The best treatment of kidney disease is facilitated by early detection when the disease can be slowed or stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed.
- Dialysis comes in two forms: hemodialysis (HD) or peritoneal dialysis (PD). Both forms remove wastes and extra fluid from your blood. Patients receive hemodialysis usually 3–4 times a week, either at home or at a dialysis center. During hemodialysis, your blood is pumped through a dialysis machine, where it is cleaned and returned to your body. With peritoneal dialysis, your blood is cleaned inside your body daily through the lining of your abdomen using a special fluid that is periodically changed. Peritoneal dialysis can be done at home, at work, at school, or even during travel. Home dialysis is an increasingly popular mode of treatment and is associated with better outcomes.
- A kidney transplant places a healthy kidney into your body from a deceased donor or from a living donor, such as a close relative, spouse, friend, or generous stranger. A kidney transplant, however, is a treatment, not a cure. Antirejection and other medications are needed to maintain the transplant. Per the United States Renal Data System (USRDS), more than 22,000 (22,393) kidney transplants were performed in the United States in 2018. The active waiting list remains substantially larger than the supply of donor kidneys, which presents a continuing challenge.
- Although it is very important for patients who are nearing the need for dialysis or kidney transplantation to be cared for by a nephrologist, in 2018, 38.8% of incident (newly occurring) KFRT patients (18–44 years) had received little or no pre-KFRT nephrology care.
In 2018, Medicare costs for all people with all stages of kidney disease were $130 billion. In 2018 Medicare spent $81 billion for people with kidney disease and an additional $49.2 billion for people with KFRT. For 2018, per person per year (PPPY) spending on KFRT patients was $80,426. Early detection of kidney disease could save a substantial percentage of these costs.
- Per type of KFRT treatment, Medicare spent: $93,191 PPPY for HD, $78,741 for PD, and $37,304 for kidney transplant (2018).
- In 2018, Medicare spent an estimated $24,674 PPPY to care for someone with non-KFRT CKD, more than double the spending on the average Medicare beneficiary($12,899).
- Almost 64.3% of new KFRT patients applied for Medicare (2018).
- In 2018, there were over 500,000 Medicare beneficiaries on maintenance dialysis(about 1% of Medicare fee-for-service population), accounting for 7.2% of the overall claims paid by Medicare.
- Total Medicare Part D spending (2009–2018) rose by 188% for those with CKD ($4.6 to $13.1 billion) and by 37% for those without CKD ($39.5 to $54.2 billion).
- For kidney transplant recipients, Medicare Part B spent $2,453 on immunosuppressive drugs, PPPY (2018).
- Medicare Part D spending was 1.7 times higher for those with CKD ($5392 PPPY) than for those without CKD ($3118 PPPY) (2018).
- Medicare Part D spending was 2.4 times higher for patients with KFRT ($8,173 PPPY) than those without ($3397 PPPY) (2018).
- There is good news, however, for patients burdened with immunosuppressive drug costs when they are no longer covered by the current 36-month limit. The NKF-supported Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (S. 3353/H.R. 5534) was passed by both the U.S. House of Representatives and U.S. Senate in December 2020. This bill ensures that transplant patients on Medicare will receive lifetime unlimited coverage for immunosuppressive medications. This legislation represents a significant, positive change in the lives of many kidney patients.
However, there is still a lot of work to be done: Minority communities may have less access to healthcare than other Americans. For example, studies found that about one-third of Hispanics or Latinos, 20% Black/African Americans, and nearly 1 out of 3 American Indians and Alaska Natives were uninsured.