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There is a growing evidence that COVID-19 negatively affects the kidneys and that the pandemic places an additional burden on people living with kidney diseases. The American Society and Nephrology (ASN) led the kidney community in urging Congressional appropriators to support $100 million in emergency supplemental funding for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The American Society of Nephrology (ASN) is troubled by the Trump Administration’s decision to require submission of hospital data on COVID-19 patients directly to the Department of Health and Human Services (HHS) instead of the Centers for Disease Control and Prevention (CDC). This decision raises serious questions about the transparency and credibility of the data as well as concerns that the move will prevent researchers, public health officials, and other stakeholders from accessing the data to make projections and crucial decisions.
As the threat of COVID-19 was emerging in the United States, ASN and the broader kidney community participated in an effort organized by the Department of Health and Human Services (HHS) to develop policy recommendations that address the effects of COVID-19 on kidney patients and kidney care professionals.
The workgroups discussed and prioritized nearly 300 COVID-19-related kidney policy recommendations across seven key issue areas. HHS has already instituted many of the recommendations ASN and other stakeholders in the community made, and the society continues to work closely with the community to advocate for the policy recommendations to improve the care of kidney patients and protect the kidney care professionals that care for them.
On April 16, 2020, the National Institute of Diabetes and Digestive Kidney Disease (NIDDK) published two notices (NOT-DK-20-023, NOT-DK-20-024) that made a significant and startling announcement. NIDDK announced the Division of Kidney, Urologic, & Hematologic Diseases (KUH’s) will no longer participate in the traditional National Institutes of Health (NIH) National Research Service Award (NRSA) T32 Program, and will instead participate in a new Institutional Training Program.
The Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the 2021 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Quality Incentive Program (QIP) on July 6. The proposed rule contains some of the nuts and bolts that run the Medicare ESRD program on the facility side. It contains numerous guardrails to protect kidney failure patients and provide them access to the best modalities.
In an editorial released on June 23rd by The Hill ASN President Anupam Agarwal, MD, FASN and NKF President Kramer, MD, MPH expressed that the intersection of COVID-19 and kidney disease is fraught with potential calamities and investment for prevention and research are necessary.
“Kidney patients – including those with kidney failure receiving dialysis and transplant recipients – are more at risk from SARS-CoV-2 exposure because of their vulnerable physical conditions, weakened immune systems, and the open settings in which they receive care. Data has shown that people with kidney diseases were 2.5 times more likely to die than other hospitalized patients with COVID-19. And recent data released from the Centers for Medicare and Medicaid Services showed that kidney disease patients undergoing dialysis were hospitalized with COVID-19 at a rate of 1,341 hospitalizations per 100,000 beneficiaries, the highest hospitalization rate among all Medicare beneficiaries. In fact, the first few deaths that occurred in the state of Washington were patients with kidney disease. Kidney disease also disproportionately affects minority populations, a population at higher risk for COVID-19 and COVID-19 associated mortality compared to non-minority populations,” states the editorial.
The Kidney Care Choices (KCC) Model, also known as the “voluntary model”, is moving forward beginning April 1, 2021 – a delay from the original start date of January 1, 2021 – due to the Public Health Emergency (PHE). The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that in addition to delaying the start of the model, the agency will also provide a second window for applications in 2021 for new participants with a starting date for that group of January 1, 2022. Additionally, applicants approved for the April 1, 2021 start date will have the option to delay their start date to January 1, 2022 without penalty or having to reapply. Also covered in this announcement was an extension of the Comprehensive ESRD Care Model (CEC) until March 31, 2021, with financial adjustments for performance year 2020 due to COVID-19. The CEC created the ESRD Seamless Care Organizations (ESCOs) of which there are 33 nationally.
Although widely thought of as a respiratory ailment, COVID-19 has demonstrated its ability to impact multiple organs. For those with existing kidney disease, the dangers of the SARS-CoV-2 coronavirus are especially stark. Researchers at New York City’s Montefiore Medical Center reported that recipients of kidney transplants who contract COVID-19 appear to be at exceptionally high risk of severe illness. Additionally, a study of electronic health record data by CarePort Health found that people with chronic kidney disease were 2.5 times more likely to die than other hospitalized COVID-19 patients. Even patients without prior kidney disease are proving susceptible to acute kidney injury (AKI) associated with the virus.
The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) sent policy recommendations to the U.S. Department of Health and Human Services (HHS) that urged the Administration to consider the unique needs of the 37 million Americans affected by kidney disease and the physicians who care for them as the country reopens.
The COVID-19 pandemic is having a uniquely significant impact on the kidney community: kidney patients are at elevated risk, kidney failure is one of the consequences many people who contract COVID-19 face, and the pandemic has accelerated several trends in kidney medicine, including the prioritization of telehealth and more home-based care. Recognizing these realities, American Society of Nephrology (ASN), and 27 other organizations in the kidney community urged Congressional appropriators to provide emergency supplemental funding for NIDDK and KidneyX to enable a robust and appropriate response.
