Fully 37 million American adults have chronic kidney disease -- and as many as 90% don't know they have it. Dr. David Cook of OptumLabs joins the podcast to explain why -- and how -- health care is responding.
Nearly 800,000 Americans have irreversible kidney failure and need dialysis or a kidney transplant to survive, and more than half a million of these patients receive dialysis to replace kidney function. In this episode of the Weekly Dose Podcast, Dr. David Cook, Senior Vice President and Senior Research Fellow at UnitedHealth Group's OptumLabs, explains the crisis in kidney care as well as the possible solutions.
Ira Apfel00:04
Hello, and welcome to UnitedHealth Group’s Weekly Dose Podcast, where we'll get you up to speed on the latest trends, shaping the future of health care. And now the podcast is also available on Apple podcast and Spotify. I'm your host Ira Apfel, and this week we're talking about the state of kidney disease and treatment in the United States. It's estimated that 37 million American adults have chronic kidney disease, and approximately 90% don't even know they have it. Additionally, the National Kidney Foundation estimates that nearly 800,000 Americans have irreversible kidney failure and need dialysis or kidney transplant to survive. But more than half a million these patients receive dialysis to replace kidney function. Yet, research shows that kidney care has not rebounded as expected since Americans began going back the doctor in 2021. After staying away in 2020. Clearly, kidney disease and kidney care are major challenges in health care. So how is UnitedHealth Group responding to all this? And how is the health care industry at large responding? Joining me today to discuss kidney disease and treatment is Dr. David Cook, Senior Vice President and Senior Research Fellow at UnitedHealth Group's OptumLabs. Dr. Cook also serves on the board of the National Kidney Foundation. Dr. Cook, welcome to the podcast.
Dr. David Cook01:24
Glad to do it, good morning.
Ira Apfel01:27
So I was wanting to start off, can you give listeners a sense of the challenge here? Why is kidney disease growing in the United States?
Ira Apfel01:35
So kidney disease is primarily driven by diabetes and high blood pressure. Everyone knows that the United States has gotten essentially fatter over the last two or three decades, and as that's occurred, the incidence of diabetes has just gone up. year over year over year. hypertension in this country is also really only well controlled and about 40% of people. And so both of these things, just a hammer the kidneys day after day after day. And so the incidence of kidney disease is tracking right, as these other disease do.
Ira Apfel02:21
Okay, and I'm wondering, what are the costs to patients, and we're also the cost to the health care system to treat these patients
Dr. David Cook02:31
Kidney disease is expensive. I think it's about $130 billion annually. In just in in Medicare. The financial cost is only a small part of this, if kidney disease becomes advanced, and if patients are unable to get transplant, the cost of dialysis to patients and their families is just enormous. dialysis is you know, four times a week for half a day, you know, typically going to a center someplace and it prevents people from working. And it's just super hard on families as well and their caregivers.
Ira Apfel03:22
One of the things that struck me as we were preparing for the this interview today was I was doing some research and I found that 90% of Americans aren't even aware that they have chronic kidney disease. Why are so many people unaware of it?
Dr. David Cook03:42
Well, it's not only that 90% of people are unaware of it. Right now the statistics are about one person in seven, one adult and seven in the United States has got at least early kidney disease. And the reason is, is unlike so many other conditions, kidney disease is clinically silent. It doesn't have symptoms until pretty much your kidneys are shot. And as a result of that people don't seem to care for it. It just tends to fly under the radar and unless you're specifically looking for it, um, it ends up getting not diagnosed. I think also, kidney disease progresses slowly. And in today's health care environment where primary care doctors are just incredibly busy. It kind of goes down to the bottom of their list. And so one of the most important things that we can do as united as a society as physicians and provider organizations like OptumCare is just increase awareness around this problem.
Ira Apfel04:57
And I'm wondering too, how did the pandemic impact kidney care and kidney disease, I imagine it must have been very difficult for patients with end stage renal disease to, you know, get into a dialysis center.
Dr. David Cook05:15
Yeah, the pandemic affected all everyone in this country, it affects certain groups, particularly hard research that we've done with the National Kidney Foundation showed that about Gosh, 35% of care was essentially not delivered during the pandemic, people were not seeing their providers, they were not getting their regular medications, they were not they were not getting their sort of laboratory and on an ongoing assessment. This is an COVID is particularly important in people with later stage disease are on dialysis. Because they're effectively at least mildly immunocompromised, and they tend to be in even a dialysis center, they would be crowded together. So these are at risk people. Additionally, COVID is really compromised kidney function, or put somebody actually in the hospital on dialysis, how this is going to play out long term, we don't know, telemedicine made up for a small part of the gaps in care for this population. But again, we're working with National Kidney Foundation to find out whether that sort of 30% reduction in care that's occurred during the pandemic is going to affect the long-term health trajectory of these patients. And we're trying to communicate around that to make sure these kinds of gaps don't happen in the future. Those are the kinds of things that um, UnitedHealthcare can help support.
