Annual Center for Chronic Disease Research and Policy symposium targets kidney disease

The CDC estimates chronic kidney disease will afflict more than one in seven people in the United States. Many, if not most, of these people are also unaware they are sick. Kidneys are responsible for several functions in the body, including filtering waste and excess fluids, helping to make red blood cells, balancing minerals, and maintaining blood pressure. Although symptoms may go unnoticed until the disease is advanced, the consequences of chronic kidney disease are serious, leading to weakness, increased risk of heart disease and stroke, and early death. People with end-stage kidney disease need regular dialysis or a transplant.

Kidney disease is most common in adults over the age of 65, especially in Black, Hispanic, Native American, and Asian populations. Its risk factors include diabetes, hypertension, heart disease, autoimmune disease, obesity, smoking, and heredity. Kidney disease can be diagnosed with blood and urine tests, as well as imaging and biopsy.

“Kidney disease disproportionately affects disadvantaged populations,” said Milda Saunders, MD, MPH, Associate Professor of Medicine at the University of Chicago and co-organizer of the Center for Chronic Disease Research and Policy’s 12th annual symposium, “Intersections of Policy, Innovation, Healthcare, and Financialization for Kidney Disease: Where Are We in America Today?” which will take place on October 16, 2024 in the Rubenstein Forum.

Co-sponsored by the UChicago Medicine Section of Nephrology and Transplant Institute, the day-long symposium features several speakers, including:

• A keynote lecture by Tom Duvall, Director of the Division of Special Populations and Projects at the Centers for Medicare and Medicaid, as well as talks by:
• Michelle Josephson, Professor of Medicine, Director of Education of the Transplant Institute, and former president of the American Society of Nephrology
• UChicago Assistant Professor of Medicine and Public Health Sciences William F. Parker
• James Lash, Robert Wood Keeton Professor of Medicine and Chief of the Division of Nephrology at the University of Illinois at Chicago College of Medicine

A general internist and health policy researcher with interests in housing and community development, Saunders began her study of chronic kidney disease because of what the disease could reveal about how neighborhoods affect health.

“I grew up in Chicago, where we are hyper segregated, so I already knew neighborhoods impact health,” she said. “The kidney was a great opportunity to study how, because in the U.S. people on dialysis are eligible for Medicare, so we have a data set that has information on all the people who have end-stage kidney disease and where they live. That’s just not heard of for any other disease.”

Chronic kidney disease is a common and underrecognized disease that especially affects racial and ethnic minorities and economically disadvantaged populations, revealing structural health disparities.  “People who have the same insurance, who presumably have the same access to care because they go to dialysis three times a week, still have different outcomes,” Saunders said. “We have found that being Black or another racial ethnic minority or living in a poor neighborhood determines the quality of care you receive in your dialysis facility and determines the likelihood that you will appear on the transplant wait list.”

Saunders’s research includes broad analysis of the national data set on kidney disease compiled by the United States Renal Data System (USRDS), as well as local interventions with patients at UChicago hospitals to identify minority patients with chronic kidney disease and educate them on care to prevent kidney failure.

“Kidney disease is a highly morbid condition,” she said. “The mortality rate is a 5-year 50% mortality rate, so when you are diagnosed with end-stage kidney disease, it is like getting a diagnosis of cancer. If we can prevent this diagnosis, then we have really done a service.”

One of the things that makes kidney disease so interesting is that a lot of the outcomes are determined by policy, Saunders says. “In the early days they would have to ration dialysis based on how valuable you were seen as a person and how likely you were to survive,” she said. “We made a policy decision to fund every citizen who's eligible for dialysis through Medicare, which is unheard of for other diseases. Now it's not a scarce resource: whoever wants dialysis can get it. It's no longer an immediately life-threatening disease, it's a chronic disease.”

Because of these policy decisions, Medicare is the primary regulator of dialysis and transplants now. “All of the issues that we struggle with in our health care system in general are magnified within kidney disease, because you're able to see how one policy change that affects most of the people who have that disease can impact outcomes. It is like a policy lab: if you can make it work for end-stage kidney disease, you can try it in other diseases,” Saunders said.

In addition to raising awareness on kidney disease at the symposium, which convenes clinicians, educators, researchers, policymakers, and community members, Saunders anticipates a series of talks that broaden the conversation to health policy’s relationship to health equity.

“The goal is to improve quality, reduce cost, and improve equity and efficiency,” she said.