LITTLE ROCK, Ark. — Doctors and others involved in the care of Arkansans with kidney disease are eager to learn how a recently announced federal initiative will address renal disease in the state, which has one of the nation’s highest rates of related deaths.
President Donald Trump signed an executive order July 10 directing government agencies to take action on chronic kidney disease, including changes in preventive care and payment models through the Centers for Medicare and Medicaid Services.
An overall goal of the directive is to double the number of kidneys available for transplant by 2030.
In a recent phone interview, Dr. Lyle Burdine, director for solid-organ transplants at the University of Arkansas for Medical Sciences, was optimistic about the plan’s prospects but said he wanted to see more specifics.
“It’s a pretty vague statement, so it’s a little bit hard to know exactly how that’s going to affect us on a day-to-day basis. But the overall impression I get is that it’s going to be helpful,” he told the Arkansas Democrat-Gazette.
“Anytime they bring awareness to end-stage organ disease, I think it’s great. It only benefits the patients that are in our state with that problem.”
According to the federal Centers for Disease Control and Prevention, Arkansas has more kidney disease deaths per 100,000 people — about 20 — than any states except Louisiana and Alabama. The rate of end-stage renal disease in southern Arkansas also is among the country’s highest, Burdine said.
The problem affects so many that a state entity, the Arkansas Kidney Disease Commission, offers payment assistance for some medications and therapies for people affected by the illness, which is estimated to affect 37 million people in the United States.
U.S. Department of Health and Human Services Secretary Alex Azar called the “Advancing American Kidney Health” plan the biggest change to kidney disease treatment — which accounts for about 20% of Medicare expenditures — in decades.
“Too many Americans don’t know about or aren’t supported in shifting to more convenient dialysis options, and too many Americans never get a chance at a kidney transplant,” he said in a statement. “That has to change.”
Materials released by government agencies said the federal initiative aims to improve outcomes by incentivizing doctors who slow disease progression, revamping reimbursement rates, creating financial supports for living donors and improving organ recovery.
At the Arkansas Regional Organ Recovery Agency, communications director Audrey Coleman said the staff watched a live-stream of the ceremony announcing the plan, but employees were still digesting what it meant.
“We’re trying to figure out what’s going with it, as well,” she said. “How it’s going to affect us locally, it’s almost impossible to say right now. I think it’s going to affect the transplant centers more than us.”
Transplants are the best and most economical treatment for people with kidney disease. Compared with dialysis, a kidney transplant pays for itself in 14-15 months and can help a patient survive 20 or 30 years, Burdine said.
While organ donation and transplant rates have been pretty good in Arkansas in the past few years, U.S. regional shortages have become a problem, Burdine said. Some more populous states’ donation rates aren’t keeping up with their kidney disease rates, and a solution that’s recently been floated might have drawbacks for Arkansas.
“One thing that’s being batted around is sort of expanding, putting everybody in the same organ pool,” he said. “Statistically (that) sort of makes it difficult for our patients to get the care and organs they need when they get lumped in with larger states.”
To address shortages, the federal plan calls for policy changes to reduce the organ discard rate, such as a review of rules around donors who have hepatitis C and the development of better matching tools. Right now, 18%-20% of kidneys that are procured are discarded.
Another key component of the federal initiative involves a shift away from dialysis centers, using payment incentives to allow more people to get dialysis at home.
Travel three times a week to and from centers can be a financial and emotional burden on patients, and home dialysis can reduce the risk of infection, said Steve Ficklan, regional operations director for Fidelity Home Dialysis.
″(The federal plan) is a push toward that, and we think it would be a good thing,” he said. “Individuals do better in their own environment and settings, so certainly there is a win-win and a plus there.”
Medicare and Medicaid don’t currently cover hemodialysis — one of two types of home dialysis — so for some patients that treatment can be cost-prohibitive, he said. At this time, his company has just one customer receiving dialysis at home. The rest go to centers.
This is at least the third recent Trump administration program targeting a specific public-health issue. Earlier initiatives have committed resources to fighting use of opioids and ending the HIV epidemic.
The kidney disease plan also includes a call for the Health and Human Services Department to encourage public-private partnerships for kidney disease research, including the development of implantable or wearable kidneys.
Burdine, who once trained at a University of California at San Francisco center that has worked on an artificial kidney, said he doesn’t expect that technology to be immediately on deck.
“I don’t see it happening in the next five to 10 years,” he says. “We need another organ source. I don’t think it’s unreasonable to go after it, but it’s definitely not ready for prime time yet.”