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Kidney disease costs healthcare billions as US cases mount

Low early testing levels and poor access to care among disadvantaged populations is driving up the expense.

Jeff Lagasse, Associate Editor

Not only is kidney disease a pervasive problem in the U.S., but the cost to treat it is high.

According to an annual data report from the United State Renal Data System, the overall burden of kidney disease remains high, with the rates of kidney failure requiring dialysis or kidney transplantation ranking among the highest in the world.

[Also: Preventive care, specialists for kidney failure cut public health spending, JAMA study finds]

The prevalence of earlier stages of chronic kidney disease, while relatively stable at 14.8 percent, implies an estimated 30 million American adults have chronic kidney disease, with millions of others at increased risk.

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In 2015, 124,111 new cases of end-stage renal disease were reported with a total of nearly 500,000 patients receiving dialysis treatment and well over 200,000 living with a kidney transplant. Trends in the prevalence of chronic kidney disease are important for healthcare policy and planning.

The cost to care for patients with chronic kidney disease is also significant. In 2015, total Medicare spending for beneficiaries with kidney disease was nearly $100 billion. That included more than $64 billion in spending for all Medicare beneficiaries who have chronic kidney disease and another $34 billion for beneficiaries with end-stage renal disease.

In sharp contrast to the high burden and cost is the low awareness about the condition among patients with kidney disease, especially those in stages 1 to 3. This may well relate to low levels of urine testing for protein among those with risk factors for the disease, researchers saids, or quite simply the consequence of poor access to care among disadvantaged populations. This represents a major roadblock in the efforts to prevent progressive kidney failure with high rates of premature morbidity, mortality, risk of end stage renal disease and high societal cost.

A projected one-third of patients starting dialysis haven't had their kidneys evaluated prior to the onset of disease, the report showed.

The good news is that kidney allocation system policy changes resulted in a first-time decrease in the kidney transplant waiting list by 2.3 percent. While it's too soon to predict the longer-term benefits, the new policy may help minorities and low-income individuals, who often take longer to get waitlisted.

Mortality rates have also improved. Between 2001 and 2015, adjusted mortality rates decreased by 28 percent for dialysis patients. The net reductions in mortality from 2001 to 2015 were 27 percent for hemodialysis patients and 41 percent for peritoneal dialysis patients. But there's been a stabilization in mortality rates in recent years, to the authors caution against complacency.

Twitter: @JELagasse
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