Challenges to Kidney Care: How ASN is Creating Positive Change

 

More than 37,000,000 Americans are affected by kidney diseases, and inequities and disparities have long plagued the care for many of those affected. In a series of key recommendations to the Biden Administration, ASN pledged its support to address the twin public health crises of COVID-19 and systemic racism.

The recent Biden administration announcement of a Partnership to Vaccinate Dialysis Patients, a top ASN priority, demonstrated the commitment of the White House, ASN, CDC, and the broader kidney community to address inequities and disparities ranging from higher rates of kidney failure to inequitable access to transplantation.

ASN led a 45-kidney organization dialysis vaccine allocation request to the White House and CDC that helped launch this Partnership, addressing these inequities is ASN's number one policy priority for the new administration.

Following are the main areas of focus in ASN's work with the Biden administration.

Kidney Transplantation

Black Americans are less likely than white Americans to be identified as transplant candidates, referred for evaluation, put on the kidney transplant waitlist, receive a kidney transplant, or receive a higher-quality kidney from a living donor. They are more likely to receive lower quality kidneys and experience poorer transplant graft survival.

ASN recommends:

  • Establishing an Office of Organ and Transplant Policy to coordinate currently siloed organ policy efforts, with an emphasis on increasing equity in transplantation.
  • Implementing organ procurement metric and accountability reform to increase organ supply (42 CFR 486, "Organ Procurement Organization Conditions for Coverage" final rule).
  • Aligning quality metrics within the transplant system that currently work at cross-purposes to increase equitable access to kidney transplants. Work with stakeholders developing alternate proposals, including ASN.
  • Recognizing removal of the use of race in clinical decision-making algorithms, such as the Kidney Donor Profile Index (KDPI) and estimated glomerular filtration rate (eGFR). Current race-based equations should be replaced by accurate, unbiased and standardized approaches to diagnosis.

 

Social Determinants of Health and Disparities in Access to Care

Kidney diseases and kidney failure are closely associated with social determinants of health (SDOH): economic stability, education, social and community contexts, access to health care, access to nutritional resources, and living environments.

ASN recommends:

  • Equalizing access to care choices by establishing funding for staff-assisted home dialysis care and improving social support for home dialysis.
  • Considering solutions that provide more equitable kidney care to people experiencing housing instability and other factors that lead to decreased care access.
  • Maintaining expansion of supplemental nutritional assistance programs.
  • Increasing federal funding to mitigate kidney health disparities in vulnerable populations, particularly Black Americans, in the president's budget for FY 2022.

Transforming Kidney Care

Advancing equity for all Americans affected by kidney disease also requires innovation in kidney devices and therapies, and in care delivery.

ASN recommends:

  • Investing in KidneyX, a public private partnership that helps launch new health care technologies, with a specific focus on funding the Artificial Kidney Prize as a COVID-19 therapeutic through existing or future COVID-19 relief funds and/or in the FY22 President's Budget.
  • Continuing the Center for Medicare and Medicaid Innovation models: End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and Kidney Care Choices (KCC) Model.
  • Increasing federal funding of kidney research to a level that is commensurate with the federal costs of kidney care, such as the National Institutes of Health (NIH) -- especially the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Patient-Centered Outcomes Research Institute (PCORI), Agency for Health Research and Quality (AHRQ) Veterans Health Administration (VA), and Department of Defense (DoD).

These are just the initial opportunities to improve kidney health and equity in kidney care. ASN will work with the Biden Administration over the next four years to build a sea change in support of Americans with kidney disease.

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