March is National Kidney Month. Each year, patient advocacy organizations, medical and nursing societies, and government agencies work to promote awareness and education about the importance of kidney health and the impact of kidney disease. This month-long campaign culminates with World Kidney Day on March 9, a global effort to reduce the frequency and impact of kidney disease worldwide. The Clarify Health Institute, the research arm of Clarify Health, is circulating new data highlighting the costs of acute and chronic kidney disease to promote increased awareness and prevention of this serious illness.

According to the National Kidney Foundation, more than 37 million American adults have chronic kidney disease, although most patients are unaware of their condition. Over 750,000 Americans have reached kidney failure, which can require dialysis or a kidney transplant for survival. Unfortunately, that number is expected to surpass one million patients by 2030. The cost of treating these conditions is immense and generally borne by taxpayers through a special entitlement for end-stage renal disease (ESRD) to the Medicare program. Costs for treatment of chronic kidney disease annually account for over $125 billion in healthcare expenditures in the Medicare program alone. Fortunately, healthcare organizations, including Clarify Health, are leading the charge to find innovative ways to prevent, diagnose, and manage kidney diseases and common comorbid conditions such as heart disease and diabetes, alleviating some of the burdens on our healthcare institutions.

Although the impacts of both acute and chronic kidney disease are well known, an analysis by the Clarify Health Institute (CHI) of recent commercial and Medicaid insurance claims for over 44 million American adults further highlights the clinical and economic burden of kidney disease for patients and the broader U.S. healthcare system. The Clarify Health Institute found that in 2021, commercially insured patients with kidney disease had¹:

• 2.9 times as many professional office visits
• 5.6 times as many emergency room visits
• 13 times as many inpatient admissions as those without kidney disease

Similarly, patients with kidney disease insured through Medicaid managed care plans had²:

• 2.6 times as many professional office visits
• 3.9 times as many emergency room visits
• 10.6 times as many inpatient admissions as those without kidney disease

Using Clarify standard amount methods, care for adult patients with kidney disease is annually:

• 8.1 times more costly than those without kidney disease in the commercial population
• 9.3 times more costly in the Medicaid population³

Some of these differences in resource use are driven by other patient differences. For example, patients with kidney disease in Clarify’s commercial and Medicaid samples were substantially older on average. They also had a greater prevalence of comorbidities overall. On average, patients with kidney disease had 5.6 and 6.3 times the total number of chronic conditions compared to other adults in the commercial and Medicaid populations, respectively⁴. In addition to having higher rates of comorbidities, patients with kidney disease appear less likely to receive necessary treatments for these conditions:

• Patients with both kidney disease and chronic heart failure are less likely to receive guideline-directed medication treatments for their heart condition than those with heart failure alone: from 1.5% fewer patients in the commercially insured population to 5.2% fewer patients with Medicaid⁵.
• Similarly, patients with both kidney disease and diabetes are less likely to receive oral anti-diabetic medications than those without kidney disease: from 4.3% fewer in the commercially-insured population to 10% fewer for patients with Medicaid⁶.

These striking statistics highlight the heavy burden that kidney disease imparts on patients, their families, clinicians, health systems, employers, and other payers. This National Kidney Month, let us all recognize the seriousness of kidney disease and commit to taking proactive steps to protect our kidney health.

Individual clinicians, dialysis providers, health systems, and payers have an integral role to play in raising awareness and ensuring access to quality care. We must continue to work together to build healthier communities for all. Increased acceptance and monitoring of clinical practice guidelines for the treatment of kidney disease are critical. In addition, burgeoning efforts to focus care for complex patients within health systems’ centers of excellence may be fruitful. In support of National Kidney Month, Clarify Health Institute’s analysis reinforces why it’s so important to do what we can to bring awareness to kidney health and the prevention of kidney disease. We owe it to ourselves and to the generations that follow to make a positive difference in our own well-being and the quality of care for patients suffering with kidney disease.

Footnotes:

1. Annually incurring 9.8 average office visits for adults with kidney disease vs. 2.9 for those without; 0.4 vs. 0.02 average emergency room visits; and 0.5 vs. 0.04 average inpatient admissions.
2. Annually incurring 10.5 average office visits for adults with kidney disease vs. 4.0 for those without; 0.7 vs. 0.4 average emergency room visits; 0.9 vs. 0.08 average inpatient admissions.
3. Annual differences in estimated costs were $18,794 and $29,200 in 2021, respectively in the commercial and Medicaid populations.
4. 6.1 vs. 1.1 chronic conditions in the commercial population; 5.8 vs. 0.9 chronic conditions in the Medicaid population.
5. 89.6% vs. 90.9% in the commercial population; 80.5% vs. 84.9% in the Medicaid population.
6. 73.8% vs. 77.2% in the commercial population; 64.4% vs. 71.6% in the Medicaid population.