Americas kidney disease epidemic merits congressional attention
August 4, 2017
Published by The Hill
Written By Dr. Eleanor D. Lederer
When a young Dutchman named Dr. Willem Kolff began developing the first artificial kidney in the 1930s, anyone suffering from kidney failure faced almost certain death. Over the next 30 years, however, Kolff – along with several other notable scientists – successfully developed an artificial means to cleanse the body of toxins, eliminate excess fluid, and balance electrolytes. That process – what we now call hemodialysis – is one of the most remarkable medical breakthroughs of our time, allowing millions worldwide to survive acute kidney injury and chronic kidney failure.
While ongoing biomedical research has helped to fine-tune the science behind hemodialysis, the need for ongoing and adequately funded kidney care research has only increased. Today, approximately 40 million Americans suffer from kidney diseases – and another 650,000 suffer from kidney failure, largely due to increased incidence of diabetes and high blood pressure. The numbers are staggering, yet the amount of resources dedicated to improving the outlook pales in comparison.
According to a Government Accountability Office (GAO) report released this January, there is a tremendous gap between investment in kidney research and the actual disease burden. In other words, the federal government spends tens of billions of dollars caring for those with kidney failure, while investing just a small fraction of that number in biomedical research that could help slow disease progression or prevent failure altogether. This is lack of balance between costs for care and investment in research needs to change.
The numbers are telling. Even though kidney disease affects 40 million Americans, the government’s National Institute of Health dedicates only $564 million out of its $30 billion budget in kidney disease research.
Moreover, the American Society of Nephrology estimates that less than 1.7 percent of the annual total cost of care for kidney failure is invested in research to improve therapies and discover cures. It’s a drop in the bucket when you consider the growing need, as well as the funding allotted for other diseases. To put this in perspective, NIH spends approximately $2,500 per patient in its HIV/AIDS research; $371 per patient on cancer research; and $133 per patient on heart disease research. Despite the epidemic proportion of kidney disease patients, less than $14 per patient is dedicated towards kidney disease research. The advances made in the therapies for people with HIV/AIDS, cancer, and heart disease—such as genetically targeted drugs and implantable ventricular devices—highlight how investments in research pay dividends for patients.
it’s clear that more needs to be done for people with kidney diseases.
There is also little time to lose as the numbers of individuals who bear the silent risk factors for kidney disease continue to grow. It’s estimated that almost ten percent of the population is now diabetic – many of them undiagnosed – and one in three adults suffers from high blood pressure. Yet, only 2 percent of eligible patients currently receive kidney disease education services, which are crucial to helping those who are at risk of developing kidney failure manage their disease. Other programs — such as those that allow researchers to gain insights into the specific social and biological risk factors that lie behind kidney disease — may even help some patients avoid dialysis all together.
Research and education programs could pay off tremendously, especially if they result in a greater number of patients receiving a transplant. According to the National Institute of Diabetes and Digestive and Kidney Diseases, Medicare could save $250,000 for every patient who does not progress to dialysis. Hence, greater investment in kidney research is crucial if we want to deliver better outcomes, save more lives, and reduce the pressure that kidney failure puts on our nation’s Medicare program and healthcare system overall.
This Congressional session, lawmakers in Washington have the opportunity to make a wise investment in research that is certain to pay dividends in the years to come.
The bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act of 2017 (HR 2644) – recently introduced by Reps. Tom Marino (R-Pa.), John Lewis (D-Ga.), and Peter Roskam (R-Ill.) – would support research and improve education so that we can better understand the disease process, enhance current treatment technologies, and address the growing epidemic of kidney disease in minority communities.
The last point is particularly important. Because minorities are so disproportionately affected by diabetes, the legislation calls on the Department of Health and Human Services to develop a specific set of recommendations based on the unique role of kidney disease among those groups, and to investigate population-specific barriers to their care.
While this legislation is only a first step, it is an easy decision that our elected officials can act upon now. The bill also includes several provisions designed to improve the patient experience for those already receiving dialysis care including expanding access to home dialysis services, encouraging more health professionals to pursue careers in nephrology, and exploring the benefit of palliative care services.
Today’s kidney failure survivors can thank Dr. Kolff and his contemporaries for the treatments that have saved their lives. Congress now has the opportunity to make a sound investment in policies that are progressive and fiscally wise to ensure the optimal care of future generations of patients to help them live longer, healthier lives.
Eleanor D. Lederer, MD, FASN, is president of American Society of Nephrology. ASN has nearly 17,000 members representing 112 countries.