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.
Following an aspirational policy-oriented kick-off at Kidney Week, I found that the second day of Kidney Week focused on the most important aspect of what we do: our patients. From the public-private partnerships including KidneyX and Kidney Health Initiative (KHI), to the CMS proposed payment changes, to the global challenges facing nephrology, the common sentiment has been simple: we must not forget our efforts to keep the patient at the center and include patient participation and insight.
“I wish he had a better death, but more than that, I wish he had a better life.”
This is the sentiment of a provider describing the life and death of an undocumented patient suffering from end-stage renal disease in the United States, as relayed by Dr. Rajeev Raghavan, MD, FASN and Associate Professor of Medicine/Nephrology at Baylor College of Medicine. Dr. Raghavan spoke to us about the difficulties in delivering nephrology care for the undocumented, particularly with the forced reliance on Emergency-only dialysis. Emergency-only dialysis is variable among location, but the unfortunate reality is that dialysis patients present to the emergency room and dialyzed on an emergency only basis, and if they are discharged without dialysis, there is a chance that their next visit they may be “crashing” right into dialysis. We are very much aware that emergency-only dialysis is associated with nearly a 9x higher hazard ratio of death and a considerably much higher cost with an estimate of $284,000 as compared to a cost of ~$60,000 for chronic dialysis, yet policy measures still only allow for this unfavorable approach in terms of medical, holistic, cost effectiveness and ethical care.
Priority #4: ACHIEVE EQUITY and eliminate disparities. Health disparities and the incidence of kidney diseases are undoubtedly connected. We need to address disparities and achieve equity not just in kidney care, but in health care overall.