Too many kidney patients are STILL left behind

By Sylvia E. Rosas , MD, MSCE, NKF President-Elect

?As Black History Month comes to an end and National Kidney Month begins, I am reminded that everyone that works to raise awareness of kidney health and improve the lives of individuals with kidney disease is a health equity warrior.

We are in a new era for chronic kidney disease with the development of new therapies with promise to slow the decline in kidney function. Finally, FINALLY, there is renewed hope for kidney patients. But as patients, health care teams and advocates celebrate these innovations, access remains a massive issue. Early CKD screening, diagnosis and treatment must be the standard of care, yet current practices and long-held patterns are leaving many patients behind.?

Less than 15% of individuals with a diagnosis of CKD and clinically eligible for these novel therapies are receiving them, and certain groups such as women, Hispanics/Latinos, Blacks, and individuals of lower socioeconomic status are even less likely to have therapies prescribed.?

Many payers are not including access to all of these novel treatments in their formularies, while others mandate a time-intensive stepped approach to treatment, where patients must first “fail” on a treatment option (even if it is not their physician’s first choice for them) in order to qualify for one of these newer treatments. ?

With less than 12,000 nephrologists in the U.S., kidney patients may face long wait times and delays in care. Therefore, we need our colleagues in primary care, cardiology, endocrinology and other specialties to identify these patients and refer as needed. Once the kidney filters are damaged and scarred, it cannot be reversed impacting kidney function and quality of life for many patients. We have a duty to preserve kidney function.?

Because CKD progresses slowly and can be symptomless until later stages develop, screening is sporadic or not performed according to the guidelines. More than 80% of the most at-risk patients have not received guideline-recommended blood AND urine tests .?

On top of this, COVID-19 is ravaging the kidney community and health care systems. Nearly 16% of all patients on dialysis in the United States had contracted COVID-19 as of the end of 2020 and for the first time in 50 years there has been a decline in the number of patients on dialysis likely related to increase mortality from COVID-19. There are emerging groups of people who were previously kidney-healthy prior to contracting COVID-19 that have subsequently developed kidney failure due to acute kidney injury.

Let’s do better. This must change.

As we align our voices and work toward making real change during National Kidney Month, let us loudly call for improving access and reducing disparities in care. End-stage kidney disease, dialysis or kidney transplantation doesn’t have to be the future for all kidney patients if we act now.?