We're United 4 Kidney Health: ASN in Review

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Earlier this year, the American Society of Nephrology (ASN) launched “We’re United 4 Kidney Health,” an initiative that repositions nephrology as a specialty that embraces kidney health through early intervention, transplantation, innovation and patient choice, and equity. We’re United 4 Kidney Health presents a rallying cry that shows how the kidney community can advance the field by embracing four priorities:

  1. INTERVENE EARLIER to prevent, diagnose, coordinate care, and educate.

  2. TRANSFORM TRANSPLANT and increase access to donor kidneys.

  3. ACCELERATE INNOVATION and expand patient choice.

  4. ACHIEVE EQUITY and eliminate disparities.

ASN is committed to a world without kidney diseases, and the society made significant accomplishments across these four priorities in 2021. Through the broader ASN Alliance for Kidney Health, the campaign's priorities will advance more in the future.

Intervene earlier

Preventing or slowing the progression of kidney diseases and related comorbidities is the best way to improve the lives of the more than 37 million Americans living with kidney diseases. Nearly 800,000 Americans have kidney failure, a life-threatening condition for which there is no cure. Kidney failure is most commonly managed by dialysis, a therapy that has changed little in the 50 years since the federal government established the Medicare End-Stage Renal Disease (ESRD) Program. Dialysis has poor survival rates; more than 50% of people who start dialysis die within 5 years.

Diabetes is the leading cause of kidney diseases, and approximately one in three adults with diabetes develops diabetic kidney disease (DKD). ASN established the Diabetic Kidney Disease Collaborative (DKD-C) to increase coordination among health professionals and other stakeholders to deliver appropriate therapies for people living with DKD. Through DKD-C, ASN hosted three strategy conferences attended by nephrologists, primary care physicians, pharmacists, nurses, endocrinologists, cardiologists, industry, healthcare systems, and payors to define barriers and facilitate strategies that would increase access to new treatments. ASN also developed a DKD Education Module available on the society's website.

AKI!Now: Promoting Excellence in the Prevention and Treatment of Acute Kidney Injury (AKI) is helping transform the delivery of AKI care, reduce morbidity and mortality, and improve long-term outcomes. Through AKI!Now, ASN identified challenges and opportunities to improve post-AKI care, including the development of tests and supportive strategies that build capacity for the delivery of care. The AKI!Now compendium promotes collaborative and inclusive research that facilitates the translation of new discoveries, including augmented and artificial intelligence, in the development of novel therapies.

Nephrologists Transforming Dialysis Safety (NTDS)—ASN's partnership with the Centers for Disease Control and Prevention (CDC)—enhances the quality of life for people with kidney failure by engaging nephrologists and other health professionals to continuously improve the safety of life-sustaining dialysis. NTDS is eliminating preventable infections in dialysis facilities in the United States by conducting human factors assessments to determine better practices that prevent the spread of infections in dialysis facilities, designing electronic checklists to engage patients as observers of infection-prevention processes, and hosting a Targeting Zero Infections webinar series.

Additionally, NTDS partnered with Northwest Kidney Centers to develop a Pop-Up Leadership Academy—Leading Together: Creating a Culture of Collaboration—for dialysis facility medical directors and nurse managers. The academy aims to foster a team environment that focuses on the delivery of excellent patient care by ensuring physicians, nursing leaders, and staff at all levels are engaged in their work; communication is clear, direct, honest, and open; and collaboration is proactive and effective.

Throughout the SARS-CoV-2 (causing Coronavirus disease 2019 [COVID-19]) pandemic, the kidney community increasingly learned about the impact of SARS-CoV-2 infection on kidneys. According to the Centers for Medicare & Medicaid Services (CMS), people on dialysis are the most vulnerable population covered by Medicare, and people with kidney failure are most at risk among Medicare beneficiaries for severe outcomes from COVID-19, including hospitalization and death. Additionally, people with healthy kidneys who contract more severe COVID-19 often experience kidney damage.

