CKD Early Intervention: USRDS Report Highlights Need for Improvement

Early detection and intervention in chronic kidney disease (CKD) can drastically slow disease progression and improve patient outcomes. Yet, according to the recently released United States Renal Data System (USRDS) 2024 Annual Data Report (ADR), many patients go undiagnosed until their disease reaches advanced stages. Further, once patients are diagnosed, many are not exposed to care models and treatment strategies that are known to improve outcomes.

The 2024 ADR underscores a pressing need for improved early-stage CKD diagnosis and management. Here are three opportunities for improvement and the most promising advances in CKD management from the latest USRDS report.

Kidney care missed opportunity 1: Screening rates remain low

One key takeaway from the 2024 ADR is unmistakable: while earlier kidney disease detection is critical for improving patient outcomes, early-stage diagnosis continues to lag. Respected groups including KDIGO recommend CKD screening for individuals with diabetes and hypertension, which are known risk factors for CKD. Yet CKD screening rates remain low, even among high-risk groups. Less than 60 percent of patients with diabetes and only about 10 percent with hypertension were screened for CKD in 2021 or 2022.¹

Simply implementing existing screening recommendations broadly could help identify CKD earlier so more patients could benefit from timely intervention, which is especially important as many treatments now available are most effective when taken at early stages. Yet, as we’ll explore next, uptake of CKD medications remains low as well.

Kidney care missed opportunity 2: Slow adoption of medications for CKD

Despite the proven efficacy of medications to slow disease progression and help manage CKD complications, the 2024 USRDS report cites low utilization rates. In the six-month period before January 1, 2022:

• Roughly a third of Medicare fee-for-service beneficiaries aged ≥66 with stage 4 or 5 CKD received ACE inhibitors or ARBs
• Less than 3 percent of beneficiaries in the same category received prescriptions for SGLT2 inhibitors²

While there are numerous reasons why CKD medication adoption has lagged, cost is one of the biggest barriers, with SGLT2 inhibitors averaging $3,793 annually and out-of-pocket costs exceeding $600 for unsubsidized patients.³ Prices were even higher for GLP-1 RAs, which were recently approved for the treatment of CKD, averaging $6,245 annually and $841 out-of-pocket per patient. To improve treatment access, continued education and advocacy efforts are needed to encourage cost reduction and expanded coverage.

Kidney care missed opportunity 3: Lack of primary care and nephrology coordination

CKD often progresses unnoticed until symptoms become severe. Structured coordination between primary care providers (PCPs) and nephrologists can help ensure earlier identification, enabling timely treatment strategies such as blood pressure management, lifestyle changes, and medication. As the USRDS report highlights, however, many patients with CKD lack access to a nephrologist.

• Among Medicare fee-for-service beneficiaries aged ≥66 with stage 3 CKD, only one out of four had an outpatient encounter with a nephrologist in 2022
• Nephrology visits were even less common among Medicaid beneficiaries aged 18-64; only 15 percent with stage 3 CKD saw a nephrologist that same year⁴

These statistics are particularly concerning as studies show early referral to a nephrologist is associated with slowed disease progression, especially among patients with other health complications, as well as reduced hospitalizations and mortality. Given the opportunities to significantly improve outcomes, clinical researchers have called for increased PCP education and ongoing nephrology-PCP care coordination.

Positive kidney care trends: Home dialysis and transplant waitlisting increased

While the 2024 ADR demonstrates a clear and compelling need to improve early CKD intervention and management, there were bright spots in the annual report. From 2012 to 2022:

• Home dialysis increased more than 70 percent, with nearly 15 percent of individuals with end-stage kidney disease (ESKD) receiving dialysis at home in 2022⁵
• Transplant waitlisting reached an all-time high and preemptive transplant waitlisting continued to rise steadily⁶

Prevention is paramount for patients, and for a sustainable healthcare system

The most recent USRDS report also reaffirms an essential truth in medicine: early intervention isn’t just better for patients, it’s vital for the sustainability of healthcare systems. CKD management accounted for more than 25 percent of Medicare fee-for-service spending in 2022—a staggering $95.7 billion.⁷ Much of this spend was driven by rising prescription drug costs and greater utilization, especially for outpatient services. On trend with previous years, the average annual cost per patient for in-center hemodialysis ($99,369) was more than double the average cost of care for individuals with functioning kidney transplants ($45,128).⁸ These numbers reinforce the need for prevention, early referral, and proactive intervention.

Value-based care models are delivering on the promise of more proactive care

Encouragingly, value-based care models are starting to shift the tide toward more proactive, comprehensive CKD care by engaging patients earlier, helping nephrologists reach more patients, and prioritizing preemptive treatment strategies. These models are already delivering proof-of-concept, demonstrating improvements in patient outcomes including:

• Slowed CKD progression
• Reduced hospitalizations
• Improved quality performance
• Higher transplant rates
• Increased use of home dialysis

The way forward is clear. By expanding early diagnosis and empowering patients with accessible care and treatment, we can improve healthcare outcomes and quality of life for millions of people. The upward trends in home dialysis and kidney transplant waitlisting prove that change is not only possible, but already underway.

To learn how Interwell Health is improving care and outcomes for patients with CKD, visit interwellhealth.com/what-we-offer.

 

References

1. USRDS 2024 Annual Data Report: Identification and Care of Patients with CKD. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/2-identification-and-care-of-patients-with-ckd
2. USRDS 2024 Annual Data Report: Transition of Care in Chronic Kidney Disease. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/8-transition-of-care-in-chronic-kidney-disease
3. USRDS 2024 Annual Data Report: Prescription Drug Coverage in Patients with ESRD. https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/10-prescription-drug-coverage-in-patients-with-esrd
4. USRDS 2024 Annual Data Report: Identification and Care of Patients with CKD. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/2-identification-and-care-of-patients-with-ckd
5. USRDS 2024 Annual Data Report: Home Dialysis. https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/2-home-dialysis
6. USRDS 2024 Annual Data Report: Kidney Transplant. https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/7-kidney-transplant
7. USRDS 2024 Annual Data Report: Healthcare Expenditures for Persons with CKD. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd
8. USRDS 2024 Annual Data Report: Healthcare Expenditures for Persons with ESRD. https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/9-healthcare-expenditures-for-persons-with-esrd