We must act sooner to address the silent crisis of kidney disease and the inadequacy of federal support

Science is powerful. It sounds complicated, but when translated, “knowledge is power” holds true for many aspects of life, especially when it comes to managing your health.

Chronic kidney disease (CKD) is a progressive loss of kidney function with few or no symptoms. Of the 1 in 3 adults at risk for CKD, many are unaware they have the disease, creating a silent epidemic in our healthcare system. If left untreated, CKD can progress to total kidney failure, clinically known as end-stage renal disease (ESRD), requiring life-sustaining medications and frequent dialysis or kidney transplantation.

Given that Black and Hispanic patients are more likely to experience this devastating progression of kidney disease, this is not just a silent epidemic, but a serious health equity issue. These disparities are partly explained by barriers to care, including lack of educational resources and challenging social determinants that prevent patients in underserved communities from accessing the full range of care and services they need to avoid end-stage ESRD. Lifestyle interventions can help slow or manage the progression of CKD and ease the transition to dialysis, but these changes often rely on external support, which the current Medicare program requires without providing the necessary resources.

Dr. Jeffrey Silberzweig | Image: LinkedIn

To help address these issues, our team developed the Prevention and Education for Advanced Kidney Disease (PEAK) program, designed to reduce inequities in kidney care. This interdisciplinary program provides educational programs, materials, and support to people living with kidney disease. The program not only helps patients identify and treat kidney disease at an earlier stage, but it also helps them navigate our complex healthcare system.

Through the PEAK program, care teams work closely with patients to educate them about treatment options and develop personalized treatment plans. Patients have access to social workers, dietitians and other health professionals to improve their health.

In the first year, 50% of PEAK graduates began dialysis in an outpatient setting with permanent vascular access for dialysis or at home. Proactive intervention avoids costly hospital visits and helps prevent disease progression to kidney failure. In addition, the program expanded patient access to home dialysis, a treatment option associated with improved health outcomes and patient quality of life.

Despite these successes, programs like PEAK face significant challenges due to inadequate federal support. The Medicare Kidney Disease Education (KDE) benefit does not cover costs, and in recent years, the Medicare ESRD Prospective Payment System (PPS)—which determines provider payments—has consistently failed to provide adequate funding resources to the kidney care community. This year, the Centers for Medicare & Medicaid Services (CMS) proposed a meager 1.8% payment increase, well below the substantial increase in the cost of operating a medical facility.

Year after year, underpayments undermine the kidney disease community’s ability to hire staff, support the use of innovative treatments, and in too many cases, keep their doors open. The sad reality is that many dialysis centers are struggling to maintain operations. Education and outreach initiatives like PEAK and other prevention programs are often the first to be cut as medical facilities struggle to make ends meet.

To preserve and expand these patient-friendly initiatives, Congress must act. One promising solution is the bipartisan Chronic Kidney Disease Research and Treatment Improvement Act of 2023 (HR 5027/S. 4469). Similar to the goals of the PEAK program, this legislation aims to improve the lives of people with kidney disease and expand access to educational resources. Specifically, the legislation would increase access to the Kidney Disease Education (KDE) benefit and expand the annual Medicare Wellness Benefit to include kidney disease screening. Together, these reforms would help detect kidney disease at earlier, more treatable stages. That’s good news for patients—and taxpayers!

By closing the funding and policy gaps in kidney care, we can ensure that millions of Americans with kidney disease receive the comprehensive care they deserve, improving health outcomes and reducing the overall burden on our health care system. Together, we can enable people with kidney disease to live fuller, healthier lives while improving the quality and accessibility of kidney care.

About the author

Dr. Jeffrey Silberzweig is chief medical officer and vice chairman of hospital services at the Rogosin Institute, a leading kidney care center in New York City.