To coordinate efforts addressing the pandemic, ASN established a COVID-19 Response Team in spring 2020. Through the COVID-19 Response Team, ASN collaborates with external partners, including the chief medical officers of dialysis organizations, to share safety practices, testing, therapeutics, vaccines and efficacy, and data. Successful advocacy efforts resulted in the Network Administrator Model for vaccine distribution to kidney failure patients in dialysis facilities through Fresenius Medical Care and DaVita, as well as the approval of a third vaccine dose for immunosuppressed people with kidney diseases.

The COVID-19 Response Team also partnered with KidneyX—a public-private partnership between ASN and the US Department of Health and Human Services (HHS)—to award 15 innovators with a COVID-19 Kidney Care Challenge prize, all aiming to reduce transmission of SARS-CoV-2 among people with kidney diseases. ASN also developed education and collated external resources on monoclonal antibody therapies, compassion fatigue, and other important topics. Additionally, ASN published original research and other information from the kidney community related to COVID-19 across the society's peer-reviewed journals and ASN Kidney News.

Transform transplant

A kidney transplant is the optimal therapy for most people with kidney failure, yet transplantation is out of reach for many people. Each day, 12 Americans die on the 100,000-person kidney transplant waitlist. The second priority of the We’re United 4 Kidney Health campaign revolves around fundamentally improving the current transplant system.

After many years of advocacy, ASN and the kidney community celebrated the passage of the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act in December of 2020. Taking effect in 2023, this legislation indefinitely extends Medicare coverage of immunosuppressive drugs for kidney transplant recipients. This success helped propel early momentum for ASN to help transform transplant and increase access to donor kidneys in 2021.

ASN helped secure the introduction of the Living Donor Protection Act in Congress. This legislation will remove barriers to donation and increase access to life-saving transplants by ensuring that insurance companies offering life, disability, and long-term care plans do not deny or limit coverage or raise premiums based on an individual's status as a living organ donor. In March, the Biden administration, as advocated for by ASN, allowed the organ procurement organizations metric final rule to take effect, which will apply new standards of accountability, provide greater transparency to the transplant waitlist, and address elimination based on financial criteria or secondary insurance for transplant recipients.

ASN also established a Task Force on Transplant Nephrology Compensation to evaluate transplant nephrologists’ work, which, at times, is undervalued and undercompensated. The task force has been collecting data on different financial structures within institutions across the nation to better understand the nuances in funding. Based on this analysis, the task force will submit its observations and recommendations for publication by the end of the year.

During Kidney Week 2021, ASN hosted an educational symposium describing the new payment models on the delivery of posttransplant care, the major immunologic and non-immunologic threats to long-term graft survival, and advances in non-invasive monitoring of kidney transplant function. ASN also partnered with the American Society of Transplantation to host an early program on kidney transplantation updates during 2021.

Additionally, ASN expanded “Cross-Publication Collections,” bringing together articles from the society's journals (as well as related content in ASN Kidney News) on specific nephrology topics, including transplantation, for reader convenience.

Accelerate innovation

Several ASN efforts have helped accelerate innovation and expand patient choice, including KidneyX, which incentivizes innovators to fill unmet patient needs through a series of prize competitions. Including the COVID-19 Kidney Care Challenge, KidneyX has funded more than 60 innovators for solutions ranging from patient-created tools to the first concepts of an artificial kidney. In September, KidneyX announced the six Artificial Kidney Prize phase 1 winners who are splitting a $4 million prize.

The Kidney Health Initiative—a public-private partnership among ASN, the US Food and Drug Administration (FDA), and more than 100 member organizations to advance regulatory kidney science—continues to produce valuable patient-centered resources for the community. These resources include publications on patient-reported outcome measurements for vascular access and dialysis-associated muscle cramping as well as a series in CJASN on integrating patient preferences into the design and evaluation of innovations.

Advocacy by ASN and the rest of the kidney community secured $5 million in congressional appropriations for KidneyX and $2.13 billion for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in fiscal year (FY) 2021 (October 1, 2020−September 30, 2021). ASN submitted written testimony on FY 2022 funding to Congress requesting the National Institutes of Health receive an increase of 7.3% for a total of $46.11 billion: providing a real growth of 5% after accounting for the biomedical research and development price index. ASN advocated that NIDDK receive a proportional funding increase or $157 million in FY 2022.

