“I had been on dialysis for nearly four years at the time,” he said. “I told him so what if his brother wouldn’t give him a kidney. You can still live with dialysis but you have to change your attitude. You have to be able to adapt to it.”

Toxins in the Body

Dr. Melissa Rampal is a transplant nephrologist at Tift Regional Medical Center.

She is capable of taking care of patients with kidney transplants as well as treating patients who have problems with their kidneys.

“We deal with diabetes, which is the most common cause of kidney disease,” she said. “We deal with hypertension, which is the second most common cause of kidney disease and any other conditions that can affect the kidneys.”

Conditions that could lead to kidney failure, which leads to people being on dialysis.

“The kidneys are amazing organs,” Rampal said. “They’re able to perform several different functions in the body that most people aren’t aware of.”

In addition to removing toxins, the kidneys regulate blood pressure, are involved in the maturation of red blood cells and in producing an enzyme that produces vitamin D. They regulate glands responsible for calcium in the body. Bones can weaken when kidneys aren’t working correctly.

Lack of exercise, sedentary lifestyles and the “typical American diet” can take a toll on kidneys, Rampal said.

“In this area, diabetes and hypertension are responsible for the majority of dialysis cases,” said Dr. F. David Newby, a nephrologist based in Dalton.

Hypertension and diabetes can lead to kidney failure, leaving kidneys unable to remove toxins, salt and excess water from the body. Dialysis does that for patients who have lost kidney functions.

In many, but not all cases, Newby said hypertension and type 2 diabetes can be prevented by exercise and proper diet.

Rampal said there are two types of dialysis.

Peritoneal dialysis can be done at home and involves a surgeon placing a catheter inside the abdomen and using a machine to introduce liquid into the body and then removing it after it binds to toxins in the body.

Hemodialysis requires patients to visit a clinic several times a week, so they can be hooked to a machine that removes their blood from their body, cleans and filters it, then returns it to the body. It is the most common form of dialysis and can severely impact a patient’s quality of life.

“They both achieve the same goal, removing toxins from the body,” Rampal said. “They just do it in different ways.”

Diabetes is the number one cause of kidney disease and kidney failure, Rampal said.

“Disease and failure are different,” she said. “Disease you can live with for the rest of your life, and the majority of us will develop kidney disease at some point in our life because as we get older our kidney function will begin to slow down.”

Kidney failure is a different problem and someone whose kidneys have completely stopped working requires permanent dialysis or a transplant.

The majority of people start dialysis between the age of 45 to 64, Rampal said.

There are things people can do to head off kidney disease and failure.

“In the South, particularly, we have a lot of fast-food places and the majority of people eat out, so a lot of what I do is educate my patients on how to keep their kidneys healthy,” Rampal said. “A lot of that is making sure their diabetes and blood pressure is well controlled and lifestyle changes.

“If they’re smoking, try to cut down and stop. If they are going to eat out, choose from the healthy portion of the menu. Stay away from the fried stuff. Exercising. Weight loss.”

Lack of Access, Lifestyle

According to the U.S. Renal Data System, nearly 15 percent of Americans – some 30 million adults – have early stages of chronic kidney disease.

In 2015, there were 124,111 new cases of end stage renal disease, with nearly half a million patients on dialysis and more than 200,000 living with a kidney transplant, making the U.S. rate of kidney failure among the highest in the world.

Southern states tend to have even higher rates and poverty increases incidences of kidney disease.

Alicia Horkan, a nurse at Colquitt Regional Medical Center, attributes that to poor lifestyle factors and lack of access or ability to pay for health care.

“An aging population is one (factor),” she said. “People are living longer. Good health care is keeping people alive longer, so they start dialysis later. That is contributing to older people on dialysis. Some start in their 80s.”

At the Dialysis Center at Colquitt Regional in Moultrie, the oldest patient is 92.

“This part of the country, lifestyles, the foods we eat here, we have a lot of people with the need for dialysis,” she said. “There’s a lot of factors. Socioeconomic factors also play a role in how well they can manage their disease process.”

Factors include lack of money for regular health checkups that could catch kidney problems earlier and for medication even when the disease is diagnosed.

A single mother with the choice between feeding and housing her children or drugs for high blood pressure will invariably choose the former, she said.

