Kidney Disease: An Overview



“There’s a lot of things about it that’s painful,” said Bernard Zachary, a 51-year-old former construction worker from Modesto, California. He’s referring to his in-home dialysis process — a near-nightly regimen that involves a catheter inserted into his stomach, and hours of fitful time spent in bed with a churning machine nearby. The process does the job his kidneys can no longer do. He’s been waiting for a donor kidney for four years.

“I mean, it doesn’t hurt hurt,” Zachary said. “But what hurts is that because I have end-stage renal disease, it gave me limitations as to what I could do or what I can’t do, and that’s the part that hurts.”

This series was supported in part by the National Institute for Health Care Management Foundation.

Zachary’s story is one of 37 million. That’s how many people are now confronting various stages of chronic kidney disease in the United States, and the numbers are continuing to grow. Citing data from the U.S. Centers for Disease Control and Prevention, the National Kidney Foundation attributes the trend to a variety of factors, including an aging population, as well as a rise in risk factors like diabetes and hypertension.

But whatever the proximate reasons, what’s clear is there are more Americans on dialysis, and on kidney transplant waiting lists, than ever before — though not every journey through the debilitating and life-altering gauntlet of chronic kidney disease is the same.

Jo Karabasz, David White, Brian Carroll, Traci Evans-Simmons, Patrick Gee, and Bernard Zachary are among the millions of Americans living with chronic kidney disease. They are also among the many patients, doctors, politicians, advocates, and company executives interviewed for this five-part series.


Dialysis has, of course, saved countless lives — and the treatment has become available to more patients than ever before. But America’s fractured and variegated health care system has also created a regime of chronic kidney disease management that critics say raises serious questions, and perhaps even amplifies long-lingering disparities.

This series aims to examine the current state of chronic kidney disease treatment in the U.S., from diagnosis to dialysis, and from maintenance treatment to transplant (for those who are lucky). It’s a story of technological and procedural advance, but also one that has seen just two large, for-profit enterprises come to dominate the market for dialysis delivery. It’s a story of expanding access, but also one still marked by racial and ethnic disparities. And it’s a tale of medical innovation and adaptation, but also one beset by conflicts of interest and an inability to adapt to holistic modes of care that other disease specialities, from cardiology to oncology, have long ago embraced.

For the 37 million Americans navigating the corridors of kidney disease, these are likely familiar issues. But for the third of Americans at risk for renal disease — and for anyone who cares about how the nation’s health care dollars are spent — this five-part collaboration between Undark Magazine and Scientific American pulls back the curtain and provides an unflinching look at what’s working, and what’s not.

Published in five installments, the series appears both at Undark and Scientific American. Links to each chapter as it becomes available are below, at the top of this page, and embedded in each story.


Intro  |  The Market  |  The Conflicts  |  The Disparities  |  The Waiting  |  The Alternatives


Carrie Arnold

Photos & Video

Larry C. Price


Dominic Smith

Production & Direction:

Undark Magazine & Scientific American