USA to improve kidney health with more transplants, home dialysis

Grant Boone
July 12, 2019

On Wednesday, President Donald Trump signed an executive order aimed at transforming kidney care for the more than 37 million Americans with kidney disease.

President Donald Trump signed an executive order underscoring these goals, and the US health agency said it would test new payment structures, including one that rewards end-stage renal disease facilities and doctors who meet targets in these areas. Within 30 days of the date of this order, the Secretary shall select a payment model to test innovations in compensation for providers of kidney care services based on kidney patient cost and quality outcomes.

As a patient-centric organization dedicated to innovating the field of transplantation for more than 20 years, CareDx is excited about the direction the field is moving and commends HHS for its efforts to support patients living with kidney disease and their goals to increase transplantation. "These patients, their loved ones and for all those impacted by kidney disease, I am here to say we are fighting by your side and we are determined to get you the best treatment anywhere in the world". "What they do is so incredible". Some do a better job than others, but today's performance standards are self-reported, varying around the country and making it hard for government regulators or the OPOs themselves to take steps to improve. Further, since many kidney patients suffer from multiple chronic diseases and medical conditions, fostering a climate of coordinated care is essential.

Family history, high blood pressure and diabetes also put people at risk. "These historic initiatives aim to improve the quality of life for kidney disease patients by preventing disease progression, encouraging transplants over dialysis, and if dialysis is needed, more convenient home based dialysis to improve health outcomes". Only about one-third received specialized kidney care before they got so sick. Azar noted his father was on dialysis for several years before receiving a kidney transplant. Last year, there were more than 21,000 kidney transplants, according to the United Network for Organ Sharing.

Federal health officials have made clear for months that they intend to shake up a system that today favors expensive, time-consuming dialysis in large centers over easier-to-tolerate at-home care or transplants that help patients live longer.

Another goal is to improve prevention of kidney disease. While any transplant is preferable, one from a living donor is best because those organs "work better, longer and faster", Tevar said.

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KCP also stands with the Administration on broad programs including KidneyX to promote additional research and incentivize innovations in kidney disease. The administration said it would expand the number of kidneys available for transplant by increasing public awareness about the need for living donors and help those who donate a kidney.

Three times a week, hundreds of thousands of Americans with end-stage kidney disease trudge to dialysis centers to get the treatment that keeps them alive. According to data from CMS, around 88 percent of ESRD patients in 2016 started treatment with in-center dialysis. "We will continue to work with the Administration and Congress to launch programs that address broader care opportunities".

Other initiatives will require new regulations, expected to be proposed later this year. Details about who pays and who qualifies still have to be worked out. It will also call on Health and Human Services to improve support for living kidney donors, such as covering costs for child care and lost wages for living donors.

"Some OPOs are very aggressive and move forward with getting organs allocated and donors consented, and there are those that are a little more lackadaisical about it", said Pittsburgh's Tevar.

Medicare's current payment structure pushes patients into in-clinic dialysis as a default option, often providing a significant burden to the lives of end stage renal disease (ESRD) patients.

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