Caring for Individuals With Kidney Disease During the Pandemic

Nephrologist Mary Dittrich, MD, the chief medical officer and executive vice president of U.S. Renal Care as well as cofounder and partner of Boise Kidney & Hypertension Institute, discusses how to keep patients safe while providing high-quality kidney care during the coronavirus disease 2019 pandemic.

2020 placed unprecedented strain on our health care delivery system. The pandemic has forced all health care providers to adapt quickly to meet the individual needs of their patients, at risk for or battling coronavirus disease 2019 (COVID-19), especially for the physicians and providers who care for our most vulnerable patients, like those with end-stage renal disease (ESRD) who rely on dialysis treatment several times a week to live.

Patients with ESRD often also have multiple comorbidities—like diabetes, high blood pressure, and cardiac disease–coupled with a reliance on multiple medications per day. That puts them at higher risk for complications or death from COVID-19. Moreover, kidney disease itself increases susceptibility to severe manifestations of COVID-19. Dialysis patients infected with COVID-19 have a more than 1 in 4 chance of ending up in the hospital and a much higher mortality rate than the general population. Reports also indicate a higher mortality rate among kidney transplant recipients, likely because of the necessary immunosuppressant drug therapy to avoid rejection of their donor kidney, but which leaves them more susceptible to disease and infections.

The increased risk posed to our patients has required dramatic change for those of us on the front lines in the provision of dialysis care amidst a global pandemic.

Over the last 10 months, alongside our nephrologist partners, we have cared for more than 3000 patients with COVID-19; most have thankfully recovered and are now safely back amongst our general patient population. Early on in this pandemic, we wondered if we could safely treat our patients in outpatient clinics. Now we are certain that we can provide uninterrupted care as long as we all strictly adhere to our safety and protection policies.

We know that our infection control measures are effective at keeping our patients and caregivers safe. But as winter sets in and infection rates rise again, we must all combat COVID-19 fatigue. Now is the time to continue our critical work with even more rigor.

To mitigate risk and advance kidney care in these unprecedented times, we urge the broader kidney community to focus on these 7 key initiatives to keep patients safe while providing high-quality care:

Infection control: The most effective steps for keeping our patients safe remain screening; appropriate use of personal protective equipment including mask wearing; isolating infected or exposed patients; maintaining social distancing; washing hands frequently; and encouraging employees to stay home if they aren’t feeling well.

Prioritize vaccinations for our patients: Even as vaccines are distributed nationwide, dialysis patients—the most vulnerable among the kidney disease patient population–are particularly at risk from COVID-19. That’s why it is imperative that HHS specifically prioritize COVID-19 vaccinations for these individuals—as well as their care providers—by including them in the highest priority group possible during phase 1 distribution.

Increase home therapies: We know that the need for travel to in-center dialysis appointments as well as congregation in the in-center dialysis facilities increases risk for contracting COVID-19. This makes access to home therapies for appropriate patients more important than ever. With CMS’ recent announcement of the End-Stage Renal Disease Treatment Choices Model (ETC Model) and its intention of increasing the number of patients on home therapy, now is the time to educate patients on their modality options and facilitate the provision of home dialysis for appropriate patients.

Driving quality through measures that matter: Making significant investments in creating tools that help nephrologists and other caregivers drive clinically meaningful quality care is paramount. A laser-like focus on the metrics contained in Medicare’s Quality Incentive Program (QIP) and 5-star program will help providers improve quality care.

Reduce missed treatments: The United States performs the worst among industrialized countries in percentage of patients who regularly miss dialysis treatments. Missed treatments increase deaths, hospitalizations, cardiac events, and overall have a negative impact on patient outcomes. Reducing the number of missed treatments, at all times but particularly during the pandemic, is a necessary step in assuring patients health is optimized and hospitalization avoided.

Promoting innovative therapies to improve care: It is an exciting time in the kidney care profession as we are seeing new therapies and innovations that will make a measurable difference in the lives and wellbeing of our patients. The development of new therapeutics to improve outcomes for patients with CKD and ESRD, including diabetes medications as well as new options for anemia management and management of mineral bone disorders, will slow disease progression, reduce hospitalizations, and cut mortality overall. It is critical that our nation’s policymakers recognize the value of these new therapies, provide incentives for new innovations and ensure adequate Medicare reimbursement to allow the latest therapies to be used for both CKD and ESRD patient populations.

Implement value-based care models nationwide: Value-based care programs, such as Medicare’s ETC Model and the voluntary CKCC models, will continue to be strong drivers for accelerating high-quality patient care across the spectrum of kidney disease. We believe that the fee-for-service care model will be replaced by the end of this decade and that by advancing value-based care models, dialysis providers and nephrologists can lead the continue necessary to improve patient care and outcomes for those we serve.

By focusing on these targeted strategies to navigate COVID-19 and continuing to deliver uninterrupted care, we will keep our patient population safe while also maintaining our long-term vision to optimize quality patient care now and for the future.