Cardiology, oncology and many other areas of medicine have benefited from remarkable advances in recent years. However, for kidney patients the standards of care have remained much the same for decades. That could soon be changing thanks to an executive order from the Trump administration that creates a national initiative called Advancing American Kidney Health.
"The goals of the executive order are to improve the quality of care that kidney patients receive while also reducing costs. Achieving both of these objectives is going to require changes in how we approach all aspects of care," Thomas Watson, MD of Nephrology Associates said. "The first big change is that the initiative dramatically increases funding for research into better ways to prevent kidney disease, new approaches to care for kidney patients, and to improve transplant access and outcomes.
"Since Alabama's high rates of hypertension, diabetes and other chronic diseases put our patients at a higher risk for kidney disease, this initiative could make a real difference in the future health of our people. Scientists are engaged in some promising preliminary research. With the additional resources for investigation, we hope more of those ideas will be translated into advances."
Watson said some of the new diabetes medications becoming available may help to reduce the number of people who develop kidney disease in the first place.
Another focus of the initiative is to slow the progression of kidney disease. This could include both research into new treatments and encouraging nephrologists and primary physicians to work together to reduce the damage from underlying conditions, to coordinate medications and to keep patients as healthy as possible for as long as possible.
"The initiative offers incentives for helping to keep patients out of the hospital and to avoid the need for readmissions," Watson said. "We want to do whatever we can to avoid or delay the need for dialysis or transplants."
The executive order will also be driving changes in care to meet the goals of reducing the incidence of new patients needing dialysis by 25 percent by 2030, and for 80 percent of those who need more advanced care to either receive a transplant or home based dialysis by that date.
"In the past, home dialysis hasn't been recommended that often, but it can be a better choice for many people, especially those who want to continue working full time," Watson said. "Nephrology Associates has one of the largest home dialysis clinics in the country. We can set it up so patients can easily connect overnight. It's as easy as using a TV remote. Patients also tend to feel better since it's done more frequently. They can get up the next morning and go about their day as usual. They don't have to spend half a day three days a week hooked to machines or dealing with the financial worries of being unable to continue in their job."
Since the need for kidneys far exceeds the number donated, one area of research Watson is particularly excited about is the potential for genetic advances to make more kidneys available for transplant. "Researchers are looking at eventually using stem cells to grow compatible new kidneys. What could come sooner is engineering the genetics of pigs so their kidneys would be invisible to the human immune system and could be transplanted without fear of rejections. There's also interesting work going on in artificial kidneys."
A change that could make more kidneys available to older patients who need transplants is a different approach in how donor kidneys are evaluated and allocated. "In the past, if a kidney became available from a 65-year-old donor who may not be in perfect health, it usually wasn't considered for transplant," Watson said. "But it might make a world of difference in the life of a 65-year-old patient who desperately needs a kidney. It could free them from dialysis and years of declining health while waiting and competing for a younger kidney that might never come."
More kidneys are becoming available thanks to an increase in living donors and creative ideas like paired donor exchanges and donor chains.
"The surgery for recipients is fairly simple, and laparoscopic surgery is making the procedure easier for donors," Watson said. "It still requires a few weeks of recovery time, which in the past has been a barrier to donation because many people can't afford to be off work unfunded for that long. The initiative is looking at ways to provide financial support for donors to eliminate that barrier.
"Ultimately, we hope to see more people signing donor cards and letting their families know their wishes. If we had enough kidneys so we could do a preemptive transplant rather than having to wait on dialysis, it would be such a blessing for so many people."