Chronic Kidney Disease

The rate increase comes as the agency is easing up on quality reporting requirements to give health sytems breathing room amid the pandemic. Monday’s announcement also clarified some payment changes for end-stage renal disease.

This week, the top managed care news includes a CDC report says diabetes is the condition most linked with coronavirus disease 2019, CMS temporarily suspends rules to give hospitals more capacity during the COVID-19 pandemic, and a late-stage trial for dapagliflozin ends early after showing efficacy for chronic kidney disease.

The changes are aimed at helping hospitals increase their capacities for the sickest patients; expand the pool of local healthcare providers who are available to work; eliminating ordinary paperwork and documentation requirements; expanding Medicare coverage for respiratory-related devices and equipment for any medical reason; and expanding telehealth in Medicare by covering more than 80 additional services.

In a response to the coronavirus disease 2019 (COVID-19) pandemic, the American Society of Nephrology (ASN) has hosted series of webinars outlining CDC recommendations and policy changes for challenges in the dialysis setting.

Although many investigators have pushed the envelope in researching how patients with chronic kidney disease (CKD) experience disabilities, there is still a need for more knowledge on how those disabilities evolve over time, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Frailty significantly raises the risk of developing disabilities as a result of hemodialysis, so even patients who are intermediately frail should be monitored, said Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Educating primary care clinicians on how to manage chronic kidney disease in the primary care setting can help avoid referrals for nephrology consults that aren’t needed, said Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

The article identifies issues such as poor socioeconomic background and lack of family and social support as factors in poor medication adherence, which today are recognized as social determinants of health

The plan represents the latest element of the Trump administration’s comprehensive approach to renal care, which seeks to keep patients from advancing to dialysis. For those who do, the plan promotes transplants and home dialysis options.

CKDintercept, the primary care initiative of the National Kidney Foundation, involves multiple strategies aimed at improving the quality of kidney care, explained Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Physical disabilities may make it difficult for patients with chronic kidney disease to follow provider recommendations and achieve a good therapeutic alliance, which can lead to increased burden of illness, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

National Kidney Foundation and CareFirst partnered for the first time on landmark study

What should providers do about intentional nonadherence, and what strategies should they try to get their patients to take their hypertension medicine? At a session at the American Society of Nephrology (ASN)’s Kidney Week 2019, physicians discussed direct observation therapy (DOT), drug monitoring, case studies, and other published work about patients who don’t take their medications. Then they heard from a directly from a patient who shared why she stopped taking her medication and the scary consequence that developed as a result.

A scalable chronic kidney disease (CKD) quality improvement intervention demonstrated feasibility, decreased hospitalization, and reduced costs. These preliminary results support innovation in CKD by commercial health plans.

Because exercise capacity is known to be linked with several key outcome measures in patients with chronic kidney disease (CKD), routine exercise testing can help clinicians prescribe individualized exercise interventions, said Danielle Kirkman, PhD, assistant professor at Virginia Commonwealth University.

The new indication is based on results of the CREDENCE trial, which found that canagliflozin reduced the risk of renal failure or death by 30% in those that had both type 2 diabetes and diabetic kidney disease.

Dapagliflozin’s fast track designation follows findings from last year’s DECLARE-TIMI trial, a cardiovascular outcomes trial that showed the drug’s significant impact on delaying the loss of kidney function and reducing hospitalization risk for heart failure.

Coverage of DECLARE, CARMELINA, and other studies that highlight the connection between diabetes and renal outcomes

Here are the top 5 articles for the month of June.

A discussion with Naeem Khan, MD, vice president of US cardiovascular and metabolic diseases at AstraZeneca, on lessons from the wave of cardiovascular outcomes trials, the new focus on renal outcomes, and what’s next for SGLT2 inhibitors.

Presentations at 2 major scientific conferences showed that the SGLT2 inhibitor cut the risk of renal failure or death by 30% and had renal benefits for patients with and without previous cardiovascular disease.

Two doctors of pharmacy review the impact of recent outcomes trials for newer classes of type 2 diabetes therapy.

The EMPEROR trials could lead to new indications for the SGLT2 inhibitor for patients with and without diabetes.

Evidence that newer type 2 diabetes therapies offer cardiovasular and renal benefits offer opportunities for greater collaboration among specialists and more value for patients. Payers must take notice.