Despite advances over time and an awareness of growing disease burden, nephrology (the study of kidney diseases) still has challenges to overcome, such as:

• insufficient funding for research into kidney disease compared with other diseases, such as cancer and diabetes;
• little interest in kidney disease from venture capitalists; and
• lack of innovation regarding the prevention and treatment of kidney disease.

Fortunately, steps are being taken to address these critical issues. President Mark Rosenberg and Vice President Tod Ibrahim of the American Society of Nephrology (ASN) present an overview of new, encouraging initiatives to win the war on kidney disease.*

How are these challenges being addressed? 

In July 2019, the federal government declared a “war on kidney disease” by launching the Advancing American Kidney Health (AAKH) initiative, with the intention of creating a system that “pays for kidney health, rather than kidney sickness.” 

The aim of AAKH is to:

• reduce the number of Americans with kidney failure by 25% over the next decade;
• double the number of kidneys available for transplant; and
• provide more options to people with kidney failure, such as accessible, convenient home dialysis and the creation of an artificial kidney.

To achieve these ends, the ASN has entered into several public-private partnerships to develop initiatives that will move the agenda forward.

Reducing the risk of kidney failure

To prevent, detect, and slow kidney disease progression, Rosenberg and Ibrahim state that the federal government, ASN, and the health community must work together to:

• address comorbid risk factors, such as diabetes and hypertension;
• raise awareness among at-risk populations;
• ensure that people in the early stages are identified and receive high-quality care; and
• slow, and eventually stop, the progression of kidney disease to kidney failure.

For its part, the ASN will:

• collaborate to switch the global focus from the umbrella term CKD (chronic kidney disease) to specific types of kidney disease for specialization and more accurate data;
• develop new care initiatives and means to track disease progression;
• partner with organizations that represent various healthcare providers to promote screening, diagnosis, treatment, and referral of people with kidney disease; and
• work to improve how kidney medicine is taught to students and health professionals, and encourage lifelong learning.

Improving treatment options 

According to Rosenberg and Ibrahim, in order to improve treatment options, the following needs to occur:

• 80% of new patients with kidney failure must receive effective home dialysis (as opposed to in-center dialysis) by 2025.
• Funding for the National Institutes of Health (NIH) must increase funds to support programs, such as the:
  • APOL1 Long-Term Kidney Transplantation Outcomes Network, 
  • Kidney Precision Medicine Project, and
  • diverse kidney research funds. 

Moreover, ASN must:

• • partner with the U.S. Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services to streamline regulatory and reimbursement processes;
  • actively develop and nurture a widespread community and culture that better support clinical trials; and
  • support the launch of five new, value-based kidney care and kidney disease payment models by:
    • facilitating nephrologist participation in these models, and
    • providing educational resources to transform kidney care. 

Increasing access to kidney transplantation

To double the number of kidneys available for transplant by 2030, the authors call upon the federal government to:

• increase organ recovery from deceased donors and reduce the discard rate;
• encourage living organ donation by ensuring appropriate financial support and protecting donors from discrimination by employers and insurance companies;
• pass the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act, which would ensure access to immunosuppressive medications.

“The federal government must fund research into kidney disease at the same level as cancer and diabetes,” stated Rosenberg and Ibrahim. “The kidney community must overcome these challenges to thrive as a meaningful specialty and to extend the lives, and quality of life, for millions who will continue to die prematurely and unnecessarily.”

*Rosenberg, M. and Ibrahim, T. (2019, Dec.). “Winning the War on Kidney Disease.” Clinical Journal of the American Society of Nephrology.