Issue: December 2019
October 14, 2019
2 min read

Nurses look at challenges, opportunities of Advancing American Kidney Health

Issue: December 2019
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Tamara Kear

SAN DIEGO — Nephrology nurses are optimistic Advancing American Kidney Health will improve kidney care. However, getting to the goals set by HHS will be challenging and could stress a nephrology nursing profession already facing a future workforce shortage.

“When you look at what the president announced and what he focused on ... I think everyone here and everyone in the community would agree that the number of cases of CKD and ESRD are high,” James Twaddell, health policy consultant for the American Nephrology Nurses Association, said during panel discussion of the executive order at the American Nephrology Nurses Association’s Nephrology Nursing Practice, Management and Leadership Conference, here.

“We know everyone here is working hard to lowering those factors that lead to those diseases ... The question is ‘How do we do it [the executive order]? How do we implement it?” he said.

Advancing American Kidney Health, which was signed as an executive order by President Donald Trump on July 10, sets three major goals:

  • reduce the number of cases of kidney disease by 30% by 2030;
  • double the number of organs available for kidney transplant by 2030; and
  • have 80% of incident patients with ESKD be treated with home dialysis or have a transplant by 2025.

Donna Bednarski, MSN, RN, ANP-BC, ANNA’s liaison to the advocacy group Kidney Care Partners, said it is important that the executive order still gives patients the opportunity to make modality choices.

“When you look at the mandate for home therapies and transplant at 80% by 2025, does that give patients a lot of choice?” Bednarski said. “Then we have to look at access to care.” To meet the government mandate, “Do people in rural areas have access to transplant centers and home programs?” she said.

Kidney Care Partners has recommended in comments to CMS that the goals of the Advancing American Kidney Health be divided into two tracks – one to increase the transplant rate and one to increase the number of patients on home dialysis – and set a goal of a 25% increase in patients selecting those treatment options by 2025.

“Where did the 80% come from? Is it realistic?” Bednarski said.

Meeting the goal of preventing the number of cases of ESKD by 2030 will also require a major change in the kidney community.

“This will be a huge overhaul as we shift to prevention,” Bednarski said. “Who will be the caregivers?”

Tamara Kear, PhD, RN, CNS, CNN, ANNA National President, said training and allocating more nurses to CKD care will be difficult as the profession faces an ongoing nephrology nursing shortage. ANNA has started a task force to address the issue. There is no competition among other kidney organizations to meet the executive order, she said.

“We need everyone’s strengths,” Kear said. – by Mark E. Neumann


Bednarski D, et al. Session 201. Presented at: American Nephrology Nurses Association’s Nephrology Nursing Practice, Management and Leadership Conference. Oct. 12-14, 2019; San Diego.

Disclosures: Bednarski, Kear, and Twaddell report no relevant financial disclosures.