PEORIA — Kidney disease patients in central Illinois will soon be seeing changes in their care because of President Trump’s executive order advancing kidney care in America, said Dr. Samer Sader, a nephrologist with RenalCare Associates in Peoria.
Sader praised the order, which was issued in July, during an interview in his office at OSF HealthCare St. Francis Medical Center recently.
“This is the first time any administration has truly looked at kidney failure and tried to do something different about it. The executive order from the Trump administration is looking at very aspirational goals, and truly changing the way we provide healthcare for people with kidney disease,” said Sader. “Just the fact that we they are bringing attention to it, that people are really talking about kidney disease for the first time since the 1970s and putting a spotlight on it, is critical.”
Kidney disease is the ninth-leading cause of death in the U.S. About 37 million Americans suffer from chronic kidney disease, and more than 726,000 have end-stage renal disease, according to statistics included in the executive order. Currently more than 100,000 Americans are waiting for a kidney transplant. Of the more than 100,000 people who begin dialysis each year, 20 percent die within a year, and 50 percent die within five years.
Through education, innovation, incentives, and changes in payment models, the order aims to fundamentally change the course of care for kidney patients. It presents three major goals: Reducing the number of patients with kidney failure through earlier diagnosis and treatment; increasing the number of kidneys available for transplantation by modernizing the organ recovery and transplantation system and providing better reimbursements and protections for living donors; and increasing treatment options, patient education, and incentivizing the use of home dialysis over the use of dialysis centers.
“Every patient that goes toward dialysis needs to be offered a transplant or dialysis that you can do at home,” said Sader. “They want to achieve 80 percent of patients getting one of these two treatments in the future.”
Very soon, patients will be seeing more kidneys available for transplantation because of changes to the organ recovery and transplantation system. In the past, there were no incentives for organ procurement agencies to offer less than perfect kidneys for transplantation. This needs to change because even an organ that is not of the highest quality is better than dialysis, said Sader
“Once you are on dialysis, your life expectancy is significantly reduced,” he said. “If you are 70 and you are on dialysis, and you get an organ that is not good for a 16-year-old but may be good enough for a 70-year-old, and it gets you off dialysis, it’s likely to improve your quality of life and probably your survival. That’s a real win for everybody.”
Another way the order will likely increase the number of available kidneys is by providing more protections and reimbursements for living donors.
“If you have a cousin who wants to donate and he has to leave his job and travel from New York City to Peoria, we will have more leeway to reimburse all those expenses,” said Sader. “There will also be protections for someone who leaves his job, and a certain amount of time for recovery. It’s a real hero moment for that person and it takes courage to do that, so the administration is looking towards ‘how are the people who want to do this protected?’”
Home dialysis is likely to become more widely used under the tenants of the executive order, and that’s a good thing, said Sader. Home dialysis is more convenient and allows patients to do dialysis every day, which is healthier.
“Your kidneys work 24 hours a day, seven days a week. When you go to a center for dialysis, you get four to five hours of dialysis three times a week. If you do peritoneal dialysis at home every night while you sleep, you are getting dialysis 40 to 50 percent of the day,” he said. “It’s easier on your body.”
In central Illinois only about 18 percent of patients are doing home dialysis, which is better than the national average of 10 to 12 percent. While a certain percentage of people will have trouble doing their own dialysis, it’s not a difficult process, said Sader. Even hemodialysis, which is a bit more complicated, can be accomplished at home, he said.
“I haven’t really had a patient who wanted to do it that couldn’t, with some assistance, get it done,” he said.
The third major goal of the order, to reduce the number of patients ending up on dialysis by 25 percent by 2030, is the most important goal in the order, said Sader.
“A lot of people are diagnosed late, though it doesn’t happen nearly as much as when I was in training,” he said. “I graduated in 2005. Back in those days a large number of patients came in on the verge of needing dialysis or needing a transplant. Now all the labs give you an estimation of your kidney function any time you have a blood test that looks at your basic chemistries. Primary care providers look at that number and refer patients earlier.”
An earlier referral can help nip problems in the bud.
“A lot of the growth in the number of patients with kidney disease is related to the rising rates of diabetes and high blood pressure in the population,” said Sader. “If I treated your high blood pressure when you were 30 instead of when you were 50, I’m likely to make a big difference. If I convince you to take care of your diabetes, improve your weight, take care of your blood sugars and eat better, you are likely to do better.”
Reducing the number of patients who end up on dialysis by 25 percent is a high bar — whether or not that can be done remains to be seen, said Sader. But setting high goals is a good way to affect real change.
“This is pushing us to do better, and that’s why I call it ‘aspirational.’ I think sometimes you have to have goals that are a little bit out of reach, so I don’t think it’s crazy to do this,” said Sader. “And surprisingly, not a lot of people have been critical. This has been pretty well received from just about every angle — dialysis providers, physicians, and patients.”
Leslie Renken can be reached at 686-3250 or email@example.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.