Nav: Home

Chronic kidney disease outcomes can be improved by expanding specialist care

October 02, 2018

Providing specialized medical care and coordination to patients whose kidneys are failing before they need dialysis treatment could save the U.S. health care system more than $1 billion annually, according to a new RAND Corporation analysis.

About 60 percent of the savings come from avoiding the initiation of kidney dialysis in a hospital setting, while the remainder stems from other improvements in care. The findings are published the in the Journal of American Society of Nephrology.

The analysis by researchers shows savings only when the specialized care is extended to people in the latest stages of kidney disease and not when patients are at earlier stages of their illness.

"Extending specialized care to patients with advanced kidney disease before their kidneys fail would have benefits both for patients and for the organizations that pay for their health services," said Harry Liu, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. "But new payment models may be needed to encourage this change."

Nearly one in seven Americans has chronic kidney disease, a progressive condition that is associated with other ailments such as cardiovascular disease. About 90 percent of people with chronic kidney disease will end up needing hemodialysis, which costs Medicare an average of $80,000 annually per patient. In 2015, Medicare spent 20 percent of its budget providing care to patients with chronic kidney disease.

Liu and co-author Sophia Zhao of Massachusetts General Hospital examined several potential strategies to lower the cost of care for chronic kidney disease and improve outcomes for patients.

Previous studies have shown that patients who are seen by nephrologists one to six months before beginning dialysis do better medically, have shorter hospital stays associated with dialysis and have lower mortality rates over the following five years. (Nephrologists are medical specialists who focus on disorders that affect the way the kidneys work.)

However, patients with chronic kidney disease frequently are not referred to a nephrologist. Researchers say one reason may be that non-Medicare payers who cover younger patients may not be motivated to slow progression of kidney disease -- at least in part -- because Medicare ultimately pays the cost for kidney dialysis.

To quantify the potential savings from improving care for chronic kidney disease care, researchers created a simulation model to help estimate possible savings from improving care. They focused on patients with Stage 3 and Stage 4 kidney disease, examining whether there would be savings from increasing use of nephrologists to slow disease progression and improve coordination of care for patients who undergo kidney replacement surgery.

The analysis showed that increasing nephrology care for Stage 3 patients would not generate net savings. However, increasing nephrology care and improving care coordination among Stage 4 patients would create an estimated $1.36 billion in annual savings, including $730 million in savings for Medicare.

Researchers say that several newer models of paying for health care could be used to help spur the earlier use of nephrology care for patients with advanced kidney disease.

This could include expanding Medicare's chronic condition special needs plans to cover advanced chronic kidney disease patients. Because these plans are paid on a per-patient basis, they would create financial incentives for providers to improve outcomes and reduce costs, researchers say.

Another option is to establish episode-based payments models for chronic kidney disease. These models also pay providers on a per disease episode basis rather than paying for each task or procedure.
-end-
No outside funding supported the analysis.

RAND Health Care has a broad research portfolio that focuses on health care costs and quality, among other topics.

RAND Corporation

Related Kidney Disease Articles:

Waistline matters in kidney disease
Does fat matter in kidney disease? The investigators found that all measures of higher abdominal fat content (including visceral fat, liver fat, or subcutaneous fat) and slower walk times were associated with increased levels of cardiometabolic risk factors in adults with non-dialysis dependent kidney disease.
Reducing urinary protein for patients with rare kidney disease slows kidney decline
New findings show that reducing the amount of protein in the urine of patients with focal segmental glomerulosclerosis can significantly slow declines in kidney function and extend time before patients' kidneys fail.
Antioxidant agent may prevent chronic kidney disease and Parkinson's disease
Researchers from Osaka University developed a novel dietary silicon-based antioxidant agent with renoprotective and neuroprotective effects.
Acute kidney injury and end stage kidney disease in severe COVID-19
Many COVID-19 patients experience hematuria, proteinuria and elevated serum creatinine concentration early in the course of the disease.
Genes tell a story about diabetic kidney disease
Studying Finnish genes leads to unique revelations about the development of a serious complication of diabetes, and informs an ongoing genomic study of a Singaporean cohort as part of Singapore's Diabetes Study in Nephropathy and other Microvascular Complications (DYNAMO).
New study provides insight into chronic kidney disease
Researchers have further analyzed a known signaling pathway they believe brings them one step closer to understanding the complex physiology of patients with chronic kidney disease (CKD), which might provide a path to new treatment options.
Predicting risk of chronic kidney disease
Data from about 5 million people (with and without diabetes) in 28 countries were used to develop equations to help identify people at increased five-year risk of chronic kidney disease, defined as reduced estimated glomerular filtration rate (eGFR).
A healthy diet may help prevent kidney disease
In an analysis of published studies, a healthy dietary pattern was associated with a 30% lower incidence of chronic kidney disease.
Is kidney failure a man's disease?
A new analysis of the ERA-EDTA Registry [1] reveals a striking gender difference in the incidence and prevalence of end-stage renal disease.
Chronic kidney disease: Everyone's concern
850 million people worldwide are affected by kidney disease. This worrying figure was published last June.
More Kidney Disease News and Kidney Disease Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.