The flurry of kidney-related policies continues unabated, and 2022 brings to the fore another set of policy challenges and opportunities (Figure 1).
Policies to Watch in 2022
A new eGFR equation
In 2020, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a joint task force aimed at addressing the use of race in the estimated glomerular filtration rate (eGFR). In a highly anticipated recommendation, the task force published alternatives to using race, a social construct, in eGFR. The task force also tackled challenges for the nephrology community moving forward (1
On the heels of an historic election with record voter turnout comes no shortage of kidney policies. While coronavirus infectious disease 2019 (COVID-19) remains the priority, developments in kidney policies will continue unabated, including two payment models, new Medicare Advantage rules, and reductions in barriers to kidney transplantation.
During the pandemic, the kidney community led the nation in innovating infection control measures, especially in dialysis facilities. Tragically, patients on dialysis still experienced a disproportionate share of hospitalizations and mortality. One silver lining is that peritoneal dialysis was associated with fewer hospitalizations (1), which may provide tailwinds for
The last two years have brought several promising trials with novel therapies for the treatment of membranous nephropathy, the most common etiology of nephrotic syndrome in adults (1, 2).
Currently, the mainstay of treatment is steroids in combination with alkylating agents (modified Ponticelli regimen) or calcineurin inhibitors (3). With the identification of auto-antibodies against the phospholipase-2 receptor (PLA2R) comes the potential for new therapies (4, 5), including monoclonal antibodies against CD20 on B-lymphocytes: rituximab and obinutuzumab (4).
In 2019, the MENTOR randomized controlled trial showed that rituximab was
One thing I’ve noticed in the last fifteen years is how aware Americans have become of health policy issues. When I first told people as an undergrad that I wanted to pursue a career in health policy, I almost always received glazed looks in response. “What would that look like exactly?” Now, virtually everyone I meet (Lyft drivers, new friends at get-togethers, strangers on the plane, new colleagues) has an opinion, when they learn that I am a nephrologist and health policy researcher.
The past few years have seen a number of for-profit companies seeking to partner with nephrologists to manage their patients with later stage chronic kidney disease (CKD). Kidney disease is an expensive medical condition to treat: Medicare's total cost of care for patients with kidney disease in 2018 was $81.8 billion (1). Both Medicare and private payers have advanced care models that reduce that cost. New value-based care (VBC) initiatives focus on the patient population that is at risk for developing end stage kidney disease (ESKD). These programs will financially reward providers who successfully slow kidney disease progression