Breakthroughs in kidney care: What payers should know

One fast-growing need in the fields of medical research and health-focused tech is assistance for the 37 million people with chronic kidney disease (CKD), the prevalence of which has been steadily — and stealthily — climbing for years. CKD now affects more than 1 in 7 adults in the United States, which is about 15% of the nation’s adult population.¹ Despite this, awareness of the disease — which often has no symptoms until advanced stages — remains frighteningly low. In fact, a jaw-dropping 9 in 10 people with late-stage CKD don’t know they have it.²

That’s why it’s critical that new advancements in renal care focus not only on treatment but also on increasing the rate of diagnosis — and doing so early enough to make a meaningful difference for patients. Fortunately, many of the latest innovations in this field have zeroed in on exactly that challenge. From using artificial intelligence (AI) to identify those in the dark about their condition to employing large swaths of data to more quickly match transplant candidates with available kidneys, tech advancements are changing the kidney care game.

The medical community has also made enormous strides in kidney treatment modalities. From the increasing adoption of at-home dialysis to more holistic approaches to kidney care, new approaches are reimagining treatment options for CKD patients — crafting a form of care that treats not just the disease, but also the individual patient. The upshot? A two-pronged approach that promises to revolutionize the way CKD is diagnosed and treated in the years to come, if not sooner. Here are some of the advances that payers should carefully watch.

1. The growing adoption of value-based care (VBC) for renal disease. Increasingly, a stronger emphasis is being placed on VBC models for treating kidney disease, which can deliver greater value and increased patient quality of life. For many patients, the days when they received their diagnosis, saw a nephrologist once, and then were left to navigate dialysis and the complex health care system on their own are long gone. Now, new programs assign dedicated nephrology nurses to each patient to help coordinate appointments and treatments, understand the condition and prognosis, and aid in mitigating or removing obstacles to continued care adherence. The net effect is significant: more patients receiving preemptive transplants instead of dialysis, fewer hospitalizations and ER visits, and far greater patient engagement.³
   
   
2. Algorithms facilitating more widespread CKD diagnosis. The essential conundrum of CKD is its stealthy nature, with millions not realizing they are affected because symptoms don’t usually appear until the disease is advanced. But how can providers diagnose people who never come in complaining of symptoms — because they have none? That’s where data capture and analysis via AI can make a serious difference. By combing through massive troves of electronic patient data to find likely markers and comorbidities of CKD, these powerful algorithms can identify those at greatest risk of developing CKD and provide them with outreach before the disease progresses. What does this methodology look like in practice? One medtech startup generates customized risk scores for each patient,⁴ while another creates a digital “mathematical twin” to predict — and head off — potentially negative medical outcomes.⁵
   
   
3. Data-driven transplant decisions. Other new research is also investigating clever ways to use AI in the realm of organ donation, simplifying the matchmaking process between harvested organs and those waiting for a kidney transplant. One project funded by the National Science Foundation (NSF)⁶ aims to address the shortfall of available kidneys for the 110,000 people waiting for one, as well as the dire fact that many harvested organs simply go unused. Every day, 17 people die waiting for a kidney,⁷ and around 1 in 5 kidneys harvested will not be transplanted.⁸
   
   The algorithms being developed by the NSF project will ensure not only that more organs find recipients, but also that the inequities that have plagued the organ transplant field for decades will be mitigated. Presently, though end-stage renal disease is 4 times as prevalent among Black Americans than their white counterparts, Black people are far less likely to be placed on the kidney transplant waiting list and are also less likely to receive a kidney transplant once on the list.⁹ Putting these decisions in the hands of an algorithm helps to reduce the opportunity for bias.
   
   
4. The advent of the 3D-printed kidney. In the medical field, 3D printing is already being used to create prosthetics and tooth implants. Now, multiple startups are working to perfect the additive manufacturing process for organ creation and tissue grafting.^10,11 Rather than plastic or metal, this form of 3D printing would utilize biological materials instead. Though the prospect of a fully functional manufactured kidney is still some years off, it goes without saying that this development will have an enormous impact on the field of organ transplantation if widely adopted, potentially saving tens of thousands of lives each year.
   
