©2018 Kidney Care Partners
Published by The Tennessean
September 13, 2015
When it comes to biomedical research, resources yield results. And those results — coming in the form of innovative treatments — fundamentally alter the lives of American patients each day. Because of the incredible potential to impact millions, we have devoted our careers to translational research in renal disease with the goal of helping patients.
While largely out of the public eye, 26 million Americans suffer from chronic kidney disease (CKD). And more than 636,000 of those have been diagnosed with CKD’s final phase, End Stage Renal Disease (ESRD) — an irreversible condition, which is fatal without a kidney transplant or weekly dialysis treatments.
For decades, we have treated ESRD the same way. And while dialysis treatments can delay death, technological advancement has provided us with an opportunity to truly elevate quality of life for ESRD patients. Unfortunately, though, myriad hurdles continue to stymie progress — a burden levied on vulnerable patients and generations more to come.
In our work at Vanderbilt University and University of California, San Francisco, for instance, we have been engineering an implantable artificial kidney as a permanent solution to ESRD — essentially a bioengineered transplant organ to add to the very limited pool of donor organs that are available for transplant.
Yet, despite years of support from the FDA and National Institutes of Health (NIH), progress has slowed due to limited funding for kidney care research.
Unfortunately, our story is not unique; it simply represents a growing trend in the renal research community. However, not only is it possible to overcome current shortfalls in kidney care innovation, the decision to support ESRD research makes sense for patients and our nation as a whole.
Consider this: The Medicare ESRD program — which singularly provides coverage, regardless of age or income, to virtually every American with kidney failure — currently costs the government and taxpayers more than $34 billion each year. Our most powerful tool to bend the cost curve is medical research. However, we dedicate only $585 million in federal funds (a minuscule $30 per patient) for kidney-specific projects.
Along with unfunded and underfunded research endeavors, an unintended consequence of such funding levels is “brain drain” in kidney disease and kidney failure research. Indeed, many of nephrology’s brightest minds are shying away from careers in research and choosing other professions altogether or entering the more lucrative world of private practice — something we have personally witnessed among peers.
It doesn’t take a doctor to see the potential danger for those suffering kidney disease. Nor does it take an expert to realize that investing in research will spur incredible returns — not just for patients, but our nation’s coffers.
One must only look at our nation’s most prominent current research efforts. Robust investments in HIV, for instance, have effectively transformed the once fatal disease into a manageable chronic illness.
Likewise, extensive efforts to understand and combat cancer have ensured better outcomes for patients, while slashing overall costs. Now it’s time to offer similar devotion to kidney disease, which touches more lives than HIV and cancer combined.
The simplest solution is an outright increase in federal funding for kidney care research, which is something we certainly hope to see.
However, especially in the wake of the financial crisis less than a decade ago, bolstering the efficiency of current kidney research efforts and advancing our understanding of kidney diseases is an attainable goal in the short-term. And it’s one that proposed bipartisan legislation, “The Chronic Kidney Disease Improvement in Research and Treatment Act,” sets out to achieve.
Specifically, the legislation would help assess the adequacy of funding and identify gaps in CKD federal research. Additionally, it would improve collaboration among research agencies and require the Department of Health and Human Services to conduct a study to better understand the progression of kidney disease and treatment of kidney failure in minority populations.
The Chronic Kidney Disease Improvement in Research and Treatment Act is an important step toward a smart, necessary investment in kidney research.
Ultimately, it is imperative to close the gap between the sheer magnitude of kidney disease and scale of our nation’s response. And if we wish to sustain the quality improvements we’ve achieved in the past decade and elevate the quality of kidney care for future generations, medical research is the silver bullet.
At this very moment, the future of medical research rests in the hands of policymakers. Therefore, innovative policy may truly be our best chance for breakthroughs in kidney care and beyond.
Dr. William H. Fissell IV is associate professor nephrology and hypertension at Vanderbilt University. Dr. Shuvo Roy is professor of bioengineering and therapeutic sciences at University of California, San Francisco.