The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Abstract

The Healthy People 2020 initiative established goals for patients with CKD and ESRD. We assessed United States progress toward some of these key goals. Using data from the Centers for Medicare and Medicaid Services ESRD database, we created yearly cohorts of patients on incident and prevalent dialysis from 2000 to 2013. Change in event rate or proportion change over the study years was modeled using Poisson regression with adjustment for age, race, sex, and primary cause of ESRD. For all-cause mortality in prevalent patients, Healthy People 2020 sought approximately 0.8% relative annual improvement; actual improvement was 2.7%. Improvement was greatest for patients ages 18-44 years old (3.8%; P<0.01 versus 2.8% for ages 65-74 years old) and 2.3% even for patients ages ≥75 years old. For mortality in incident patients, the relative annual decrease was 2.1% overall, a twofold improvement over the goal; mortality decreased nearly twice as much in black as in white patients (3.2% versus 1.8%; P<0.001). Geographic variation was substantial; the relative annual decrease was 0.6% in the Midwest and more than fourfold greater (2.7%) in the South. Cardiovascular mortality in prevalent patients decreased dramatically at 5.0% per year, far exceeding the annual goal of approximately 0.8%; the decrease was greatest in patients ages ≥75 years old (5.5%; P<0.001 versus ages 65-74 years old; 5.1%). The relative annual increase in percentages of patients with a fistula at dialysis initiation was 2.4%, roughly three times the goal; the increase was greater for black than white patients (3.2% versus 2.3%; P<0.01). Adjusted regional differences varied greater than twofold: 2.0% for the South versus 4.1% for the Midwest. Thus, although gains have been substantial, not all groups have benefitted equally. Goal development for Healthy People 2030 should consider changes in goal paradigms, such as tailoring by geographic region and incorporating patient-centered goals.

Don't Pick the PICC

“…Providers have treated chronic kidney failure with hemodialysis for decades. Increasing fistula placement in hemodialysis patients has been a national public health priority . Peripherally inserted central catheters were originally invented to administer hypertonic parenteral nutrition solutions that normally required central venous catheters (CVCs).…”

Burden of end‐stage renal disease and evolving challenges in kidney transplantation

“…In the past decades, chronic kidney disease (CKD) has become a major public health problem, as it is associated with increased morbidity, mortality, and social and healthcare expenditures . The World Health Organization (WHO) has recognized the burden posed by CKD, promoting focused national programs . The observed shifting epidemiology of ESRD from glomerulopathies to diabetic and vascular nephropathies, mirroring cardiovascular morbidity trends in the general population, emphasizes that renal health should be considered as a medical priority.…”

“…These improved outcomes could be the result of many factors, including a decrease in cardiovascular morbimortality because of early management and the use of less invasive therapeutic procedures, technological progresses in the field of dialysis, as well as optimized medical therapy and follow‐up after transplantation. Thus, the current improved care has resulted in an increase of ESRD patients needing specialized and expensive procedures , a trend that is unlikely to change in the upcoming years. It also implies older patients and patients with important comorbidities on dialysis and awaiting transplantation.…”

Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

“…CVD is responsible for 2 of every 5 deaths in prevalent dialysis patients and remains the leading cause of hospitalization in this population. 1,2 Although CVD-related outcomes have improved in recent years, 3 CVD in dialysis patients remains a substantial burden for patients, providers, payers, and society in general.…”