ATLANTA — Three days a week Chardae Sanders, a senior at Kennesaw State University, has excess fluid, waste and toxins filtered from her blood at a for-profit dialysis clinic downtown. She doesn’t flinch when a clinician pokes a needle the size of a coffee straw into her leg; the only part that still seems unnatural is when the clean blood is reintroduced into her body at the end of the treatment. “It’s like when you drink a glass of ice-cold water really fast,” she says. “It feels like a part of you is in the machine, and then you get her back.” 

Sanders found out that her kidneys had failed the same week as her 21st birthday, in November of 2007. They had been ravaged by the autoimmune disorder lupus, which she has been suffering from since high school. She’s been on dialysis ever since. 

The procedure keeps Sanders alive — there’s no comparable remedy for people whose livers fail, for example. But it’s brutal: Chronic pain afflicts close to two-thirds of dialysis patients, who often complain of fatigue, cramping and nausea, according to a 2011 article by Teri Browne, who studies kidney-transplant disparity at the University of South Carolina. To prevent health complications, doctors recommend a strict diet that regulates patients’ water, potassium and sodium intake. The treatment also restricts movement; most patients on dialysis need to be tethered to a machine four hours a day, three days a week.

Sanders follows her doctor’s orders: She eats well, stays active and is on top of her medication. But she knows that she can’t stay on dialysis forever. While some people spend decades hooked up to a mechanical kidney, the average life expectancy on dialysis is five to six years. Like most patients, Sanders views it as an interim treatment while waiting for a kidney transplant, which is considerably cheaper, adds an average of 10 years to people’s lives and allows patients to resume a relatively normal life.

Whether or when Sanders will receive a transplant, though, is particularly uncertain because she lives in Georgia, which has the lowest transplant rate in the nation. In 2013, less than three percent of Georgians with end-stage renal disease received a new kidney, according to data from the United Network for Organ Sharing. And Emory University researchers found that between 2005 and 2011, people living in some northeastern states were four times more likely to get a transplant than Georgians. As a result, many patients in the southern state spend a disproportionate amount of time on dialysis; they live and die hooked up to the machine. 

...