By Tom Loranger, TFG Washington, DC
The Trump Administration recently announced its Advancing American Kidney Health initiative, an ambitious plan designed to confront the epidemic of kidney disease by, among other steps, incentivizing home dialysis treatment and kidney transplantation (dialysis is the process of removing toxins, water, etc. from the blood of people whose kidneys no longer perform this function. For those with kidney failure, otherwise known as End-Stage Renal Disease or ESRD, dialysis or transplants are the only life-saving options). The Administration’s unprecedented focus on kidney disease won praise from The Rogosin Institute, a New York City-based hospital that treats more than 20,000 patients with Chronic Kidney Disease (CKD) and close to 2,000 patients with ESRD.
Kidney disease in the United States is a growing, complex and expensive problem that is at epidemic levels. Indeed, the statistics are alarming: almost forty million Americans are living with some degree of chronic kidney disease; more than 750,000 suffer from kidney failure (with 500,000 on dialysis); more than 120,000 Americans are diagnosed with kidney failure each year; and almost 100,000 patients are currently waiting for a kidney transplant. The cost of caring for American patients with kidney disease represents 23 percent of the Medicare budget (or about $115 billion per year). The dramatic rise in kidney failure is largely attributable to the corresponding increase in two chronic diseases that are leading risk factors for kidney failure: diabetes and hypertension.
The Administration’s plan has three fundamental goals: “going upstream” to confront the disease earlier in order to reduce kidney failure; treating more patients in the home setting (versus in-center); and making more kidneys available for transplant. As Health and Human Services (HHS) Secretary Alex Azar said, “Decades of paying for sickness and procedures in kidney care, rather than paying for health, have produced less-than-satisfactory outcomes at a tremendous cost. “
The Rogosin Institute, a pioneer in the field of kidney care, including transplantation, has been largely supportive of the initiative, which involves nationwide demonstration programs including a mandatory model. In a letter to HHS, Dr. Barry Smith, President and CEO of Rogosin, and Dr. Jeffrey Silberzweig, the Chief Medical Officer, said, “We greatly appreciate the Administration’s Initiative with its inclusion of programs to slow the progression of CKD, improve access to, and quality of, patient-centered treatment options, with a special emphasis on increasing home dialysis and improved access to kidney transplantation. These are programs that are clearly moving in the right direction.”
The initiative was greeted with largely bi-partisan support. However, Rogosin, and many other stakeholders, expressed concerns over the scope of the mandatory model, the manner in which home dialysis and transplantation are measured in the model, and certain problematic payment mechanisms. Rogosin is hopeful that the Administration addresses these issues prior to program implementation.
It’s little wonder that The Rogosin Institute would embrace innovative care initiatives. Under the leadership of Dr. Smith, Rogosin has made “awareness and prevention” of kidney disease central to its mission.
Dr. Smith said, “At Rogosin, we have a passion for improving the treatment of disease but also for enhancing the quality of the lives of people with kidney disease. By that I mean doing more than treating patients at our facilities; I mean going into communities and homes to impact the lives of people in a positive way.”
The Rogosin Institute hopes that the American Kidney Health Initiative will bolster these objectives by fundamentally changing the way kidney disease is treated. Patients currently suffering from this terrible disease – and future generations who might also do so – deserve no less.
NOTE: The Rogosin Institute is an independent, not-for-profit institution for the research, treatment and prevention of kidney disease. Rogosin has clinical facilities in Manhattan, Brooklyn and Queens and facilities for diabetes and cancer research in Xenia, Ohio. Rogosin is affiliated with the New York-Presbyterian Hospital (NYP) and Weill Cornell Medical College. It is a Sponsored Member of the New York Presbyterian Regional Hospital Network. The founder of Rogosin performed the first hemodialysis in the New York metropolitan area in 1957 and, in collaboration with the NYP surgeons, the first living-related kidney-donor transplant in 1963. Rogosin has recently established a laboratory of Kidney Regenerative Medicine to develop kidney stem-cell organoids to repair damaged kidneys and ultimately build new kidneys so that every person who needs a new kidney can have one promptly and return to a full, normal, and productive life.
For more information on The Rogosin Institute, please visit www.rogosin.org.