A bipartisan solution to address chronic kidney disease in America

June 25, 2021
The Hill
By John Butler

Our country has faced significant public health challenges over the past year and a half. While in the U.S. the COVID-19 pandemic is beginning to come under control, another under-recognized epidemic has continued unabated.

According to the latest statistics from the Centers for Disease Control and Prevention, 37 million Americans — or about 15 percent of the U.S. population — are currently living with chronic kidney disease (CKD). If untreated, CKD can ultimately progress to kidney failure or End-Stage Renal Disease (ESRD), which requires dialysis care several hours a day, at least three times per week, until a transplant becomes available. It’s no surprise then that kidney failure claims more lives each year than breast cancer or prostate cancer.

Kidney failure is indiscriminate in the toll it takes on patient lives and bodies. However, it is well established that kidney disease does not affect all Americans equally: Black Americans are almost four times as likely as whites to develop kidney failure. Further, Hispanics are nearly 1.3 times more likely to be diagnosed with kidney failure.

Ensuring that all Americans receive exceptional kidney care — and helping those Americans most at-risk to avoid an ESRD diagnosis — is within our power to accomplish. This year, policymakers in Washington have an opportunity to pass legislation to achieve this.

The bipartisan, bicameral Chronic Kidney Disease Improvement in Research and Treatment Act (S. 1971) would address many of the most urgent issues facing Americans’ kidney health by expanding kidney disease awareness and education, making necessary investments in dialysis care and disease research, reforming quality standards, and increasing patient care choices.

Far too many patients don’t even realize they have kidney disease until after their kidneys fail and they are in need of dialysis. To correct this, the bill would expand Medicare’s annual Wellness Benefit to include kidney disease screening. The impact could mean that at-risk beneficiaries can be diagnosed at earlier stages and seek treatment sooner to slow the progression toward kidney failure or prepare for dialysis if needed.

The bill would also increase patient access to the Medicare Kidney Disease Education Benefit. This benefit, which is woefully underutilized today, makes it easier for dialysis facilities to offer educational services and allow more health care providers to serve as referral sources. If adopted, Medicare beneficiaries with Stage 5 CKD will be able to access this benefit even if they are not yet on dialysis.

Policymakers must pay more attention to health equity when making decisions about improving the treatment of kidney disease. Therefore, the bill calls on the Department of Health and Human Services (HHS) to submit a report to Congress outlining recommendations for how we as a nation can better understand the progression of kidney disease and treatment of ESRD in minority populations and identify any disincentives in the Medicare payment systems that create barriers to kidney transplants and post-transplant care.

The future and the success of kidney care in the United States will also depend upon the economic stability of our nation’s dialysis infrastructure, innovations that propel care forward, and increases in patient access to the type of care they prefer. The kidney care community is pleased that this legislation supports these initiatives. Specifically, it refines the Medicare ERSD Payment System to improve accuracy in payment and supports access to innovative therapies; improves the accuracy and transparency of ESRD Quality Programs to give patients increased access to quality performance information; and it expands patient choice of coverage through greater access to Medigap and Medicare Advantage plans.

Our community is hopeful that we will soon see positive advancements with this legislation for the benefit of patients with kidney disease. We strongly urge Congress to support and adopt the Chronic Kidney Disease Improvement in Research and Treatment Act.

John Butler is chair of Kidney Care Partners and CEO of Akebia Therapeutics.

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