Population Health Management of Chronic Kidney Disease (CKD) - Episode 2

Populations That Develop CKD

Dr Feldman describes the populations that are most at risk of developing CKD.

Ryan Haumschild, PharmD, MS, MBA: I’d like to pivot a little bit and talk about the populations that are most at risk for developing CKD because it builds off the great information we’ve had this far. As we focus on education, targeting unique patient populations, it’s important to understand who has the most risk. Dr. Feldman, you have a lot of expertise here, and you hit on it earlier, but do you mind reminding us and the viewers what the populations are that are most at risk for developing CKD?

Jeffrey Feldman, MD: I’m going to pivot off what Dr. Agarwal said, and looking at the end-stage renal population, which is our costliest population, and it’s the reason why we need programs like this. The burden of most of those patients are African Americans or Hispanics, and if you go back and look at the population at risk, African Americans are 12% of American population. In New Jersey, where I am, most of the patients I’m seeing are African Americans and Hispanics. The patients that develop CKD, diabetes, and obesity with the comorbidities that we discuss are predominantly overrepresented, African Americans and Hispanics, compared with Caucasians. The problem is identifying the patients early, getting them on treatment, and with disparities care. We need to bring them into our offices and get them on guideline-directed therapy to prevent worsening kidney function, worsening complications of diabetes, heart failure, coronary disease. These are the patients we need to look at, follow, and get very aggressive with in order to bring them in and prevent them from ending up on dialysis or needing a renal transplant, which is cost quite costly. As part of our ACO [accountable care organization] in New Jersey, we have 400–600 patients on dialysis. We are overrepresented in New Jersey. It costs $100,000 a year for a patient on dialysis. Dr. Agarwal could tell you what it costs in Indiana, but it’s much less in other states. It’s about $70,000. There’s the burden also with these patients developing heart failure and multiple admissions to the hospital. It’s the comorbidities of heart failure, end-stage renal disease, coronary disease that is most costly and can be prevented with the current types of therapies that we now have available.

Ryan Haumschild, PharmD, MS, MBA: I love how you brought up that we’ve got to be really thoughtful in how we’re treating these patients. Early intervention, managing the comorbidities, that’s going to give these patients the best chance at great outcomes, but also managing total cost to care. And Doctor Feldman I think that’s something that you have a unique perspective on, being involved in the ACO and bringing in that economic burden as well as clinical burden as you as one of the treating physicians.

Transcript edited for clarity.