ASN also supported the Patient Access to ESRD New Innovative Devices Act, which would direct CMS to provide a 3-year temporary add-on payment adjustment through the ESRD Prospective Payment System—more commonly known as “the bundle”—that provides reimbursement for dialysis care. This bill would increase patient access to new products by removing bureaucratic red tape and allowing new and innovative devices for kidney failure that meet approval standards set by the FDA to be reimbursed by Medicare. Without a clear and assured mechanism to add innovative new devices to the payment bundle for dialysis services, there is little incentive to develop novel technologies for people with kidney failure.

In addition to launching the ASN Home Dialysis Task Force—an organization-wide initiative to increase access to and the use of home dialysis therapies through education, training, advocacy, and other means—ASN supported the introduction of key legislation to accelerate innovation and expand patient choice, including the Improving Access to Home Dialysis Act. This legislation would allow CMS to pay professional staff to work with kidney patients directly in their homes to assist them in learning how to properly implement home dialysis.

To communicate the latest scientific and medical breakthroughs with the kidney community, ASN added “early access” to the publication process for JASN and CJASN, bringing unedited and unformatted manuscript content to readers expeditiously. A full summary of recent advances through the innovation pipeline were highlighted during a special session at Kidney Week 2021, “Accelerating Up the Innovation Curve in Kidney Medicine.”

Achieve equity

The fourth priority centers on achieving equity and eliminating disparities. The roots of disparities in kidney medicine are multifactorial, and these disparities are linked to social determinants of health and systemic racism on a national level. The entire kidney community must begin to address these disparities.

ASN has attempted to meet this goal through a variety of initiatives, including a letter to the White House Office of Management and Budget encouraging the Biden administration to adopt a blueprint for addressing equity across the federal government. For example, ASN recommended HHS conduct a more systematic assessment of social determinants of health data, including the most common non-clinical barriers to home dialysis, such as housing or financial insecurity, minimal caregiver support, other mental and certain physical illnesses, or advanced age. This information will help identify barriers to equitable care and develop policies to overcome these barriers.

ASN and the National Kidney Foundation championed a joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases that released its interim and final reports in 2021. Timed with two publications in The New England Journal of Medicine, the task force's final report outlined new race-free approaches to diagnosing kidney diseases. The task force recommended the adoption of the new estimated glomerular filtration rate (eGFR) 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation that estimates kidney function without a race variable and the increased use of cystatin C combined with serum (blood) creatinine as a confirmatory assessment of GFR or kidney function. Also, the task force recommended that more research funding is dedicated to exploring new approaches for precise and unbiased GFR estimation as well as for the estimation of physiologic function in other areas of medicine.

The ASN Loan Mitigation Pilot Program opened its first round of applications in summer 2021. ASN has committed $2.7 million to the 5-year pilot program to reduce the loan burden of those entering the field of nephrology and increase interest in the specialty. The first year of the program centered on individuals who are historically underrepresented in medicine with the intention of strengthening the specialty's reflection of the patient population it serves. Six individuals selected this year will receive $50,000 over the course of 3 years toward the repayment of eligible student loans.

To further guarantee that achieving equity and eliminating disparities remain core principles of ASN, the society established a Health Care Justice Committee to identify opportunities to promote justice in healthcare and society and influence social determinants of health. The committee is focusing its activities on education, clinical care and innovation, and scholarship and advocacy.

Supporting the fourth priority of the We’re United 4 Kidney Health campaign, the ASN Kidney Week Education Committee devoted ePosters, oral abstracts, and educational sessions for content related to race and equity. For example, the Race and Ethnicity in Kidney Diseases: Joint ASN-JSN session that featured representatives from ASN and the Japanese Society of Nephrology discussed considerations regarding race and ethnicity relevant to their settings.

ASN's 2022 outlook

The achievements of 2021 provide renewed hope, enthusiasm, and momentum that greater triumphs await the kidney community in 2022 and beyond. ASN and the broader ASN Alliance for Kidney Health will continue to focus on meeting their shared mission of “elevating care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.”

If you are interested in supporting the We’re United 4 Kidney Health campaign and making the campaign's priorities a reality, please visit www.4KidneyHealth.org to learn more.

ASN Kidney Week 2021 content is available on the virtual meeting platform until Friday, January 7, 2022.