Ira Apfel06:54
You know, speaking of dialysis, I'm wondering, too, there's been a broad push in recent years to improve access to at home dialysis. So where does that stand at? What are the challenges that remain? And also, what are the benefits of at home dialysis?
Dr. David Cook07:08
Well, I'm at home dialysis, probably the most important thing is elite, it allows people to potentially lead their lives relatively normally. At home, dialysis is simple. It's something that's done overnight, while a patient is asleep, it's finished when they wake up in the morning, it allows them to go to work, and allows them to sort of live their lives in normal ways, as opposed to, you know, again, going to a dialysis center, you know, every other day, and effectively not being able to work from home dialysis in the United States is much, much, much less common than it is in other places in the world. And some of that is around the incentive. Some of that is around public awareness, public education and public policy. I know that the previous administration is really, really push them initiatives to get dialysis, dumb and dumb in the home. But again, it's going to require ways that we educate people and support them in that option. More important and better than dialysis, though, is pushing to increase kidney transplant. kidney transplant is effectively a cure. And while there's a need for immunosuppressive drugs, essentially, it's effectively a cure. And united has done some things to improve the ability of donors, which is really what the barrier is. I think there's, I don't know the exact numbers it might be one donor for every five or 10 people that need a kidney. But united has made it easier for people to do don't live in donations. But again, it's a matter of, of educating the public and encouraging these kinds of choices. And people need to know that they can donate a kidney and if they're in good health at, you know, age 30 or 40 or 50 and don't have those underlying conditions. A kidney donation is safe and reliable and it's an incredible gift. So that's, that's really a better solution than home dialysis or dialysis at all.
Ira Apfel09:48
Okay, so what I'm hearing from you is UHG and OptumLabs, they're looking at education and they're looking at donation as two prongs in this fight to improve Prove kidney care. Is there anything else that that the enterprise is doing? Are those just the two main thrusts?
Dr. David Cook10:09
Well, those are important because they address that critical problem in late-stage disease. But ultimately, what we really need to do is reduced the number of people who end up in late-stage disease. And that is really focusing on early identification, focusing on surveillance, and educating both physicians and in patients of what they need to do, to essentially arrest the disease. So these this is work we're doing currently with our Medicare and retirement population. Last year, we did a study where we piloted home testing with employees, we looked at about lonely live, we reached out to about 500 employees that had risk factors for from for kidney disease, because they were older, they had diabetes or hypertension, we sent them a home test, just to make it easy to reduce barriers to getting kidney disease identified. Surprisingly, about 40% of people who were sent a home test and no cost didn't return it, which is something we have to figure out how we're going to do, we made it as easy as possible. But of those member of those beneficiaries of those employees, we found that a little more than 20% actually had indications of kidney dysfunction. And what we did was we encourage them to follow up and we'll track those employees over the course of the next year and see whether or not home testing is able to improve their utilization of services and whether they start to get better managed as a result of that. But reducing barriers is going to be important. And educating.
Ira Apfel12:01
You mentioned also several times here at National Kidney Foundation, and obviously UHG and OptumLabs is working pretty closely with them. What are some of the things that you were working on? I know that there's some sort of campaign you undertook last year? What was that about?
Dr. David Cook12:16
Yeah, NKF (National Kidney Foundation), really is trying to increase awareness. And we saw this as such a priority. We essentially replicated the NKF campaign called, you know, are you in the 33%. Really across our networks, then what we did to try to improve awareness of kidney disease is we use social media, we use radio, waves media pitching, and I think we reached at least we touched over about 5 million people. And we invited them to participate in a survey that helped them assess their risk. Because again, if you can, if you if you can identify it, if you become aware, that's the beginning of everything. And important part of that campaign that UHG/UHC did with NKF is when made as a special attempt to reach African American populations. African Americans, you know, struggle, often with access. And their incidence of kidney disease is probably close to three-fold higher than it is in non-African Americans. It's also much higher in Hispanic. So part of that campaign is we use the black Information Network running public service announcements in 23. States, again, trying to increase awareness and pull people in to start to get the kind of services that they needed. What we ended up with, I think, was more than 10,000 people that participated in surveys, where they were able to get an overall kind of estimate of their health risk around kidney disease and a significant number of them, you know, asked to be ongoing participants in research that we do related to kidney health. So we're trying to work this from all possible directions.
Ira Apfel14:36
Well, Dr. David Cook, thank you so much for being on the podcast with us today.
Dr. David Cook14:41
Glad to do it. I'm so pleased to be able to share this message. Thank you.
Ira Apfel14:46
That's it for this episode of UnitedHealth group's weekly dose podcast. In the coming weeks, we'll be discussing more trending health care topics including the future of nursing, community-based health care and more. And don't forget, you can now subscribe to the weekly dose of Apple podcast and Spotify. Thanks for listening and have a great rest of your week.