clearn.png
Thursday September 19th, 2019 9:26PM

Trump directs government to revamp care for kidney disease

By The Associated Press
Related Articles
  Contact Editor

WASHINGTON (AP) — President Donald Trump signed an executive order Wednesday revamping care for kidney disease so more people whose kidneys fail can have a chance at early transplants and home dialysis, and others don't get that sick in the first place.

Trump said his order was aimed at "making life better and longer for millions" by increasing the supply of donated kidneys, making it easier for patients to have dialysis in the comfort of their own homes and prioritizing the development of an artificial kidney.

The changes won't happen overnight because some initiatives will require new government regulations.

Because a severe organ shortage complicates the call for more transplants, the Trump administration will try to ease the financial hardships for living donors by reimbursing them for expenses such as lost wages and child care.

"Those people, I have to say, have never gotten enough credit," Trump said. "What they do is so incredible."

Another key change: steps to help the groups that collect deceased donations do a better job. Trump said it may be possible to find 17,000 more kidneys and 11,000 other organs from deceased donors for transplant every year.

For families like those of 1-year-old Hudson Nash, the lack of organs is frightening. Hudson was born with damaged kidneys, and his parents hope he will be big enough for a transplant in another year. Until then, "to keep him going, he takes numerous medicines, receives multiple shots, blood draws and more doctors' visits than I can count," said his mother, Jamie Nash of Santa Barbara, California.

Today's system favors expensive, time-consuming dialysis in large centers — what Trump called so onerous "it's like a full-time job" — over easier-to-tolerate at-home care or transplants that help patients live longer.

More than 30 million American adults have chronic kidney disease, costing Medicare a staggering $113 billion.

Careful treatment — including control of diabetes and high blood pressure, the two main culprits — can help prevent further kidney deterioration. But more than 700,000 people have end-stage renal disease, meaning their kidneys have failed, and require either a transplant or dialysis to survive. Only about one-third received specialized kidney care before they got so sick.

"My health care providers failed me at the beginning of the dialysis continuum," said transplant recipient Tunisia Bullock of Rocky Mount, North Carolina. Her kidney failure struck while she was being treated for another disease, and she woke up in the hospital attached to a dialysis machine. She told Trump that she hoped the new initiatives help other patients find care "with less confusion and more ease."

More than 94,000 of the 113,000 people on the national organ waiting list need a kidney. Last year, there were 21,167 kidney transplants. Of those, 6,442 were from living donors, according to the United Network for Organ Sharing, which oversees the nation's transplant system.

"The longer you're on dialysis, the outcomes are worse," said Dr. Amit Tevar, a transplant surgeon at the University of Pittsburgh Medical Center, who praised the administration's initiatives.

Too often, transplant centers don't see a kidney patient until he or she has been on dialysis for years, Tevar said. While any transplant is preferable, one from a living donor is best because those organs "work better, longer and faster," Tevar said.

Among the initiatives that take effect first:

—Medicare payment changes that would provide a financial incentive for doctors and clinics to help kidney patients stave off end-stage disease. The goal is to lower the number of new kidney failure cases by 25% by 2030.

—a bonus to kidney specialists who help prepare patients for early transplant, with steps that can begin even before they need dialysis.

—additional Medicare changes so that dialysis providers can earn as much by helping patients get dialysis at home as in the large centers that predominate today. Patients typically must spend hours three or four times a week hooked to machines that filter waste out of their blood.

Home options include portable blood-cleansing machines, or what's called peritoneal dialysis that works through an abdominal tube, usually while patients are sleeping.

Today, about 11% of patients in kidney failure get at-home dialysis and an additional 3 percent get an early transplant. By 2025, the goal is to have 80% of people with newly diagnosed kidney failure getting one of those options, officials said.

These changes are being put in place through Medicare's innovation center, created under the Obama-era Affordable Care Act and empowered to seek savings and improved quality. The administration is relying on the innovation center even as it argues in federal court that the law that created it is unconstitutional and should be struck down entirely.

Other initiatives will require new regulations, expected to be proposed later this year. Among them:

—allowing reimbursement of lost wages and other expenses for living donors, who can give one of their kidneys or a piece of their liver. The transplant recipient's insurance pays the donor's medical bills. But donors are out of work for weeks recuperating, and one study found more than one-third of living kidney donors reported lost wages, a median of $2,712, in the year following donation. Details about who pays and who qualifies still have to be worked out.

—clearer ways to measure how well the nation's 58 organ procurement organizations, or OPOs, collect donations from deceased donors. Some do a better job than others, but today's performance standards are self-reported, varying around the country and making it difficult for government regulators or the OPOs themselves to take steps to improve.

