Advancing American Kidney Health

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Advancing American Kidney Health is an initiative to improve kidney care in the United States which was launched through Executive Order by President Donald Trump on July 10, 2019. [1]

Contents

President Trump signs an Executive Order on Advancing American Kidney Health. President Trump's Remarks on Advancing Kidney Health (48252099336).jpg
President Trump signs an Executive Order on Advancing American Kidney Health.

In 2019, chronic kidney disease was estimated to have a prevalence of more than 15 percent among adults in the United States, and nearly 100,000 Americans were waiting for a kidney transplant. [2] [3] The purpose of the Advancing American Kidney Health initiative was to improve this situation and thereby reduce healthcare costs [4] by encouraging preventive modes of care, creating incentives to increase the proportion of home dialysis treatment and making kidney transplants available to more patients.

Goals

The initiative stated three explicit goals: to ensure that 80 percent of patients newly diagnosed with kidney failure would either receive a transplant or at-home dialysis by 2025; to reduce the instances of kidney failure by one fourth by 2030; to make twice as many kidneys available for transplant by 2030. [5] The means to achieve the goals would include a restructuring of payment models within Medicare, thus making home therapy more financially attractive and in-center therapy less so. [3]

Public reception

The initiative was generally well received at the time of launch, [6] with patient advocates and officials within the United States Department of Health and Human Services commenting that the existing health system for kidney care was overdue for reform and had failed to create incentives for early detection and prevention. [7] The implementation of reforms was slowed down by the impact of the 2020 COVID-19 pandemic. [4]

Related Research Articles

Nephrology Medical study concerned with the kidneys

Nephrology is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. The word “renal” is an adjective meaning “relating to the kidneys”, and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" or "kidney replacement therapay", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.

Dialysis Removal of nitrogenous waste and toxins from the body in place of or to augment the kidney

In medicine, dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy. The first successful dialysis was performed in 1943.

Kidney failure Disease where the kidneys fail to adequately filter waste products from the blood

Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, high blood potassium, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anemia.

Kidney disease Damage to or disease of a kidney

Kidney disease, or renal disease, also known as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.

Acute kidney injury Medical condition

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both.

Chronic kidney disease Progressive loss in kidney function over a period of months or years

Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of kidney function over a period of months to years. Initially there are generally no symptoms; later, symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications include an increased risk of heart disease, high blood pressure, bone disease, and anemia.

Kidney transplantation Medical procedure

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.

Home hemodialysis

Home hemodialysis (HHD), is the provision of hemodialysis to purify the blood of a person whose kidneys are not working normally, in their own home. This often uses peritoneal dialysis and sometimes uses the same equipment that is normally used in a hospital setting. One advantage to doing dialysis at home is that it can be done more frequently and slowly, which reduces the "washed out" feeling and other symptoms caused by rapid ultrafiltration, and it can often be done at night, while the person is sleeping.

Hepatorenal syndrome Human disease

Hepatorenal syndrome is a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure. HRS is usually fatal unless a liver transplant is performed, although various treatments, such as dialysis, can prevent advancement of the condition.

Artificial kidney is often a synonym for hemodialysis, but may also, refer to renal replacement therapies that are in use and/or in development. This article deals with bioengineered kidneys/bioartificial kidneys that are grown from renal cell lines/renal tissue.

Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney disease. Renal replacement therapy includes dialysis, hemofiltration, and hemodiafiltration, which are various ways of filtration of blood with or without machines. Renal replacement therapy also includes kidney transplantation, which is the ultimate form of replacement in that the old kidney is replaced by a donor kidney.

The National Kidney Foundation, Inc. (NKF) is a major voluntary health organization in the United States, headquartered in New York City with over 30 local offices across the country. Its mission is to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. NKF is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention and treatment of kidney disease in the US.

The American Kidney Fund (AKF) is a publicly supported 501(c)(3) non-profit organization founded in 1971.

Northwest Kidney Centers

Northwest Kidney Centers is a regional, not-for-profit community-based provider of kidney dialysis, public health education, and research into the causes and treatments of chronic kidney disease. Established in Seattle in 1962, it was the world's first out-of-hospital dialysis provider. It offers dialysis throughout the greater Seattle area in 20 free-standing clinics, eight hospitals and its home dialysis program. It opened its first clinic in Everett in 2020, the organization's first in Snohomish county.

Robert Provenzano

Robert Provenzano is an American nephrologist. He is also an Associate Clinical Professor of Medicine at Wayne State University School of Medicine.

T. Alp Ikizler is a nephrologist, currently holding the Catherine McLaughlin Hakim chair in Medicine at Vanderbilt University School of Medicine, where he does clinical work and heads a research lab. Born in Istanbul, Turkey, he received his M.D. from the Istanbul University Faculty of Medicine.

Kamyar Kalantar-Zadeh is an Iranian-American physician doing research in nephrology, kidney dialysis, nutrition, and epidemiology. He is best known as a specialist in kidney disease nutrition and chronic kidney disease and for his hypothesis about the longevity of individuals with chronic disease states, also known as reverse epidemiology including obesity paradox. According to this hypothesis, obesity or hypercholesterolemia may counterintuitively be protective and associated with greater survival in certain groups of people, such as elderly individuals, dialysis patients, or those with chronic disease states and wasting syndrome (cachexia), whereas normal to low body mass index or normal values of serum cholesterol may be detrimental and associated with worse mortality. Kalantar-Zadeh is also known for his expertise in kidney dialysis therapy, including incremental dialysis, as well as renal nutrition. He is the brother of Kourosh Kalantar-zadeh, who an Australian scientist involved in research in the fields of materials sciences, nanotechnology, and transducers.

Symptom targeted intervention (STI) is a clinical program being used in medical settings to help patients who struggle with symptoms of depression or anxiety or adherence to treatment plans but who are not interested in receiving outpatient mental health treatment. STI is an individualized therapeutic model and clinical program that teaches patients brief, effective ways to cope with difficult thoughts, feelings, and behaviors using evidence-based interventions. Its individualized engagement process employs techniques from solution-focused therapy, using a Rogerian, patient-centered philosophy. This engagement process ensures that even challenging, at-risk, and non-adherent patients are able to participate.

National Kidney Foundation Singapore

The National Kidney Foundation Singapore (NKF) is a non-profit health organisation in Singapore. Its mission is to render services to kidney patients, encourage and promote renal research, as well as to carry out public education programs on kidney diseases. As of February 2016, NKF has 29 dialysis centres in Singapore.

References

  1. "Executive Order on Advancing American Kidney Health". whitehouse.gov via National Archives.
  2. "Chronic Kidney Disease in the United States, 2019". www.cdc.gov. 13 March 2019.
  3. 1 2 "The Advancing American Kidney Health Initiative Payment Models, Public Awareness Initiative, and Incentives for Innovation | Kidney News". www.kidneynews.org.
  4. 1 2 "HHS Kidney Initiative: Reflecting On The Year One Milestone". The National Law Review.
  5. "American Society of Nephrology | Advocacy & Public Policy - View Documents". www.asn-online.org.
  6. Abelson, Reed; Thomas, Katie (10 July 2019). "Trump Proposes Ways to Improve Care for Kidney Disease and Increase Transplants" via NYTimes.com.
  7. Diamond, Dan; Roubein, Rachel. "Trump aims to shake up kidney care market". POLITICO.