Though she'd lived with type-2 diabetes for eight years, Shirley Jackson said the news that her kidney function was declining came as a shock.
"I didn't know anything about kidney failure," said the 66-year-old retired teacher. "People aren't aware that your kidneys will fail on you."
Ms. Jackson, a Chattanooga resident, said she was lucky her doctor noticed her kidney decline early. Medications and lifestyle changes helped her hold off the progression of her chronic kidney disease for seven years, until she needed dialysis. In 2004, Ms. Jackson got a kidney transplant but is now on dialysis again. Three times a week she sits for hours while a machine cleans the waste from her blood the way her kidney used to.
"That's part of your life three times a week, but it's also giving you life three times a week," she said.
Fueled largely by the obesity epidemic and the related rise in hypertension and diabetes, chronic kidney disease has grown exponentially in recent years, and the condition's costly and time-consuming treatments are burdening the already stretched health care system.
The number of people with end-stage renal failure grew from 209,000 in 1991 to 472,000 in 2004, according to a November 2007 study in the Journal of the American Medical Association. The incidence of chronic kidney disease grew to 13 percent of the adult U.S. population in 2004, up from 10 percent 10 years earlier, the study said.
The demand for kidney services and specialists locally has skyrocketed, and to meet this need, more specialists and dialysis centers are coming to town, said Dr. Don Franklin, nephrologist with Nephrology Associates of Chattanooga.
When he came to Chattanooga in 1990, he was one of five nephrologists here, Dr. Franklin said.
"Now we have 15 and we're all busy," he said.
The number of dialysis centers here has grown from three in 1990 to at least 11 today, he said.
In November, Chattanooga Kidney Centers opened a dialysis clinic on Morrison Springs Road, its second in the area behind one on Stein Drive. It has another center planned for Cleveland, Tenn.
Far too little attention is paid to the disease, which is known as the "silent killer" because symptoms don't emerge until late stages, said Dr. Billy Arant, a hypertension specialist in Chattanooga.
"This is a terrible picture. It's an expensive picture. It's not just money. It takes its toll in quality of life and family life," Dr. Arant said.
The aging of the population and rising rates of hypertension and diabetes are contributing to the increase, said Dr. John Richmond, nephrologist and president of Nephrology and Hypertension Specialists in Dalton, Ga. Better tests for kidney function also are available.
"As we live longer, our kidneys tend to bear the brunt of all the abuses we give to our bodies over the years," he said. "When you combine increasing blood pressure with people living longer and being overweight, then kidney disease is rampant."
Awareness about the disease has not kept pace with its rising incidence, said Jennifer McGlohon, executive director of the Kidney Foundation of Greater Chattanooga.
"It's not a sexy disease," she said. "It's very hard (to spread awareness) until you have the celebrity endorsement."
The local kidney foundation is launching a campaign to spread awareness about the disease and increase surveillance. The foundation will post billboards emphasizing the need to screen people at high risk for kidney disease, such as those with a family history or who have high blood pressure or diabetes.
A healthy diet and regular exercise can stave off the leading causes of chronic kidney disease, high blood pressure and diabetes, Dr. Arant said.
Caught early, the progression of kidney disease can be slowed with medications to control high blood pressure or regulate diabetes, as well as diet and exercise. But too often, the disease goes undiagnosed until a patient needs dialysis to stay alive, doctors say.
Medicare pays for the bulk of treatments for people with end-stage renal disease because it covers dialysis and kidney transplant services. Those treatments totaled $32 billion in public and private spending in 2005, according to the National Institutes of Health.
With proper treatment and lifestyle changes, though, patients with kidney disease can still lead healthy productive lives, doctors say.
Derrell Jones of LaFayette, Ga., got a transplant after undiagnosed chronic kidney disease - likely caused by high blood pressure - damaged his kidneys beyond repair. His blood pressure was so high when he was diagnosed in 2000 that his doctor immediately sent him to the emergency room for blood pressure medicine, he said.
"It blindsided me," said Mr. Jones, who is 53. After five months of dialysis he received a transplant in 2002. With careful attention to his anti-rejection drugs and diet, he's feeling pretty much as good as ever.
"I was amazed," he said.