Dialysis is expensive, and Horkan estimates that about 95 percent of people seen in Moultrie have assistance from Medicare.

Private insurance will pay for 30 months, usually at 80 percent of costs of the dialysis and medicine with the Medicare end stage renal disease program picking up the balance.

Then, people with private insurance usually get 20 percent from that source and Medicare picks up 80 percent.

Other patients are covered fully by Medicare, except for co-pays, or some combination of Medicare along with Medicaid.

People who did not pay into Social Security or have a spouse who did are usually covered by Medicaid.

“Some can self-pay on a hardship,” Horkan said. “The hospital has an indigent fund. We refer people to see if they qualify for indigent care.”

For military veterans, such as Roberts, the VA takes care of dialysis payments.

Sandra Filko, clinic manager at Fresenius Kidney Care on Kings Way in Valdosta, said the clinic would never turn away a patient because of inability to pay.

“That would be a death sentence,” Filko said. “We work with them. We have social workers come in and speak with patients all the time offering help and ways to make payments.”

Horkan said eligible patients are encouraged to apply for a kidney transplant list. Some patients may not qualify due to age or other health reasons.

“We encourage them to apply to a transplant center and let them decide if they are candidates for a kidney,” Horkan said. “We give them a choice of where they want to be referred.”

Even there, money can be an issue. To be accepted on a list, Horkan said, the patient must be able to leave on short notice on a long trip to Atlanta, Augusta, Gainesville, Macon and return for visits after receiving the organ.

Transplant wait times depend on location and demographics, Rampal said.

“In the state of Georgia, for a deceased donor, the wait time is about three to five years, and then it depends on your blood type,” she said. “If you’re blood type O, you can only receive from an O, so they may take longer. If you’re in New York, it may be between five to 10 years. If you’re in Las Vegas, it might be a year. So it just depends.”

A living donor, whether they are related or not, can provide a kidney in approximately three months.

Filko said her clinic serves about 50 patients and only about two patients get a kidney transplant a year. 

Even when a transplant is approved, things can go wrong that prevent the patient from getting a new kidney. She said she had a patient approved three times for a transplant before finally getting a kidney.

“The first time he was told they had a kidney, so he got in his car to go get it,” Filko said. “When he got down to Jacksonville, he was told it wasn’t viable and they didn’t do the surgery.”

If surgeons feel like the kidney isn’t going to work, whether because it’s damaged or a bad match for the patient, doctors will not go through with the surgery, she said. 

The second time the patent went to get a kidney, it developed clots and was no longer viable for transplant. But the third time was the charm and the patient received his new kidney.

Filko said she is hopeful there will be more permanent fixes for people on dialysis and possible artificial kidneys, so people don’t have to go through false alarms before getting a transplant.

“They’re still looking, though,” she said. “They’re searching for that magic bullet.”

With so many people on dialysis, it is no surprise that every county has at least one dialysis clinic. 

People across the SunLight Project coverage area – Valdosta, Tifton, Moultrie, Milledgeville, Dalton and Thomasville, Ga., and Live Oak, Fla. – get to know these clinics as a second home as they visit them for years, three days a week hours at a time.

Sandra Filko, clinic manager at Fresenius Kidney Care on Kings Way in Valdosta, said she knows people at her clinic who have been coming for decades and will probably be on dialysis until the day they die.

But, in Filko’s experience, clinics aren’t depressing. Patients and staff get to know each other and build bonds with one another.

“I think this is an extremely rewarding job,” Filko said.

She started as an oncology nurse at a hospital in Tennessee. She said dialysis isn’t something typically brought up in nursing school. She learned about dialysis care when a nephrologist visited her hospital and told her she would be a good fit for it.

He told her about a clinic not far from where she lived and said she should stop by one day and check it out.

“I did and it was so nice,” Filko said. “It was like it is here (at the clinic in Valdosta). It’s the camaraderie between patients and everyone there to take care of them. You could see them come in sick and wouldn’t even know I was in the room. Then they would start their treatment and you would slowly see them feel better.

“It created this connection with making people feeling better, and as a nurse, that’s why we do what we do. We want to help people,” she said.

There are five walk-in dialysis clinics in Valdosta: Fresenius or Rai Kidney Care on Kings Way and Rai Kidney Care on Patterson Street, U.S. Renal Care South Georgia Dialysis and Central Valdosta and DaVita Oak Street Dialysis.

