Advancing kidney care: How a focus on prevention can fight a silent epidemic

As a country, we spend billions of dollars each year treating advanced kidney disease. Yet, controversy still exists around prioritizing and implementing early detection. An estimated 37 million Americans are living with chronic kidney disease (CKD). Even more shocking is the fact that nearly 90% of them are completely unaware they have it.

CKD is a costly “silent epidemic.” Almost 24% of Medicare spending each year goes to CKD, and hemodialysis care costs the Medicare system about $90,000 per patient, annually, for a total of $28 billion.

CKD disproportionately affects minority populations who also often experience adverse social determinants of health and limited access to screening and treatment options. This combination of inequities inevitably leads to unnoticed or accelerated advancement of the disease.

The fight against these kidney disease-related inequities begins with supporting and empowering the primary care physician (PCP). PCPs play a critical role in recognizing and diagnosing CKD in its early stages. This helps slow the disease progression, improving outcomes and lowering total costs of care. 

For patients, early detection affords them time to process their diagnosis, slow disease progression, and if needed, prepare for dialysis or a pre-emptive transplant. It also allows them to get nutritional and other social support to achieve the best quality of life.

Early detection of kidney disease also allows the opportunity to address social determinants of care, those non-medical factors that affect health and wellness. There are also new medications on the market that can be implemented to slow the progression of kidney disease and reduce other complications such as heart disease.

Targeted screening of high-risk individuals, followed by disease risk stratification and patient-centered treatment, is imperative to improve outcomes for persons living with kidney disease. We need to do better, and we can do better!

Alex Azar, former U.S. Secretary of Health and Human Services, put it this way: “The health system’s current approach to kidney care demands disruption and primary care physicians are the catalysts for that change. Their leadership can help drive the shift from reactionary treatments to proactive and preventative care to not only improve lives but create a more sustainable health care landscape.”

New value-based payment models focused on pay for performance have paved the way to build system incentives that improve outcomes, better address social determinants of health and reduce costs, overall.

I am optimistic that this approach to kidney disease management will mean better care and quality of life for all affected persons. A review underway this year by the U.S. Preventive Services Task Force will determine whether to expand routine screening to even more people. Additionally, a 2020 Kidney Disease Improving Global Outcomes statement presents the evidence for an approach based on early detection, risk stratification and treatment of kidney disease in high-risk groups – strengthening the case for early identification of CKD. These efforts support our goal to treat kidney disease before it progresses to later stages.

Unfortunately, because of the structure of the current system, early intervention is not happening in many primary care settings – allowing advanced kidney disease to expand its foothold and leaving more and more patients with a devastating prognosis and diminishing quality of life. Payers, policy makers and health providers need to come together to find ways for PCPs to efficiently incorporate effective screening into their clinical operations and include nephrologists at the right stage, well before kidney failure.

“Detecting kidney disease early improves patient lives,” said my colleague, Dr. George Hart, chief medical officer for Interwell Health. “It also paves the way for more cost-effective interventions that can ease the burden of kidney disease on the entire health care system and by extension PCPs and their practice.”

He is correct. A shared stakeholder focus on finding and treating CKD in its earlier stages will benefit millions of Americans, allowing them to live their best lives.

Carmen A. Peralta, MD, MAS, FASN, serves as the chief clinical officer for Interwell Health where she is working to develop the company’s health equity strategy and refine its value-based model of care to better support people with kidney disease. Former HHS Secretary Alex Azar is a board member of Interwell Health.