Keith P. McCullough
The dialysis and transplant community could be treating more than 1 million people for ESRD by the year 2030 as improved efforts to reduce mortality lose the battle against the spread of obesity and escalating hypertension and diabetes.
“The increase in ESRD incidence rates within age and race groups has leveled off and/or declined in recent years, but our model indicates that population changes in age and race distribution, obesity and diabetes prevalence, and ESRD survival will result in a 11% to 18% increase in the crude incidence rate from 2015 to 2030,” Keith P. McCullough, MD, of Arbor Research Collaborative for Health, and University of Michigan colleagues wrote in the Journal of the American Society of Nephrology.
“This incidence trend along with reductions in ESRD mortality will increase the number of patients with ESRD by 29% to 68% during the same period to between 971,000 and 1,259,000 in 2030,” the authors wrote.
Adults who live longer and have kidney failure later in life will provide an added financial burden for the ESRD program.
“The United States population is expected to continue to age both through the baby boomer effect and through generally increased lifespans,” the authors wrote. “Because age is strongly associated with ESRD incidence, the aging population will offset the decreasing age-specic incidence rates ... resulting in an increasing crude incidence rate of ESRD.”
As this older ESRD population ages – approximately 40% of all patients with ESRD were older than 65 years in 2013 – the proportion will increase to 55% to 61%.
“The aging ESRD population will likely affect the types of care provided to the dialysis population, resulting in increases in their sources required for the dialysis population beyond the quantitative increases projected in these analyses,” the authors wrote.
To contain those increasing costs, McCullough and colleagues suggest Medicare – already paying more than $30 billion a year for ESRD treatment - begin looking for more cost-effective ways to provide dialysis and focus on preventive care within the CKD population. Program costs will continue to escalate “unless costs per patient are somehow reduced (eg, through increasing use of more economical treatment modalities for ESRD, such as peritoneal dialysis and home hemodialysis, both of which are cheaper than in-center hemodialysis) ... It is imperative to develop new treatment and prevention options that will ameliorate this projected trend,” they wrote.
The employer of McCullough, Arbor Research Collaborative for Health, has received funding for projects that he has worked on from Amgen, Kyowa Hakko Kirin, Baxter Healthcare, AstraZeneca, Fresenius Medical Care Asia-Pacic Ltd., Janssen, Keryx, Proteon, Roche and Vifor Fresenius Medical Care Renal Pharma.
Please see the study for all other authors’ relevant financial disclosures.