Kidney community must push for more research dollars
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Research in the past decade has led to the identification of new genetic variants for kidney diseases previously attributed to hypertension, new medications to slow diabetic kidney disease progression and reduced cardiovascular risk.
It has also advanced understanding of the pathophysiology of anemia in advanced kidney disease.
These advances are all due to years of research investment in kidney disease and will revolutionize the identification and treatment of children and adults with kidney disease, as well as potentially prevent or delay kidney failure and reduce mortality.
Research investment
However, advances for patients with kidney disease compared to patients with other common chronic conditions demonstrates wide gaps in research investment, especially when the societal cost of kidney disease is considered.
Kidney failure treatment options, such as dialysis, transplant or palliative care and hospice, have not changed substantially in the past 40 years. Funding for the NIH increased 37% between fiscal years 2015 and 2020, while kidney research funding increased by approximately half that percentage during that period.1-2
Funding for kidney-related research and disease prevention under the National Institute of Diabetes and Digestive and Kidney Diseases was approximately $700 million in fiscal year FY 2020,3 less than 2% of NIH funding, while traditional Medicare spending on patients with chronic kidney disease reached $130 billion, or approximately $1 in $5.4 This is unacceptable when 15% of the U.S. population has CKD. 5
Stark disparities exist at every CKD stage. African American or Black individuals constitute 35% of U.S. patients receiving dialysis but only 13% of the U.S. population 6 and Hispanic/Latino individuals are 1.3 times more likely than non-Hispanic individuals to have kidney failure.7
Differences in CKD outcomes – whether due to genetic factors, economic and social factors or systemic racism – are unconscionable and data from the Indian Health Services demonstrate that most kidney failure in underrepresented groups can likely be prevented. COVID-19 has amplified these disparities, as adults with kidney failure treated with dialysis or kidney transplants are at higher risk for severe COVID-19 hospitalization and mortality.8
NKF roundtables
An increased federal commitment is needed to promote pivotal CKD research. In January 2021, NKF convened two research roundtables comprised of nephrology leaders to identify and prioritize opportunities for kidney research. An advisory group of patients, caregivers and living donors shared their perspectives on areas of need. The resulting roadmap identifies areas for additional investment in preclinical and clinical research that will yield better therapeutic options to manage progression, reduce incidence, improve quality of life and potentially lower health care costs. Priorities were identified for preclinical research (data science; define the CKD mechanism and identify new therapeutic targets; develop better models of human disease; and develop cell-specific drug delivery systems and gene editing) and for clinical research (clinical trials; health disparities; implementation science).
Despite the prevalence and impact of CKD, federal support for CKD research is insufficient, resulting in lost opportunities for breakthroughs that can lead to new detection models, new treatments to slow disease progression and address disparities through greater utilization of proven therapies. The NKF urges Congress and the Biden administration to address the striking inequity that exists in CKD research.
- References:
- Murray R, et al. Am J Kidney Dis. 2021;doi:10.1053/j.ajkd.2021.04.006.
- Estimates of funding for various research, condition, and disease categories (RCDC). NIH Report. 2021. https://report.nih.gov/funding/categorical-spending#/ “Kidney Disease” and “Polycystic Kidney Disease.”
- Estimates of funding for various research, condition, and disease categories (RCDC). NIH Report. 2021. https://report.nih.gov/funding/categorical-spending#/
- CMS announces transformative new model of care for Medicare beneficiaries with chronic kidney disease. Available at: www.cms.gov/newsroom/press-releases/cms-announces-transformative-new-model-care-medicare-beneficiaries-chronic-kidney-disease. Published Sept. 18, 2020. Accessed Oct. 19, 2021.
- Chronic kidney disease in the United States, 2021. Atlanta, GA: HHS, CDC; 2021.www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf
- United States Renal Data System (USRDS). 2020 USRDS annual data report: epidemiology of kidney disease in the United States. NIH, NIDDK, Bethesda, Md, 2020. https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities [Volume 2 End-Stage Renal Disease: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities; Highlights: Bullet #8: The adjusted prevalence of ESRD was 3.4 times higher in Blacks than whites in 2018 (Figure 1.8).]
- Chronic kidney disease in the United States, 2021. Atlanta, GA:HHS, CDC; 2021.www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf
- ERA-EDTA Council, ERACODA Working Group. Nephrol Dial Transplant. 2021;doi:10.1093/ndt/gfaa314
- For more information
- Holly Kramer, MD, MPH, is professor of public health sciences and medicine, division of nephrology and hypertension at Loyola University Chicago and is immediate past president of the NKF.
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