In the Tift area, there are two dialysis clinics, one related to Tift Regional and the other a DaVita Tifton Dialysis.

The Tift Regional clinic has between 100-110 hemodialysis patients and approximately 30 peritoneal dialysis patients.

FMC Dialysis Services is the one clinic in the Live Oak, Fla., region.

Milledgeville has four dialysis clinics spread throughout the community: U.S. Renal Care, Milledgeville Dialysis, Baldwin Dialysis Center, Dialysis Center of Milledgeville and DaVita Dialysis.

The Baldwin Dialysis Center currently sees more than 40 patients and is one of five American Renal Associates affiliate facilities owned and operated by Central Georgia Kidney Specialists.

The most frequent reason Baldwin Dialysis Center sees patients needing dialysis is lack of education, said Chasity Wilson, a BDC employee.

Wilson said she believes there is a rising demand for dialysis in most communities. At present, she said she believes the clinic is meeting the needs of patients in middle Georgia as a result of the partnership between American Renal Associates and Central Georgia Kidney Specialists.

“We’ll continue to work to meet those needs,” Wilson said.

DaVita’s Milledgeville clinic has 12 chairs and currently serves 55 patients.

The Milledgeville DaVita site, as well as all DaVita dialysis centers, has a kidney care team to support patients including a nurse, dietician, social worker, insurance counselor and patient care technicians.

Insurance counselors work with patients to review insurance and payment options.

Moultrie has three Thomasville nephrologists, Drs. Raul Santos, the medical director, Daryl Crenshaw and Walter Hicks have office hours at the center on 31st Avenue Southeast down the street from the hospital four times each month.

“I’m glad the physicians are offering their services here so (patients) don’t have to drive to Thomasville,” said Alicia Horkan, a nurse at Colquitt Regional Medical Center.

Dr. Merrill Hicks, a Thomasville nephrologist, said more can be done for dialysis patients. He said the government could provide transportation to dialysis clinics, repricing home dialysis and paying more for medication for kidney transplants.

The government encourages home peritoneal dialysis, the physician said.

The gentlest form of home dialysis is peritoneal dialysis, which uses the lining of the abdomen to filter blood. Hemodialysis uses a machine to filter the blood.

“If it were up to me, I would put a happy face on home dialysis,” Hicks said.

He said home hemodialysis is discouraged because of the cost.

“However, there have been recent technical improvements which lower the costs substantially,” Hicks said. “The community at large needs to understand that all forms of home dialysis, both peritoneal dialysis and home hemodialysis, are gentler with superior results, compared to three times weekly in-center dialysis.”

Blood pressure control is the most important goal of dialysis, he said.

He said anti-inflammatory drugs, such as ibuprofen, aggravate high blood pressure and kidney disease.

Thomasville has two dialysis clinics. Neither responded to requests for information.

Curtis Hall of Sylvester is one of Hicks’ patients. He tried other facilities and went to the Thomasville nephrologist when his kidneys failed in 2006.

“He has been such a wonderful, wonderful doctor and friend,” Hall said.

The 50-year-old has autoimmune glomerulonephritis and has managed with home hemodialysis for more than 11 years. 

He injects himself with two needles every night. One needle takes his blood into a machine that cleans it and removes excess fluids. The blood is then returned through the other needle.

Hall undergoes the treatment five nights a week. He can skip two nights a week, as long as the nights are not consecutive.

The treatment is time-consuming, but Hall, an AT&T engineer, said it has given him his life back by not having to go to a dialysis center.

Hall rarely feels bad, he said. He has missed only one of his son’s high school or college games since his condition was diagnosed when the boy was 12.

“I can take my machine anywhere I go. It gives me an opportunity to have a full life,” Hall said.

He decided against a kidney transplant. With a transplant, the disease could return and attack the transplanted kidney. Hall opted to stay on dialysis.

“Dialysis is my best option right now,” he said.

The SunLight Project team of journalists who contributed to this report includes Thomas Lynn, Patti Dozier, Eve Copeland, Charles Oliver, Gil Pound, Alan Mauldin and Terry Richards.

Thomas Lynn is a government and education reporter for The Valdosta Daily Times. He can be reached at (229)244-3400 ext. 1256