Better Care for Chronic Kidney Disease is Less Expensive Care
Chronic kidney disease is a very dangerous, expensive, and growing problem in the United States. The greatest risk factors for this problem are hypertension, diabetes, and aging. The annual cost for patients with CKD who are not on dialysis in the Medicare system is $81 billion and that represents 22% of Medicare fee-for-service spending. Spending for this group of patients increased by 7% in just one year. It is growing faster than the cost of treating diabetes and congestive heart failure because the CKD population is growing more rapidly. If a patient with diabetes has CKD at age fifty-five, by age 68 half of them are dead in usual care. Most patients with CKD don’t make it to dialysis. It is a very dangerous condition. Patients with CKD in the Medicare program have multiple challenges. Sixty-two percent have diabetes and/or heart failure. The Medicare patient with diabetes and CKD who is not on dialysis costs 47% more than individuals with diabetes alone. The number of Medicare beneficiaries with CKD has increased by 89% over the last decade. Most of the costs in these patients come from hospitalizations. Half of those hospital costs are related to infections or cardiovascular causes.
The critical factor to reduce these costs is slowing the progression or CKD and preventing vascular events like heart attack and amputation. We now have 21 years of data from patients with diabetes and chronic kidney disease that shows we can do just that. Patients with diabetes and CKD on optimal medical therapy (OMT) have one fourth as many heart attacks and one fifth as many strokes as patients on usual care. One sixth as many progress to dialysis and one third as many need lower extremity amputations. OMT reduces hospitalizations for heart failure by seventy percent. These conditions are all related.
Check out the image above that contains deidentified data. I treated 81 patients with an estimated glomerular filtration rate (eGFR) of 60 or less for two or three years with OMT and they improved their eGFR by 7.5 ml/min on average. OMT is very effective in improving clinical and financial outcomes for these patients compared with usual care. OMT can be very helpful for your Medicare Advantage population. We can protect millions of Americans from the misery of heart failure and kidney disease but we must change what we are doing.