Wednesday, March 11, 2015





          Is it possible that the seriousness of kidney disease is unappreciated and underfunded?  The 9th leading cause of death in the United States seems to remain a mystery to the general public and our lawmakers.  The evidence seems to suggest that on World Kidney Day 2015, we need to take a hard look at how kidney disease awareness is promoted, both to the general public and to Congress. The numbers are staggering:

·       In our population of 73 million Americans, 1 in 3 is at risk to develop chronic kidney disease(CKD);

·       26 million Americans current have CKD, but most do not know it;

·       2.9 million Medicare Patients have CKD, but have not yet suffered total renal failure;

·       636,905 Americans have suffered total renal failure;

·       115,000 Americans per year are diagnosed with End Stage Renal Failure;

·       450,602 of us are currently on dialysis;

·       Only 186,303 Americans live with a transplant;

·       88,686 Americans die every year from renal failure;

·       Only 15,416 Americans received a lifesaving transplant in 2013;

·       As of February 20, 2015, 101,603 kidney patients were waiting on a transplant list for a new kidney;

·       12 people die every day while on the list, waiting for a kidney transplant;

·       38% of ESRD patients had a primary diagnosis of diabetes, the leading cause of ESRD;

·       25% of ESRD patients had a primary diagnosis of hypertension, the second leading cause of ESRD;

·       33% of ESRD patients were cared for by a nephrologist the year prior to their kidney failure;

·       75.5% of New ESRD patients apply for Medicare;

·       Kidney disease occurs in Americans more often than lung and breast cancer combined;

·       Most striking is according to the Kidney Cares Partners, the incidence of kidney disease is expected to double within the next decade!


The costs of kidney disease alone should attract more attention than they do:

·       $58 billion is the Annual Medicare costs to treat people with CKD;

·       $29 billion is the Annual cost of the Medicare ESRD program;

·       $125,967 is what Medicare spends for kidney transplant per patient in the first year;

·       $86,592 is what Medicare spends on a dialysis patient, per-year;

·       $24,438 is what Medicare spends for a functioning transplant patient, per-year (after the first year);

·       $3,599 Medicare Part B spending on immunosuppressive drugs, per year.


Yet according to kidney scholars, CKD seems to fall below the radar.

 “Because chronic kidney disease and end-stage renal disease are not in the public consciousness (to the level of cancer, ALS or heart disease), many people remain unaware of the need to do basic screening for kidney disease and its chief risk factors -- diabetes and hypertension. This lack of awareness is common even though blood and urine screening tests are inexpensive, widely available and simple to perform.”   

A recent study published in the American Journal of Nephrology found that only 6 percent of the 2,615 adults interviewed with abnormal kidney function were aware of having the disease.

 Why are so many people unaware that they have an incurable, but manageable disease? Is because of the slow progression of kidney disease? The inability to appreciate the function and importance kidney disease plays in our overall health?  Late referrals to expert nephrologists? Lack of visits to a primary care physician?

The experts seem to traditionally give voice to these reasons, but also point to a lack of funding and study by government agencies on this subject:

·       The National Institutes of Health -- the leading funder of medical research in the United States -- spent nearly $7.8 billion to support research on all cancers in 2013, but spent only $551 million for kidney disease (or $30 per patient) in 2013;

·        The estimated 2015 NIH budget increased to more than $8 billion for all cancers, but remained at $551 million for kidney disease;

·       Experts have stated, “The amount of research funding for kidney disease seems disproportionately low compared to the high prevalence of chronic kidney disease, and its costs… As the spending on kidney disease continues to rise, greater emphasis should be placed on prevention of disease progression and optimizing management of end-stage renal disease. That includes early referral for kidney transplantation or home hemodialysis, as governing bodies, foundations, and the United States Renal Data System 2014 have suggested.”


My feverant wish for World Kidney Day, 2015, is that all members of the kidney community support The Chronic Kidney Disease Improvement and Research Act and petition the Secretary of Health and Human Services in the upcoming 21st Chronic Diseases section of the 21st Century Cures final bill “to conduct a longitudinal study in several states to improve outcomes of kidney patients through better understanding by primary practitioners of the risks of disease progression, and proper diagnosis and management of people with CKD. The study should be funded and conducted through the Centers for Disease Control and Prevention, which conducts a kidney disease surveillance program, but has little funding to expand the program to study outcomes for patients.”


Sources:  Kidney Disease by the Numbers, National Kidney Foundation, updated for 2015, Gordon and Fischer, Save Money, Save Lives: Why the Silence on the Fiscal and Fatal Consequences of Kidney Disease Matters, (February 25, 2015); 2015 Kidney Patient Summit, Issue Briefs, Chronic Kidney Disease Detection, Diagnosis and Management, National Kidney Foundation (2015).