About 30 million Americans suffer from some form of kidney disease and it was the nation’s ninth leading cause of death in 2017. When patients reach the final stage of kidney failure, they require either a transplant or frequent dialysis to stay alive. Only about 12 percent start their dialysis treatment at home.
President Trump’s Advancing Kidney Health Executive Order is a welcome move that shone the national spotlight on the immense burden of kidney disease. How it will be implemented is yet to be seen.
“The last 30 years as a country all we’ve done is wait for kidneys to fail and we put people on dialysis,” said Bobby Sepucha, the chief administrative officer at Cricket Health, a kidney care provider.
Bobby Sepucha appears to be an advocate for renal care and kidney patients. I feel this statement is very dismissive and diminishes what physicians have been doing all these years treating and managing CKD.
Nephrologists especially have been waging this battle for decades. Since the advent of Ace inhibitors, and later Angiotensin receptor blockers, we have been able to successfully slow the progression of kidney disease in many cases. The aggressive treatment of diabetes and hypertension, the two major causes of chronic kidney disease, has also helped to delay progression.
This has been shown in trials such as the REENAL, REIN, IDNT and many others. The search for other ways to slow and even stop progression is ongoing. Physicians including Nephrologists are constantly battling the obesity epidemic in our offices as it is another major cause of chronic kidney disease.
CKD clinics around the country are treating associated diseases such as anemia and secondary hyperparathyroidism and managing the increased burden of cardiovascular disease in that population.
All our stage four CKD patients are required to tour the dialysis units and learn about in- center and home dialysis modalities. Many are referred to transplant centers for evaluation. The sad truth is that most do not qualify and there is a dire organ shortage.
The degree of debilitation of the ESRD population in the United States is grossly underestimated and most cannot do home dialysis. The goal of eighty percent home dialysis and transplant is exceedingly lofty at best and almost laughable given the current situation. There will need to be a huge paradigm shift at all levels to enable more successful home dialysis.
Currently most nursing homes also do not offer the service and do not want to deal with the liability of patients/ spouses performing it themselves.
As a nephrologist, I am thrilled that there is now a national spotlight on CKD/ESRD. However, please do not diminish what Nephrologists and other primary care physicians have been battling, and have achieved despite all odds. Also tying reimbursement to largely unachievable goals of home dialysis and transplant is going to make Nephrology an even more undesirable specialty for upcoming doctors. And that is the last thing the country currently needs.