15500.00 Dollar US$ Chronic Kidney Disease Improvement in Research.... Abeokuta

They go on: “The Chronic Kidney Disease Improvement in Research and Treatment Act would incentivize innovation in kidney care. It will require Medicare to provide a long-term, sustainable payment pathway for new drugs, biologics, medical devices, and other technologies that can help diagnose and treat kidney disease. It would also help to ensure Medicare Advantage plans support access to innovative therapies and treatments that are not currently covered. By expanding access to cutting-edge treatment options, these provisions will lower costs and result in better care for our nation’s kidney community.”

Lack of awareness of CKD remains a major issue. The National Kidney Foundation has done a lot, such as promotion of estimated glomerular filtration rate (eGFR), the kidney risk equation, the kidney heat map, and so on. Likewise, the International Society of Nephrology has championed World Kidney Day each March. Still, if we believe the surveys I’ve cited, it doesn’t seem to be enough. Unlike CVD, where awareness and education are high among HCPs and the general population, we don’t have a similar situation with CKD. For example, the importance of measuring urinary albumin excretion (UACR) is not widely recognized or implemented. While this might change with its adoption as a Healthcare Effectiveness Data and Information Set measure later this year, there is very little promotion of UACR among the primary care community.

Does education of HCPs about CKD make a difference? Research is limited. A cursory search of PubMed revealed very little original research over the past 10 years. However, insightful conversations I had recently with Dr. Victory, an associate chief of nephrology in the Renal Division at the University of Pittsburgh, point to three things that seem to make a difference: outreach directly to primary care practices, use of the electronic medical record to identify at-risk patients, and use of academic detailing (individualized contact with HCPs either through eConsults or personalized emails) advising them on what therapies to consider and how to manage the complexities of treatment, such as the initial dip in eGFR one sees with initiation of a renin-angiotensin-aldosterone system inhibitor or sodium-glucose cotransporter-2 (SGLT2) inhibitor, or managing acute hyperkalemia.

The problem is that most health systems and health insurers are not motivated to increase awareness about CKD, because with greater awareness comes earlier detection and treatment, both of which increase cost to the system. However, this approach is short-sighted and doesn’t consider the later consequences of CKD progression—heart failure hospitalizations, vascular complications, and even end-stage kidney disease (ESKD). In addition, the saying “more people die with CKD than progress to end-stage kidney disease” isn’t a punchline, it is true and supported by good data. The human cost of not managing CKD remains high.

The recently introduced bill HR 5027 would help increase awareness and education and provide pathways for patients to access newer preventive treatments for CKD, such as SGLT2 inhibitors. It would also push Medicare Advantage plans to cover these newer treatments—something that would be a major benefit to seniors. The first part of the dialysis moonshot is to prevent the need for dialysis. Of course, we also need innovations in ESKD treatment. So, I am all for HR 5028 and will write to my congressional representative. You should too. for more information call on 08140054416

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