Read more: Recognize diabetes before it's too late
ELKINS, W.Va. -- For four hours, Bill Hall used to lie on a padded vinyl recliner, one arm stretched out, two thick needles sticking out of it. One needle drained the blood from his body. The other put it back.
His blood ran through a humming kidney dialysis machine. The machine cleaned it of toxins. His kidney used to do that before it quit working.
Hall, 65, fought in Vietnam. One of his legs was amputated at the knee. He didn't lose it to the war. He lost it to diabetes, which cut off the circulation to his foot. His leg had to be amputated so gangrene wouldn't infect his whole body.
"Diabetes is not for sissies," he half-joked in December.
Some days, he showed up at the Elkins kidney dialysis clinic in the dark, at 5 a.m. Three days a week, so do about a dozen others. Before the sun came up, they all lay on the vinyl recliners, each doing the same thing.
Lona Kittle, who used to run a diner in Belington, can't see out of one eye. Diabetes blinded it. She hopes to save the other. She likes the recliner in the corner.
Linton Wright, a retired Forest Service soil scientist, used to maintain an active schedule as a Jehovah's Witness minister. He can't do that anymore. He doesn't have any energy after running his blood through the machine.
Three days a week, patients come to the clinic and attach themselves to a machine for four hours. "After you're finished, you go back home and recover," Wright said. "The day is shot."
They're all in Stage 4 kidney failure. Usually, it could have been prevented, says nurse practitioner Barbara Weaner.
"We have people in their 20s coming to this clinic," Weaner said. "It's happening earlier and earlier. People don't understand until it's too late that they can prevent it. It's sad."
Hall lost his job after his kidneys shut down, because he had to be on dialysis three days a week. He used to travel a lot for his job. "I loved to go places," he said in November. But he couldn't skip treatments.
He went on disability. "I didn't have much choice," he said. The toxins kill a person if they stay in the blood.
"They've got mobile units you can take home, but people get infections from that," he said. He lived on an isolated Barbour County farm, "so far out, I don't want to risk it."
In December, he was hoping for a kidney transplant. "As long as he stays on dialysis, he probably won't die of kidney failure," Weaner said then. "Ninety percent of people on dialysis die of heart attack or stroke."
In early January, at age 64, Bill Hall died of heart failure. "It was heartbreaking," Weaner said.
Dialysis in W.Va. costs $147 million a year and counting
In 2009, 1,897 West Virginians were on dialysis, according to the National Renal Data System. Their dialysis treatment cost more than $147 million. Taxpayers pay much of that.
Hundreds more West Virginians go on dialysis every year. The number has doubled since 1993, when there were 929. "Dialysis clinics are popping up everywhere in West Virginia," said Gina Wood, director of the West Virginia Diabetes Prevention and Control Program.
Nobody knows exactly how many clinics there are, since existing health care facilities don't have to get a certificate of need from the state Health Care Authority if they open one. But as of this spring, 35 clinics have certificates of need, compared with 24 in 2006. So the number of clinics has increased by at least 45 percent in the past six years.
Dialysis costs about $77,000 per year per person, including medication, according to the National Kidney Foundation.
"It's a lot cheaper to prevent it," said Dr. Rebecca Schmidt, a West Virginia University professor who has been instrumental in making kidney screening and treatment available in West Virginia's rural areas.
West Virginia leads the nation in percent of people in kidney failure who start dialysis. The Elkins clinic's 40 patients alone cost about $3 million a year.
Many dialysis patients are on disability after the bills wipe out their resources. Taxpayers pay a lot of the bill.
People on dialysis have advanced chronic kidney disease, called CKD. The disease can be reversed before the person reaches dialysis, but it gives the patient very few physical warnings, so a lot of people don't know they have it till it's too late, Schmidt said.
Many doctors do not know how to diagnose CKD, she said. "We need a statewide education campaign."