USVI Community Pulse

Urgent Call to Action: Nephrologist Highlights Dialysis Dilemma



German-born nephrologist, Dr. Walter Rohloff, emphasized the critical state of dialysis services during his testimony before the Senate Committee on Health, Hospitals, and Human Services this Wednesday. His comprehensive address shed light on the escalating challenge in the USVI, explored alternatives beyond the territory, and proposed a roadmap to enhance local treatment.

Dr. Rohloff shared alarming statistics – in the US, one in every 13 individuals of African descent is predicted to encounter end-stage kidney disease in their lifetime. “The situation is even more dire in the Caribbean, where the figure stands at one in 10,” he added.

He drew attention to the surging number of end-stage kidney disease patients, marking it as a grave concern. Over the past three decades, the count of individuals requiring dialysis in the territory has quadrupled from about 50 to over 200. Dr. Rohloff mentioned, “A total of 219 Virgin Islanders, residing on both St. Croix and St. Thomas, are currently dependent on dialysis services. Additionally, between 20 to 40 patients are off-island, unable to return due to inadequate outpatient dialysis facilities. While some have initiated home dialysis, the lack of this option locally hinders their transition back.”

Residents of St. John and Water Island face a bleak scenario with no dialysis facilities available, necessitating thrice-weekly commutes to St. Thomas for four-hour dialysis sessions, he elaborated.

Dr. Rohloff underlined the financial strain and personnel shortage plaguing dialysis centers, recounting a recent Senate resolution to allocate $72,000 bi-weekly to support Caribbean Kidney Center, a private dialysis provider. He cautioned that without a substantial transformation in the dialysis treatment landscape, such scenarios would recur, impacting both private and public providers.

To pivot away from this troubling trajectory, the lead at The Kidney Center on St. Thomas delineated a six-pronged strategy. This includes introducing new treatment alternatives like kidney disease mitigation programs or home dialysis; reducing the patient load through preventive outreach programs; enhancing patient survival and life quality via transplantation or home dialysis; bolstering service quality and stability through improved staff retention and training, financial stability, and emergency preparedness; and finally, achieving financial self-sufficiency to minimize reliance on governmental aid.

Home dialysis emerged as a focal point in Dr. Rohloff’s discourse. He highlighted its cost-effectiveness and lessened dependency on resources like staffing. Unlike in-center dialysis, home dialysis empowers patients with more control, requiring only monthly medical consultations, he explained. The modality can endure post-disaster scenarios, offering a vital lifeline in storm-hit regions.

However, the dearth of skilled personnel, partly due to brain drain, has hampered the successful implementation of home dialysis in the territory. Dr. Rohloff proposed aligning with prominent national kidney care entities to overcome this hurdle, thereby unlocking cost savings and consolidating essential services.

He also applauded the forthcoming Dialysis Clinic Inc-operated center in St. Croix, anticipating it would bridge many existing service gaps. Dr. Rohloff voiced his support for the VI Healthcare Foundation’s efforts in establishing the new clinic, encouraging legislative backing to overcome the final financial barrier.

The Senators, while intrigued, exhibited caution, particularly around the self-discipline required for home dialysis adherence. Senator Marise James questioned the patients’ ability to self-administer dialysis daily. Committee Chair Senator Ray Fonseca directed Dr. Rohloff to liaise with Health Commissioner Justa Encarnacion for a thorough review and approval of his proposal before revisiting the Committee for further discussions.

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