2018 ASN Kidney Week officially kicked off on October 25 with a Plenary Session focused on the changing dynamics in nephrology and the influence of policy and advocacy in achieving innovations in care. ASN President, Dr. Mark Okusa, MD, FASN, delivered his opening remarks with not just aspirational goals for the direction of nephrology, but also outlining the stark realities confronting nephrology.

“We believe that more than 850 million people worldwide live with kidney diseases – that’s more than double the people with diabetes and 20 times more than [patients] with cancer or HIV/AIDS,” remarked Dr. Okusa.

As a member of the ASN Policy and Advocacy Committee, it was clear to me that policy and innovation are visible and present at KW18.

Pediatric nephrology

Following Dr. Okusa’s address, I heard how the Kidney Health Initiative (KHI), a private/public partnership established by the US Food and Drug Administration and ASN in 2012, is tackling innovation in pediatric nephrology. KHI announced the launch of a pilot project called Kidney-PATCH (Pediatric Accelerator Trial Clearing House), a partnership geared towards repairing the gaps in communication that prevent conduction of clinical trials in pediatric nephrology and subsequent appropriate drug delivery. Further information about Kidney-PATCH will also be presented at the ASPN/PAS meeting in 2019. 

Innovation through team-based strategies

Learning more about the new ACC/AHA Hypertension guidelines, discussed in a session by the same name today, highlighted the benefits of team-based strategies in bridging and combining resources from the PCP, cardiologist, nephrologist as well as dieticians, clinical pharmacologists, and family members in efforts to innovate approaches to care. 

Consolidation of care

Parallel to collaborative care is the increasing reality of consolidated care and its implications for nephrology policy. In the delivery of the Christopher R. Blagg, MD Lectureship in Renal Disease and Public Policy, Dr. Janis Orlowski, MD, MACP, Chief Health Care Officer with the Association of American Medical Colleges informed us of the realities of consolidated care. “Since 2017, there have been more than 200 hospital mergers, acquisitions, and partnerships that occurred with major medical institutions in the United States and in addition to that, payment has changed with the expansion of the Affordable Care Act”, stated Dr. Orlowski.  Clinical Integration and care management are crucial factors in ensuring cost effective, efficient and quality delivery of care as we accept that consolidation of care is here to stay was a prevalent theme in her presentation. 

Racial and socioeconomic disparities in access to care

In the next policy presentation on the Affordable Care Act and Medicaid expansion, Dr. Amal Trivedi, MD, MPH, unveiled his findings that were simultaneously being published today in JAMA, which found that patients with ESRD who lived in states with Medicaid expansion had lower 1-year mortality as well as mortality concentrated in health care amenable causes of death. This is particularly true for younger patients (aged 19-44), as well as Non-Hispanic Black patients. The implications of this is bountiful and cannot be understated – racial disparities in access to care and quality of care is a known problematic entity, and Medicaid expansion appears to be a tool and strategy to address this.

Efforts to reduce costs were also addressed during today’s meeting. “Spending on health care accounts for ~18% of the GDP in the US. 5% of the population accounts for more than half of the health care spending,” according to Dr. Bruce Culleton, MD, MBA, and CMO of Kidney Care and CVS Health. Most of these costs are driven by patients with chronic disease, particularly those with multiple chronic diseases such as CKD. On top of that, Dr. Culleton highlighted that 51% of patients are not happy with their overall healthcare experience, and 91% do not understand the 4 most basic health insurance terms. It would appear that, at the moment, we are not hitting the marks we need to in healthcare. There are clearly unmet clinical needs that drive a change particularly in kidney care, with our patients having up to a 10x higher mortality rate than average, hospitalization on average of 11 days per year with 1 in 3 of the patients being readmitted, and significant issues with patient awareness as to their extent of disease. To address this, CVS is also rolling out a kidney program in 2019 to help identify at risk patients for CKD and ESRD and implement multi-disciplinary approaches for preventative strategies as well as home care for ESRD and transplantation.

As a clinical nephrologist serving an underserved population of patients who suffer from kidney disease, I am privy to the challenges that both CKD and ESRD patients have and the additional barriers to care in terms of socioeconomic and racial disparities. It is about time we make some changes to combat the barriers in delivering a high quality of care with innovation, and leave the approaches associated with astronomical costs for care that is not compatible with the standard of life we should all expect. We may not be there just yet, but today’s ASN Kidney Week sessions create hope that we can aspire to be there soon.

“Limiting inequalities in healthcare access and treatment, recommit to the excellence in education of renal physiology and kidney diseases and ultimately save lives by preventing death from kidney diseases.  I am optimistic for our future because of our past and present that will guide us in our advancements.  We have challenges, but let’s look at how to meet them.”   - Mark Okusa

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