Paving the Way for Veterans’ Health: A VA Research Primer

With a budget of $1.95 billion last year, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the largest source of federal funding for kidney research, but certainly not the only one. The U.S. Department of Veterans Affairs (VA) has a comprehensive research portfolio aimed at advancing the treatment of kidney failure, as well as preventing and slowing the progression of kidney disease.

Like the National Institutes of Health (NIH), VA research grant proposals are subject to a peer review process. Only the most promising proposals based on objective, evidence-based science are funded. Unlike NIH, the VA does not have an extramural research program. Consequently, all VA-funded investigators must hold a VA appointment such that at least five-eighths of their work time is with the agency.

Last year the VA released a report on “The State of VA Research” that highlights some significant kidney-related research, including a 2011 study that found cystatin C (a blood marker of kidney function) is significantly more accurate than the standard blood marker (creatinine) in predicting serious complications of kidney disease. “Among adults who were identified as having kidney disease by high creatinine levels, the researchers found that only patients who also had abnormally high levels of cystatin C were at high risk for death, cardiovascular disease, heart failure, or kidney failure. People with high creatinine but normal cystatin C levels had risks similar to those with normal creatinine levels.”

VA researchers also demonstrated in a large 2008 multisite clinical trial that more intensive treatment for acute kidney injury (the rapid loss of kidney function over a few hours or a few days)—e.g., dialysis six times instead of three times per week—may not result in any added benefit.

One of ASN’s top policy priorities is advancing support for medical research within federal research agencies, including the VA. ASN is on the Executive Committee of the Friends of VA Medical Care and Health Research (FOVA), and works closely with a number of other medical research advocacy coalitions.

FOVA was founded more than 20 years ago to ensure that America’s veterans receive high-quality health care. Today, FOVA is a diverse coalition representing national academic, medical, and scientific societies; voluntary health and patient advocacy groups; and veteran-focused associations. FOVA works in concert with “The Independent Budget.” The Independent Budget is a recommendation released annually by veterans’ service organizations around the same time the President releases his annual budget recommendations. The recommendation is highly regarded and used by Congress to determine VA budget needs.

This year FOVA and The Independent Budget are recommending a $611 million increase for the VA’s Medical and Prosthetic Research account in Fiscal Year 2014, a $30 million, or 5.2 percent, increase over 2012 levels. FOVA estimates that $17 million, or 2.9 percent, of that total is needed to keep pace with the rising cost of medical research. The additional $13 million is needed to support new research into conditions veterans returning from Iraq and Afghanistan face, including polytrauma, or multiple traumatic injuries such as a serious head injury in addition to a serious burn.

Thanks in part to the work of FOVA, the VA released a congressionally requested report last year detailing an in-depth survey and analysis of the physical condition of all VA research facilities (www.aamc.org/varpt). The survey and analysis evaluated and documented deficiencies in five areas and prioritized those deficiencies from 1 (life-threatening issues such as a chemical shower over electrical cords) to 5 (items that should be fixed but pose no threat to the health and safety of personnel are not required immediately). Altogether, the deficiencies total $774 million to correct.

In response to this report, for the first time, FOVA and The Independent Budget are also making specific budget requests for VA research construction and infrastructure needs. Construction and infrastructure funding for VA research needs currently competes with funding for VA clinical needs like patient beds and elevators, which typically take precedence. As a consequence, many VA facilities have run out of adequate research space, or existing space is unable to meet current research standards and safety codes.

FOVA believes specifically designating funds as a line item in the VA’s budget to address these deficiencies is the only way to break this stalemate. Consequently, as a down payment for the $774 million cost to correct all the deficiencies, FOVA is recommending $50 million or more in Fiscal Year 2014 for up to five major VA research facility construction projects and $175 million in non-recurring maintenance and minor construction funding to address priority 1 and 2 deficiencies identified in the 2012 VA research facility report.

“VA research has led to countless discoveries and innovations that have advanced health care not just for our nation’s veterans, but for all Americans. Now the architecture that made this possible is languishing, and in some cases literally falling apart around the investigators that work in VA research facilities,” said John R. Sedor, MD, ASN Research Advocacy chair. “If we don’t make the necessary investments to bring these facilities up to current code and standards, the VA will have a tough time attracting new investigators, and research will suffer as a consequence. ASN supports the important work that FOVA is doing to advance the VA research program.”

March 2013 (Vol. 5, Number 3)