Here's a breakdown of some of the highlights from Days 1 and 2 of the 2022 National Kidney Foundation (NKF) Spring Clinical Meeting.
The National Kidney Foundation (NKF) 2022 Spring Clinical Meeting kicked off with a broad range of educational, multidisciplinary sessions exploring a variety of topics and highlighting clinical practices strategies and emerging research in the field of nephrology.
Below are some of the highlights from Day 1 of the NKF 2022 Spring Clinical Meeting.
A Look at Medicare Advantage in Kidney Care
Kidney care is often divided into three separate categories: pre-dialysis, dialysis, and transplantation care. But can care coordination bridge the gap between them? On Day 1 of the National Kidney Foundation’s Spring Clinical Meeting, Dr. Eugene Lin and Dr. Sri Lekha Tummalapalli chaired the “Is It Care Coordination’s Turn to Finally Shine?” session on private health plans, transplantation, and care coordination to improve care for patients with late-stage kidney disease.
The first presentation was given by Dr. Stanley Crittenden, Chief Medical Officer at Evergreen Nephrology, on Medicare Advantage, Special Needs Plans, and the 21st Century Cures Act.
Dr. Crittenden began with a brief history of Medicare, explaining how politically charged this policy has been since its initial inception back in 1912, and gave an overview of Medicare health plans available, with a focus on one plan in particular: Medicare Advantage and Special Needs Plans. According to him, Medicare Advantage can play a key role in improving care coordination for patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
According to Dr. Crittenden, There are a few other components that make Medicare Advantage the best option for our patients with kidney disease, including:
- Dynamic value-based contracts with nephrologists to drive incentives for providers
- Strategies to help close primary care gaps, such as HEDIS and STARS care gaps and screening gaps
- Virtual platforms and telemedicine benefits to help meet patients where they are
- Resources for home care to provide cost-effective healthcare for our patients
To end the session, Dr. Crittenden detailed how Medicare Advantage has been positioned to improve kidney care by removing barriers to treatment with limited copays and staff-assisted home dialysis treatments and explained how it might be the right option for our patients.
Getting Out of the Dialysis Rut & Paving the Way to Transplantation
Staying on the topic of dialysis, Dr. Eliot Heher, Founder of Square Knot Health, presented strategies to improve kidney transplantation.
He began by walking us through the current barriers to kidney transplantation. According to Dr. Heher, because of the U.S.’s dialysis-first approach to kidney disease, 30% of patients are never referred to a nephrologist, 30% have unplanned “crash dialysis,” and 30-75% are never referred to a transplant evaluation.
What’s contributing to these limitations is that of the 300,000 new, stage 4 chronic kidney disease patients and 400,000 potential donors, there are only 200 transplant centers and just about 700-1,000 transplant nephrologists and coordinators.
By broadening access to transplants and increasing resources for donor education, assessment, and support, nephrologists can help our patients, especially those with failing kidneys, get kidney transplants more quickly and easily. Broadening access and increasing resources can also:
- Improve equity in the system for all races and ethnicities
- Encourage the use of living donors—an opportunity that hasn't been maximized in the U.S.
- Increase opportunities for preemptive transplant
- Identify and address individual barriers to transplant and live donation
- Motivate candidates to pursue healthy behaviors
- Help meet patients’ expectations that all patients will have a chance at a transplant
- Accurately quantify the population that is waiting for a kidney transplant
Dr. Heher ended his session by turning his attention back to the patient, where he explained that increasing access to transplants can be the antidote for decreasing motivation in these patients. Increased access could have a halo effect, leading to delayed CKD progression, improved adherence to dialysis, and reduced hospitalizations and ED visits.
The Free Market’s Response to Care Coordination
In the final presentation of the session, three clinical experts shared their perspectives on how the free market has responded to the need for improving care coordination.
Dr. Shika Pappose, Chief Medical Officer at Strife Health, shared how the kidney space has changed due to things like value-based care, and how clinicians are beginning to take a closer look at upstream care, focusing on screening for CKD, slowing disease progression, managing complications, and educating patients. And while these benefits have improved kidney care, there’s still work to be done when it comes to improving care coordination.
Dr. Abi Sundaramoorthy, Executive Vice President of the Clinical Enterprise at Somatus, agreed with Dr. Pappose, explaining that about 400,000 patients die every year due to errors and/or acquired conditions from the hospital and that care coordination needs improvement in order to prevent these things from happening.
Following that, Dr. Carmen Peralata, Chief Medical Officer at Cricket Health, shifted the focus back to value-based care to explain that while this is one of the bigger opportunities in kidney care, payers and policymakers need to be doing more to focus on multidisciplinary care and health equity. Implementing care coordination much earlier in the journey can help preemptively eliminate the risk of that first hospitalization.
