Kidney failure is a growing crisis in the U.S. — especially in LTC Facilities

The Kidney Failure Crisis In the US


In 2018, 786,000 Americans were living with ESRD ( end-stage renal disease)


80% of patients with ESRD are age 65+


The Financial Impact of Kidney Disease


In 2018, total Medicare spending on patients with ESRD reached $49 billion — Up 11% from 2009 (adjusted for inflation)
Hemodialysis: $93,191 per patient per year
Peritoneal dialysis: $78,741 per patient per year
Transplant care: $37,304 per patient per year


Patients with ESRD make up 1% of Medicare beneficiaries, but account for 7% of Medicare spending
Yet mortality risk for kidney failure is higher in the United States than in countries that spend less on kidney care
15% higher than in Europe
33% higher than in Japan


Dialysis Treatment Options


70% of patients with ESRD are undergoing dialysis — 30% have functioning kidney transplants


Location


86% – Outpatient Hemodialysis
The patient travels to the clinic multiple times for treatment
The clinical staff is present during treatments

12% – At Home Peritoneal Dialysis
The patient receives treatment in the comfort of their own home
Clinical staff provide training, oversight, and equipment
<2% – At Home Hemodialysis
The patient receives treatment in the comfort of their own home
Clinical staff provide training, oversight, and equipment


Home Hemodialysis Treatment Options (Weekly treatment time)


Option one:
Conventional (3-day) Dialysis
9 – 12 HOURS per week


Option two:
Daily Dialysis
10 – 21 HOURS per week


For too long, the industry has focused on the needs of active, middle-aged dialysis patients and failed to address the needs of a growing nursing home population


The Nursing Home Dialysis Dilemma


The Limits of Outpatient Services


Outpatient dialysis clinics are not designed for nursing home residents
Outpatient treatment poses an infection risk — for dialysis patients, staff, and other residents
Highly acute residents struggle to find placement at outpatient clinics
Traveling to a dialysis clinic is disruptive, confusing, and time-consuming
Outpatient providers have failed to address the needs of an aging population of patients with ESRD, especially nursing home residents


Nursing Homes Need 3-Day On-Site Dialysis (Not Daily)


Benefits for Residents with ESRD


Conventional dialysis is provided on-site, eliminating outpatient drawbacks
98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis
Switching to daily dialysis requires prescription changes
Changes may cause confusion and disrupt the continuity of care
On-site, 3-day dialysis requires 17% less treatment time than daily dialysis and eliminates hours of travel time per week
More time for therapies and social activities
Decreased risk of infection and complications
Daily dialysis carries greater risk potentially leading to hospitalization or surgery, and greater opportunity for missed treatments
Greater opportunity for missed treatments
Higher risk of complications
Difficulty with the blood-access site
Blood clots
Aneurysms


Benefits For Nursing Home Operators


On-site dialysis is at the forefront of clinical innovation
Better collaboration of care
Fewer hospital readmissions
A stronger relationship with hospital partners
Nursing homes with on-site dialysis can accept higher acuity patients
Eliminate transportation costs
Providing ambulance transportation for outpatient dialysis may cost nursing home operators up to $411 per round trip


For the same initial investment on-site, 3-day dialysis provides treatment to 3x more patients than daily dialysis


6 chairs can support

3-day dialysis can support 36 patients
Daily dialysis can support only 12 patients


Large dialysis providers have failed to deliver effective and flexible treatment for nursing home patients, highlighting the need for a different model


Concerto Renal Services is the Solution


Nursing homes need in-house dialysis care designed for geriatric patients

Sources:


https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities


https://pharm.ucsf.edu/kidney/need/statistics


https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease


https://www.kidney.org/atoz/content/homehemo


https://pharm.ucsf.edu/kidney/need/statistics


https://skillednursingnews.com/2020/04/as-hospitals-struggle-to-free-up-beds-and-nursing-homes-lock-down-in-house-dialysis-provides-relief/


https://www.sciencedirect.com/science/article/pii/S2590059520302065


https://www.mcknights.com/news/cms-cuts-to-ambulance-pay-for-dialysis-will-devastate-access-for-some/


https://www.medicinenet.com/script/main/art.asp?articlekey=167667


https://renprors.com/benefits-of-nursing-home-dialysis-over-outpatient-clinic/


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393476/

KIDNEY FUNCTION


Ninety-five percent of the population is born with a pair of kidneys, located on the right and left sides of one’s upper abdomen. Shaped like beans and about the size of a fist, kidneys perform the critical function of keeping your body clean by removing waste and unwanted fluids.


The kidneys work as a pair of filters for the body’s blood, cycling numerous times daily. The process includes the following steps:

1. The renal artery carries blood to the kidneys directly from the heart.
2. The blood is filtered clean by means of millions of tiny filters – called nephrons – inside each kidney.
3. The clean blood is filtered through to the body while the collected waste is sent to the bladder by means of tubes called ureters.
4. The waste is stored in the bladder as urine and expelled.


Our kidneys work around the clock cleaning our blood and keeping our body healthy.


WHAT CAUSES KIDNEY FAILURE


Untreated kidneys malfunction leads to organ failure as more and more nephrons stop working. Some of the most common reasons that lead to kidney failure include the following:


An unaddressed blood pressure condition
A condition inherited from earlier generations, e.g. cysts
Recurring infections in the urinary tract
Unflushed deposits of waste called kidney stones
Persistent drug abuse
Poorly managed diabetes


COMMON DISORDERS THAT AFFECT KIDNEYS


A number of disorders develop in the kidneys when the organs begin to deteriorate. In most cases, kidney disorder leads to eventual failure. This condition is often called Chronic Kidney Disease. This disease is briefly described below.


CHRONIC KIDNEY DISEASE (CKD)


CKD may take years to develop, potentially growing unnoticed, and ultimately escalating to its most detrimental phase called End-Stage Renal Disease (ESRD). Once it has reached the ESRD phase, CKD can only be treated with frequent rounds of hemodialysis or organ transplant.


SYMPTOMS OF ESRD:


While CKD grows quietly in the kidneys – often without any noticeable sign of disease – it can be diagnosed based on the following symptoms, which usually manifest in an affected pair of kidneys:


Swelling of limbs and parts of the face
Continuous exhaustion and fatigue
Sour taste in the mouth
Persistently high blood pressure
Loss of appetite


TREATMENT OF ESRD:


Dialysis treatment is provided for patients who have developed ESRD with a loss of at least 85% of kidney function. Dialysis keeps the body functioning by removing waste, salt, and excess fluids from the body, maintaining a safe level of certain chemicals in the blood, such as potassium, sodium, and bicarbonates.


Dialysis can be performed in a hospital, healthcare center, outpatient clinic, or at home. Patients suffering from ESRD should speak to their doctors about the treatment option that suits them best.


ESRD and NUTRITION


Healthy eating habits are important for everyone, but especially for those with ESRD. Good nutrition can help to maintain energy levels, prevent infection, avoid muscle loss, and slow down the progression of kidney disease.


Patients with ESRD may need to monitor the amount of protein, sodium, potassium, phosphorus, and calcium in their diet. Consult with a doctor or registered dietician about maintaining a balanced diet in order to stay healthy and feeling well.