Researcher Focuses on Treating Early-Stage Diabetic Kidney Disease Before Kidney Failure

A value-based health care system that looks at accountability in the early stages of chronic kidney disease (CKD) to prevent kidney failure may be the best solution for treating this disease, Daniel Weiner, MD, MS, associate professor at Tufts University, said during a session called “Getting the Job Done with Value-Based Care for Patients with Diabetic Kidney Disease” on November 3 at the American Society of Nephrology Kidney Week conference.

This treatment model looks to lifestyle shifts, more frequent screenings, and better patient incentives to stop the progression of CKD into kidney failure. But “we are nowhere near the levels that we want to be,” Wiener said. “If you don’t remember anything else from this talk, remember that our system is not set up to do this.”

Weiner said that the current treatment landscape is not set up to bring an end to kidney failure. Regularly, nephrologists see patients who have stage 4 CKD. These patients represent only 14% of all CKD patients but are seen and treated more often. Weiner suggests targeting patients with lower grade CDK, in whom it is easier to prevent severe CKD or kidney failure rather than treat it.

“There are a lot of things that we can do, if only we were aware of them,” Weiner said.

In a value-based health care system, the beneficiaries would not change all the time, and there would be critical, societal, and patient perspectives incorporated into a treatment plan. Quality measures include a kidney health evaluation, therapy for high blood pressure, and controlling high blood pressure.

More frequent screenings are one measure suggested to improve patient outcomes, as well as incentive programs. Weiner highlights the Quality Payment Program for Clinicians, which is a merit-based system looking at performance, cost, and quality measures, and paying transplant patients who meet the standards.

Wiener also references a pyramid treatment for diabetic patients at risk for CDK. At the base of the pyramid is the treatment with the largest impact. And for patients, the most preventative and impactful base treatment is something they can do all on their own—modify lifestyle. Elements of a lifestyle intervention include exercise, a healthy diet, not smoking, and managing weight.

Though these factors are easily modifiable and attainable, Weiner said that patients need to understand the impact of a lifestyle shift and be willing to accept it. Inherently, every patient is different, therefore, tactics to reduce overall kidney failure cannot be absolutes. There must be individuality with each patient, and ultimately, the metrics should overlap between primary care physicians and other consultants.

“People want to avoid kidney failure,” Wiener said, and there needs to be a “shared responsibility for disease prevention with lagged shared attribution for chronic diseases.”

Reference

Weiner, Daniel. Getting the Job Done with Value-Based Care for Patients with Diabetic Kidney Disease. ASN Kidney Week. November 3, 2022. https://www.asn-online.org/education/kidneyweek/2022/program-session-details.aspx?sessId=419799