Overall, all three clinicians agreed that care coordination can drive down unnecessary utilization of resources and eliminate unnecessary trips to the hospital, resulting in optimized care and minimized risk for our patients.
Tips & Tricks for Battling the Inflammation Beast
Led by dietician Ms. Melissa Prest from the National Kidney Foundation of Illinois, the “Tips and Tricks for Battling the Inflammation Beast” session focused on key interventions to help nephrologists address the different contributors of inflammation in their patients with chronic kidney disease (CKD).
Ms. Prest began by defining that inflammation is triggered by a tissue injury and can be either acute or chronic. There are a variety of factors that contribute to chronic inflammatory status in CKD, and one inflammatory marker is albumin, which is the most abundant plasma protein.
Lower serum albumin is associated with a higher risk of kidney function decline and is a strong predictor of adverse prognosis, which is why Ms. Prest urged the importance of monitoring inflammatory markers like albumin earlier on in the disease. In fact, clinical studies have determined that inflammatory markers are associated with many complications, like malnutrition and atherosclerosis.
Fortunately, there are several strategies for treating inflammation in CKD, including dietary modifications. After all, the risk of CKD itself is dependent on genetics and environment, and a patient’s diet is one environmental factor that could contribute to this disease. That’s why Ms. Prest outlined the following anti-inflammatory diet principles:
- High in fiber
- High in plant foods
- Contains prebiotics and probiotics
- Low in sugar
- Relies less on animal protein
- Includes fats from omega-3 sources, mono- and polyunsaturated fats
The Mediterranean and DASH diets are two examples of diets that follow the above principles; they’re even noted in the 2020 guidelines for nutrition management in CKD.
To further help nephrologists and their patients battle inflammation through dietary modifications, Ms. Prest also recommended the following cooking methods to reduce their intake of advanced glycation end products (AGEs):
- Cook at lower temperatures for a longer time
- Use moist cooking methods like steaming and stewing
- Marinate meats in acidic compounds
- Fill plates with fruits, vegetables, and grains
- Cook more at home
However, Ms. Prest noted that treating chronic inflammation in CKD requires a combination of interventions, so dietary changes alone may not be enough and should be added onto the following strategies:
- General lifestyle modifications, like addressing depression, increasing physical activity, addressing oral health and periodontal disease, and smoking cessation
- Anti-wasting strategies, like resistance training, appetite stimulants, growth hormone, and myostatin inhibition
- Anti-oxidate treatment strategies
- Targeted anti-cytokine treatment
All of these strategies combined can help nephrologists and their CKD patients combat inflammation and, as a result, positively influence clinical outcomes.
Laughter Therapy in Dialysis: Exercise, Activity, & Wellness
Dialysis patients suffer from higher rates of mental health conditions such as anxiety and depression, but laughter therapy may help improve their overall well-being.
On Day One of the NKF Spring Clinical Meeting, a session titled “Laughter Therapy in Dialysis: Exercise, Activity, & Wellness,” hosted by Dr. Paul Bennett, Former Director of Research and Contractor at Satellite Healthcare; Dr. Brigitte Schiller, Chief Medical Officer at Satellite Healthcare; and Robert Rivest, Certified Laughter Yoga Master Trainer, explored Intradialytic Laughter Therapy programs and how laughter can be used for patients with end-stage kidney disease (ESKD) on dialysis.
While it’s a relatively new strategy, laughter therapy and laughter yoga have been used as social work interventions for various chronic conditions, including arthritis, heart disease, cancer, and COPD, and have been proven to benefit patients.
Specifically for patients with ESKD, long periods of dialysis can lead to inactivity and decreased time with friends and family. Hemodialysis patients report lower happiness compared to the general population. But laughter can lead to positive changes in several ways.
In a clinical sense, laughter is complex, involves all senses, and can release dopamine, endorphins, oxytocin, and serotonin. Laughter can improve respiratory function, cardiac function, immune response, and pain mechanisms. Laughter has even been proven to increase pain tolerance.
Emerging data from a randomized, controlled trial shows that laughter therapy during every dialysis for eight weeks led to the following:
- Reduced depressive symptoms in a hemodialysis cohort
- Improved feelings of achievement
- Strengthened relationships
- Heightened sense of community
The session concluded by emphasizing the effectiveness of laughter therapy and reiterating the science behind laughter, and the presenters encouraged nephrologists to incorporate this type of therapy in their clinical practice to help improve patient outcomes.