"Some OPOs are very aggressive and move forward with getting organs allocated and donors consented, and there are those that are a little more lackadaisical about it," said Pittsburgh's Tevar. Unlike the medical advances in transplantation, "we haven't really made big dents and progress and moves in increasing cadaveric organs or increasing live donor options."

___

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

  • Associated Categories: Associated Press (AP), AP National News, AP Online National News, Top General short headlines, AP Online Headlines - Washington, AP Health, AP Business, AP Business - Personal Finance
© Copyright 2019 AccessWDUN.com
All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.
Trump directs government to revamp care for kidney disease
President Donald Trump has signed an executive order directing the government to revamp the nation's care for kidney disease so more people whose kidneys fail have a chance at early transplants and home dialysis
12:51PM ( 7 minutes ago )
Amal Clooney faults 'collective shrug' over slain journalist
Human rights lawyer Amal Clooney, the British government's envoy on media freedom, has accused world leaders of failing to protect journalists and responding with "a collective shrug" to the murder of Saudi writer Jamal Khashoggi
12:48PM ( 9 minutes ago )
Valentina Cortese, Italian screen diva, dead at 96
Valentina Cortese, one of Italy's postwar screen divas, has died at age 96
12:47PM ( 10 minutes ago )
Associated Press (AP)
US appeals court sides with Trump in lawsuit involving hotel
A federal appeals court has ordered the dismissal of a lawsuit accusing President Donald Trump of illegally profiting off the presidency through his D.C. hotel
12:28PM ( 29 minutes ago )
Ivanka Trump women's initiative announces $27M in grants
A White House initiative spearheaded by Ivanka Trump to help women in developing countries get ahead economically is announcing $27 million in grants to 14 projects in 22 countries
12:11PM ( 47 minutes ago )
The Latest: Powell says deficits on 'unsustainable path'
Fed Chairman Powell says federal government budget deficits on 'unsustainable path'
12:09PM ( 48 minutes ago )
AP Online Headlines - Washington
Will and Jada Pinkett Smith launch media venture
Will and Jada Pinkett Smith are looking to expand their brands under a new corporate umbrella
12:09PM ( 49 minutes ago )
On Caribbean island whispers, suspicion about Epstein
Ask about Jeffrey Epstein on St. Thomas and rooms go quiet. When Epstein pleaded guilty in a 2008 to soliciting and procuring a minor for prostitution, his need for privacy on his private island began to appear more sinister to many.
12:02PM ( 56 minutes ago )
Stocks rise, led by tech sector, as Fed signals rate cut
Stocks are moving higher in morning trading as Wall Street welcomes new signals from the Federal Reserve that the central bank is ready to cut interest rates for the first time in a decade
11:46AM ( 1 hour ago )
AP Business
Trump directing government to revamp care for kidney disease
President Donald Trump is directing the government to revamp the nation's care for kidney disease, so that more people whose kidneys fail have a chance at early transplants and home dialysis
7:11AM ( 5 hours ago )
Trump revamps kidney care to spur transplants, home dialysis
President Donald Trump is directing the government to revamp the nation's care for kidney disease, so that more people whose kidneys fail have a chance at early transplants and home dialysis
6:11AM ( 6 hours ago )
Biden earned more than $15 million after leaving White House
Joe Biden's newly released presidential tax returns and financial disclosure show that he and his wife, Jill, have earned more than $15 million since leaving the Obama White House
6:05AM ( 6 hours ago )
AP Business - Personal Finance
Amal Clooney faults 'collective shrug' over slain journalist
Human rights lawyer Amal Clooney, the British government's envoy on media freedom, has accused world leaders of failing to protect journalists and responding with "a collective shrug" to the murder of Saudi writer Jamal Khashoggi
12:48PM ( 9 minutes ago )
Trump is going to Wisconsin to push for trade deal
Trump will be traveling to Wisconsin to push for Congress to pass the new trade deal with Mexico and Canada
12:47PM ( 10 minutes ago )
The Latest: Soccer federation head: Women deserve fair pay
U.S. Soccer Federation President Carlos Cordeiro says female athletes "deserve fair and equal pay."
12:34PM ( 24 minutes ago )
Hong Kong protesters to continue after bill declared 'dead'
Protesters opposed to the administration of Carrie Lam say they will continue their demonstration movement even after she declared that the effort to amend a highly contentious extradition bill is "dead."
12:32PM ( 25 minutes ago )
'History on a stick' signs disappearing too fast to keep up
Hurricanes, thievery and wrecks are taking out North Carolina's popular historical highway markers faster than the state can keep up
12:30PM ( 27 minutes ago )