To Fulfill The Promise Of Innovation In Kidney Disease Treatment, Congress Must Step Up – Health Affairs

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Several exciting developments this fall offer new opportunities to improve the health of the 37 million adults in the United States who have kidney disease. By recommending new equations to estimate kidney function that do not include race, nephrology took a meaningful step toward health care justice. More accurate and timely diagnosis will improve efforts to identify kidney disease in its earlier, more treatable stages, and will ensure that patients have equitable access to the transplant waitlist.
Equally exciting, surgeons are breaking new ground by transplanting genetically modified pig kidneys into humans. Once tested in clinical trials, this therapy—known as xenotransplantation—could provide an answer for the nearly 100,000 Americans on the waitlist for a donor kidney. Given what Medicare spends annually for dialysis, the financial implications of this advancement are almost as astonishing as the science.
While these developments are important steps in our fight against kidney disease, meaningful progress continues to be constrained by the federal government’s underinvestment in kidney-related prevention, research, and innovation activities. Through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institutes of Health (NIH) funds initiatives on developing precision medicine, addressing health disparities, and identifying ways to slow the progression of kidney disease and prevent kidney failure. But funding levels are woefully inadequate to deliver on their promise, especially when compared to other diseases.
The federal government spends an estimated $305 per patient on cancer research and $50 per patient on heart research, but only $18 per patient on kidney research. Funding for the Chronic Kidney Disease Initiative at the Centers for Disease Control and Prevention (CDC)—the only federal program exclusively focused on preventing or slowing the progression of kidney disease—is even more inadequate, with a budget of $2.5 million per year, or less than 10 cents per kidney patient. The paltry funding for kidney research and prevention stands in contrast to the fact that Medicare spends an estimated $130 billion on kidney care, including nearly $30 billion to provide dialysis to 554,000 Americans with kidney failure.
Even worse, NIDDK was one of the few institutes not to receive research funding in the COVID-19 packages last year, even though clear connections exist between the virus and your kidneys. People with kidney disease are more vulnerable to COVID-19 and experience some of the highest rates of hospitalization and death from the virus, while people with perfectly healthy kidneys often experience kidney damage because of the virus.
KidneyX—a public-private partnership between the Department of Health and Human Services (HHS) and the kidney community—has shown that it can incentivize new innovators to create solutions for people with kidney disease. One of us, coauthor Ibrahim, leads the American Society of Nephology (ASN), which serves as secretariat for KidneyX and collaborates with HHS to run competitions that incentivize innovators to address unmet needs. The KidneyX Steering Committee includes innovators, investors, nephrologists, and patient advocates, such as the coauthor Longino, CEO of the National Kidney Foundation (NKF).
Launched in 2019, KidneyX’s Redesign Dialysis competition awarded 21 innovators developing technologies that replicate normal kidney function and improve quality of life. This competition was followed in 2020 with a Patient Innovator Challenge, sponsored by ASN and NKF, that awarded 25 prizes. The winners included a smartphone app to monitor the results of blood tests, an app to help transplant patients keep track of their medicines, a 3D-printable wrist cuff to secure needles used in home dialysis, and a peer mentorship program for dialysis patients.
With more than 60 awards given to date, KidneyX is contributing to innovations, such as the development of a wearable or implanted artificial kidney, as well as funding xenotransplantation approaches alongside other technological advances. Multiple companies have received follow-on funding from government and the private sector, including two companies that closed initial public offerings for $275 million in 2020 and $43 million this year. For KidneyX to reach its true potential, Congress must significantly increase its investment in innovation.
In September, the cochairs of the Congressional Kidney Caucus—Representative Suzan DelBene of Washington State and Representative Larry Bucshon of Indiana—called for shifting federal policy from treating kidney failure to promoting kidney health. To accomplish this goal, they emphasized the need for more federal funding for kidney research, prevention, and KidneyX.
To guarantee that the more than 37 million Americans with kidney disease receive the care they deserve, Congress and the Biden Administration must increase funding for kidney research at NIH, KidneyX, and CDC’s Chronic Kidney Disease Initiative as well as include kidney research in any future funding related to the COVID-19 pandemic. We urge the Senate to support the House-passed $6.5 billion increase to NIH funding in fiscal year 2022, which includes a $106 million boost to NIDDK; expand the House’s $5 million appropriation to KidneyX to $25 million; and double the House’s investment in the Chronic Kidney Disease Initiative from $2.5 to $5 million.
By stepping up in this way, Congress and the Biden Administration will help ensure the success of NKF’s efforts to raise public awareness of kidney disease and ASN’s efforts to redefine the specialty. Through the “Are You the 33%?” campaign, NKF is highlighting that one in three adults in the United States are at risk for kidney disease, and most don’t know it.
ASN’s “United 4 Kidney Health Campaign” has four priorities: intervene earlier, transform transplant, accelerate innovation, and achieve equity. By raising public awareness and improving kidney health, NKF and ASN will make sure that increased federal funding will benefit the more than 37 million Americans with kidney disease.

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