Future direction of health for kidney disease

The first ever treatment for kidney failure was created and executed by Willem Kolff and Belding Scribner in 1943 (Himmelfarb et al., 2020) Kolff and Scribner pioneered the artificial kidney to provide patients with acute kidney injury an opportunity to live longer by undergoing the process of “Dialysis”. Fast forward to the 21st century and the medical application of dialysis has been expanded to various modalities such as hemodialysis, peritoneal dialysis, and home dialysis. As I reflect in my clinical setting working in nephrology I do wonder what the outcome would have been for the end stage kidney failure population if dialysis was never pioneered.

However, there is the constant pressure to innovate and facilitate on-going improvements in kidney treatments to meet the future challenges for the chronic kidney disease population. In Canada alone, the number of patients receiving dialysis has nearly doubled in the past 20 years (Canadian Institute for Health Information, 2020). Further to that, the demand for kidney disease treatment is constantly growing and the rate for renal replacement therapy grows by 1.1% per year (Canadian Institute for Health Information, 2020). There has been an ongoing demand for maintenance renal treatments nationwide but the increased general population in major cities such as Toronto, Vancouver, Montreal, etc. has made real estate costs soar for property access to in-center renal replacement options (Blake, 2020). Renal program’s have to pivot to providing and expanding renal replacement services which can be done in patients home’s to sustain current and future demands.

The challenge of constant demand and limited supply for kidney replacement therapy seems to be a global issue and is familiar to our North American neighbors. The United States has been actively pushing home dialysis treatments for present and future kidney replacement therapy demands. In early 2021, the US Department of Health and Human Services (HHS) announced the goal of changing reimbursement payments to encourage a shift to home dialysis modalities and kidney transplantation. (Chan et al., 2020). It was noted that high and densely populated areas such as Guatemala and Hong Kong had high margins of home dialysis rates and showed that developed countries are beginning to embrace home dialysis options.

Home dialysis and kidney transplantation options for kidney replacement therapy has become the future-state standard for many developing and developed nations, but still faces challenges to implement. Low patient awareness and education has been a significant barrier to increasing treatment volumes for home dialysis patients (Chan et al., 2020). Reducing incident dialysis starts by initiating patient education and awareness of dialysis modalities early in the Chronic Kidney Disease journey will provide more time and acceptance to home dialysis modalities.

Although there are challenges to meet renal replacement treatments demands, it’s comforting to know that innovation and supportive policies are continuously being implemented to further the work which Kolff and Scribner began. In July 2019, Former President Donald Trump signed an executive order on Advancing American Kidney Health (AAKH). AAKH calls on departments of health to support approval of wearable and implantable artificial kidneys and welcomes other strategies to facilitate innovation in dialysis services (Himmelfarb et al., 2020). Although I am not inclined to be in such a scenario, It's exciting to think that one day patients requiring renal replacement treatment can “strap on” their artificial kidney and go about their regular day.

References:

Blake, P. G. (2020). Global dialysis perspective: Canada. Kidney360, 1(2), 115.

Canadian Institution for Health Information. (2020). Trends in end-stage kidney disease in Canada, 2020 — Infographic. https://www.cihi.ca/en/trends-in-end-stage-kidney-disease-in-canada-2020-infographic

Chan, C. T., Collins, K., Ditschman, E. P., Koester-Wiedemann, L., Saffer, T. L., Wallace, E., & Rocco, M. V. (2020). Overcoming barriers for uptake and continued use of home dialysis: an NKF-KDOQI conference report. American Journal of Kidney Diseases, 75(6), 926-934.

Himmelfarb, J., Vanholder, R., Mehrotra, R., & Tonelli, M. (2020). The current and future landscape of dialysis. Nature Reviews Nephrology, 16(10), 573-585.