People with kidney diseases experience higher risk during health crises like the COVID-19 pandemic. To address the essential needs of this high-risk population, advocates from the American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) met with representatives, senators, and their respective staffs April 1, 2020 as part of the annual Kidney Health Advocacy Day (KHAD).

Kidney patients and nephrologists described to lawmakers the reality that kidney providers and patients face: patients are often at increased risk of exposure due to multiple factors such as in-center dialysis treatments or by virtue of being transplant recipients who take immunosuppressants. In-center dialysis clinics can be especially high-risk areas given the proximity of patients to each other, the hands-on requirements of staff, and the high volume of patients in a center.

Currently, the limited scientific understanding of how COVID-19 impacts kidney physiology, and a similar lack of scientific clinical evidence regarding managing care for people with kidney diseases and COVID-19, exacerbate ongoing risks.

The immediate need to innovate in areas such as point-of-care testing and personal protective equipment underlines the long-term gaps in innovation in all areas of kidney health, where the development of new products and therapies, such as the artificial kidney, could provide needed resilience to our nation’s kidney heath care system.

Advocates made three requests of Representatives and Senators:

1. Improve Pandemic Response in the next funding package

a. Increase funding for research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to address immediate basic scientific and clinical research needs relating to COVID-19, such as the possible link between acute kidney injury and COVID-19 due to entry into proximal tubular cells via ACE2 receptors

b. Fund innovation through product development at KidneyX, a public-private partnership to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases, enhancing our nation’s capacity to meet the unique needs of kidney patients in the current and future emergency situations

2. Reinforce US Health Workforce: Keep experts fighting COVID-19

a. Encourage the Department of State and the U.S. Citizenship and Immigration Services to extend, expedite, and protect J-1 and H-1b visas for these physicians and scientists to make sure we have a sufficient healthcare workforce

b. Protect the U.S. health care workforce which relies heavily on health professionals and scientists, including physicians and medical residents, who are practicing or otherwise lawfully present in the U.S. on a visa or other protected status
 

3. Help Patients Stay Home: Fund care partners for home dialysis

a. Provide emergency funding for care partners – both family members, patient advocates, and health professionals (which could be achieved through the home health benefit) - to accelerate the transition of in-center dialysis patients to home modalities; enable new patients to begin dialysis at home; and better support people already dialyzing at home so they can continue to receive treatment in that safe environment

b. Lower the risk of exposure through support for the home care setting; anything that can be done to increase the use of home dialysis and remove barriers to home care will reduce the spread of COVID-19 and make patients more resilient in the future

“Greater research and innovation are the best ways to prevent and improve our response to future pandemics,” said ASN President Anupam Agarwal, MD, FASN.  “We must also do everything possible to encourage care in the home setting and limit exposure because people with kidney diseases, including chronic kidney disease (CKD) patients, patients on dialysis, and kidney transplant recipients, are more likely to experience serious illness or death if they contract COVID-19. These patients are both more physiologically vulnerable to coronavirus and at high risk due to the settings in which they receive care.”

AAKP President Richard Knight, MBA, a 14-year kidney transplant patient, stated, "For the past five years, AAKP has invested significantly in the technologies and capacities that allow kidney patients to make a virtual and memorable impact on their elected leaders from anywhere in the country, 24/7. The Coronavirus has had zero impact on AAKP's effectiveness at raising an independent patient voice to Congress. We are pleased to partner again with ASN on our annual Kidney Health Advocacy Day – virtually this year – on a shared agenda to continue to support the kidney community and address our most urgent needs."

This was the 8^th annual KHAD for ASN and AAKP advocates and the first one to be conducted virtually due to the pandemic. There were 40 advocates from ASN an AKKP interacting with 75 congressional offices. ASN continues to advocate for other critical actions to be taken by Congress and the Administration to address kidney health during the COVID-19 pandemic, including calls for accelerated production and distribution of personal protective equipment and the extension of telehealth flexibility for kidney health professionals, and recently extended by the Centers for Medicare and Medicaid Services to allow telehealth visits (including telephonic visits, if necessary) for all home dialysis patients and monthly in-center consultations in response to requests by ASN and other organizations in the kidney space.