For more than 15 years ago, Michael Shlipak, MD, MPH, formerly chief of general internal medicine at the San Francisco VA Health Care System, has been trying to promote more accurate testing for kidney disease. Photo from Oct. 5, 2020 VAntage Point blog.
ROCKVILLE, MD — Several new partnerships are positioning the VA to offer more extensive services, educational material and testing for the one in six veterans estimated to have chronic kidney disease.
In 2014, between 1.1 million and 2.5 million veterans had CKD, depending on the definition used, and their care cost the VA approximately $18 million, excluding expenses associated with transplantations.1 The VA estimates that the number of veterans with CKD increases by about 30,000 each year. With so many affected and at-risk veterans, keeping as many former service members as possible from developing kidney disease and helping those who have it live their best life possible is a high priority for the VA.
As part of that effort, the VA partnered with the American Kidney Fund (AKF) to increase awareness of kidney disease risk factors, offer more resources to veterans with CKD and supplement the efforts of the VHA Kidney Program and individual VAMC initiatives. Education is particularly important because kidney disease often has few symptoms in its early stages, when it may be reversible.
“Kidney disease is the fastest growing noncommunicable disease [a disease that is not contagious] in the US, yet 90% of Americans, including veterans, who have kidney disease are unaware they have early stages,” said Michael Spigler, vice president of Patient Services and Kidney Disease Education at the AKF.
Overall, veterans have an approximate one-third higher prevalence of chronic kidney disease compared to the general population. Twenty-five percent of veterans have diabetes, the most common cause of chronic kidney disease, sharply increasing their risk. Other risk factors for the condition include hypertension, other cardiovascular disease, smoking, older age, obesity and a family history of kidney failure. African Americans, Hispanics and American Indians face a higher risk of kidney failure, and men are affected at three times the rate seen in women.
Education and Support
Together, the VA and AKF aim to raise awareness of the kidney health-related programs. These include VHA’s National Kidney Program, which provides specialized services to VAMCs across the country, and the MobileKidney app, which helps veterans increase their knowledge about the disease and how to manage it and track their personal health information related to CKD so they and their providers can see and discuss trends and potential interventions.
The VA’s eKidney Clinic offers videos on making choices that support the kidneys, such as healthy food choices, understanding kidney disease and treatment options. The videos offer accessible information on types of dialysis, kidney transplants and other aspects of care, as well.
In addition to supporting the VA’s educational and kidney health programs, the AKF offers financial support including safety net grants to pay for expenses not covered by insurance including transportation, co-pays and prescription medicines; post-transplant testing; and medication replacement and support following natural disasters. Its Kidney Kitchen site provides recipes that promote kidney health. AKF also offers its own educational webinars.
The VA and AKF “share a common goal of supporting veterans with kidney disease by helping them live healthier lives through early identification and addressing the challenges veterans face in managing their kidney health,” Spigler said. Since the partnership launched in 2020, more than 1,000 veterans have used the jointly developed resources and the Veteran News Network has aired the organizations’ Know Your Kidneys videos more than 1,700 times.
Support and Treatment
The VA has also expanded its diagnostic capabilities with a commercial partnership that will help primary care providers identify patients with diabetes who have early-stage kidney disease and assess their risk for progression to kidney failure.
The rollout of the KidneyIntelX system began in late 2021 and picked up speed in 2022. The solution combines data such as blood-based biomarkers, genetics, and information from a veteran’s electronic health record and applies an algorithm to generate a score that corresponds to the risk of deteriorating kidney function. With early identification of patients with CKD and an understanding of their personal risk of progression, physicians can focus interventions and treatment on patients who will most benefit at the point in their disease where action will have the greatest impact.
In conjunction with the rollout, a panel with experience using the system in clinical practice discussed its use in patients with Type 2 diabetes and the impact on care pathways and outcomes at a recent VA Healthcare Summit.
One panelist noted that seeing their personalized score increased patient engagement in improving kidney health. “For patients, reviewing the results of that risk score helps motivate them to take additional action toward their kidney health that is proportional to the risk,” said Joseph Vassalotti, MD, clinical professor of medicine at Icahn Mount Sinai and chief medical officer of the National Kidney Foundation. “As a nephrologist, it helps me think about the types of lifestyle modification, patient engagement, medication management and interdisciplinary care that is optimal for my patients.”
The score also can drive changes in larger systems and promote greater cooperation in patient management, said Katherine Tuttle, MD, professor of medicine at the University of Washington, executive director for Research at Providence Health Care, and a co-principal investigator at the Institute for Translational Health Sciences. “If we reduce heart failure hospitalization by identifying and managing higher risk patients more effectively, that would be a huge savings to the healthcare system. If we also prevent cases of kidney failure and the costs associated with treating patients with kidney failure, we will realize enormous cost savings. The triangulation between diabetes, heart failure and chronic kidney disease accounts for one-third of the Medicare budget, and this cost is extensive in the veteran population, as well.”
- Saran R, Pearson A, Tilea A, Shahinian V, et. al.; VA-REINS Steering Committee; VA Advisory Board. Burden and Cost of Caring for US Veterans With CKD: Initial Findings From the VA Renal Information System (VA-REINS). Am J Kidney Dis. 2021 Mar;77(3):397-405. doi: 10.1053/j.ajkd.2020.07.013. Epub 2020 Sep 2. PMID: 32890592.