   
5. Advancements in off-site care. From innovations that make home dialysis simpler and more accessible to telenephrology bringing renal care into the patient’s home, the broad shift away from the traditional clinical setting may be the most widely influential item on this list. In fact, it’s estimated that off-site treatment will have the largest impact of any forthcoming development in the realm of renal care.¹² First among those impacts is simple growth: According to one industry estimate, the home hemodialysis market is expected to swell by 10% annually between now and 2030.¹³
   
   How are these new innovations making such an impact? By eliminating many of the stumbling blocks that once made at-home treatment — particularly dialysis — prohibitive. For example, one medical device startup is working on a self-disinfecting mechanism that keeps home dialysis equipment sterile and safe.¹⁴ Another has found a way to connect its streamlined dialysis machines more easily to water sources and can even be fitted with its own portable water station.¹⁵ Yet another has developed a user-friendly, instant-read, at-home albumin-to-creatinine-ratio (ACR) test, designed to assist patients in spotting a key sign of kidney disease in the comfort of their home.¹⁶
   
   Meanwhile, telenephrology is removing many of the barriers that have long kept at-risk patients from receiving the care they need. New platforms designed expressly for telenephrology connect to patients’ wearable devices, delivering real-time data to guide treatment pathways,^17,18 and specially designed dashboards keep a firm handle on patient data to streamline treatment across providers.¹⁹

The problem of CKD may be dismayingly widespread, but as this array of forward-thinking innovations makes clear, solutions abound, and new ideas are being explored all the time. As the nation faces an increasingly prevalent health crisis, payers can take comfort in the pace of progress — and take action to bring these critical solutions to the patients who need them most.

Learn more about Optum Kidney Solutions for Health Plans.

1. Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2021. Accessed April 7, 2023.
2. Ibid.
3. Mendu ML, Tummalapalli SL. Value-based care and kidney disease: Emergence and future opportunities. Adv Chronic Kidney Dis. 2022; 29(1):30–39.
4. Renalytix. We are Renalytix. Our singular goal is to eradicate kidney disease. Accessed April 7, 2023.
5. Healio. Artificial intelligence aids nephrologists in directing kidney care. Accessed April 7, 2023.
6. Kennedy S. Researchers leverage AI to support kidney transplant process. Health IT Analytics. November 21, 2022.
7. National Research Council. Realizing the promise of equity in the organ transplantation system. Washington, DC: The National Academies Press. 2022.
8. Ibid.
9. The Mayo Clinic. Mayo Clinic experts hope new race-neutral kidney transplant listing criteria improve access for Black individuals. Accessed April 7, 2023.
10. Leonard B. Kidneys on demand: How 3D printers could make organs. Politico, March 16, 2022.
11. Trestle Biotherapeutics. Bioengineered therapies for kidney disease. Accessed April 7, 2023.
12. StartUs Insights. Top 10 kidney care trends in 2023. Accessed April 7, 2023.
13. Skyquest. Global home dialysis systems market size, share, growth analysis, by type (peritoneal dialysis and hemodialysis), by product (service, device) – industry forecast 2022-2028. Accessed April 7, 2023.
14. Relavo. Bringing safety to home dialysis. Accessed April 7, 2023.
15. Quanta. Simply smarter dialysis. Accessed April 7, 2023.
16. Healthy.io. Increase ACR testing by up to 50%. Accessed April 7, 2023.
17. Healio. Wearable devices may have a future in kidney care, but challenges remain. Accessed April 7, 2023.
18. ProtonIntel. First ever on-demand potassium monitoring. Accessed April 7, 2023.
19. Physicians Weekly. Managing kidney disease: Assessing a telenephrology dashboard for active surveillance. Accessed April 7, 2023.