More than 20 million Americans have kidney disease — many of whom are undiagnosed — and more than 600,000 Americans with kidney failure rely on dialysis or a transplant to remain alive.
Multiple factors are at play in these staggering statistics. Diabetes, high blood pressure and obesity — all conditions which can lead to kidney disease — are increasing exponentially. Orphan diseases can also contribute to kidney failure. Yet while millions of Americans suffer from kidney disease, it has remained a “back burner” health issue in the public’s consciousness.
For patients with kidney disease and their loved ones, their diagnosis presents a daunting reality. Each year, 100,000 people learn that their kidneys have failed and that they will need dialysis or a transplant to survive. Often, this comes with little warning because the disease can silently progress until it is too late. Today, more than 600,000 Americans have kidney failure and 430,000 of these rely on dialysis to stay alive.
Even as doctors and researchers work toward advances in treating kidney disease, it is projected to kill more than 90,000 Americans in 2014 alone — more than breast and prostate cancer combined.
There is a void in how kidney disease is treated. At the same time, prevention of kidney disease progression is critical to improving health and reducing health care costs. The United States has the best health care system in the world, and it is time for us to invest in research to help treat, and ultimately cure this epidemic.
Change begins with research and innovation, and innovation is spurred by financial support.
Medical advances during the past century have allowed nephrologists to expand care options, but significant gaps in knowledge remain. For instance, the progression of some types of kidney disease to kidney failure — requiring costly dialysis treatments or a rare transplant — is still poorly understood. Dialysis also cannot yet fully mirror the function of human kidneys, and we cannot guarantee the long-term health benefits of kidney transplants.
It is clear that medical research in kidney care is imperative. However, investment in kidney research has stagnated. While the Centers for Medicare & Medicaid Services spends billions each year to care for patients with kidney disease — including $35 billion in care for dialysis — only $591 million of National Institutes of Health funding is dedicated to medical research for this disease at the National Institute of Diabetes and Digestive and Kidney Diseases.
The problem is not isolated to the kidney community. Over the past 10 years, funding for medical research in this country has plateaued and is now facing a significant decline.
The NIH is our nation’s most important source for funding dedicated to medical innovation. Each year the agency invests an average of $30 billion in medical research. Nearly 95 percent of NIH’s budget is spent on research, with more than 80 percent of that dedicated to competitive research grants for universities, medical schools and other research institutions. Another 10 percent supports projects conducted by NIH’s own inventive researchers.
Yet the NIH receives nearly 25 percent less funding than a decade ago, when adjusted for inflation, and many promising kidney-focused research proposals are rejected each year. We are losing an entire generation of researchers. Without funding support, the best and brightest minds will seek careers elsewhere, while patients with kidney disease must wait that much longer for much-needed cures. This stands in stark contrast with other countries — most notably China — that are investing in research at exponential rates compared to declines seen in the United States.
The effects of recent budget cuts are particularly evident in nephrology — with fewer clinical trials than any other major therapeutic area — but the consequences affect the entire health care system. Proposals that aim to cure diseases such as cancer, Alzheimer’s, diabetes and even Ebola, have been consistently turned down due to lack of funding — resulting in fewer new therapies for patients as critical areas of study lose momentum.
Lawmakers must provide stable and predictable investment in the NIH to restore America’s leadership in medical innovation and foster our nation’s brightest minds. By restoring funding to NIH to support the development of new discoveries, lawmakers can effectively reduce health care spending and relieve the burden of greater health care costs to taxpayers.
The kidney community supports the bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act proposed last year by Reps. Tom Marino, R-Pa., and John Lewis, D-Ga. This proposal lays important groundwork for smart and much needed investments in kidney disease research, as well as policies that would improve treatment options for individuals living with kidney failure. However, for these investments to come to fruition we must first assure that researchers have stable and sufficient financial support.
That means reinvesting in the NIH to finally cure kidney disease and hundreds of other debilitating diseases.
Sharon M. Moe, M.D., is a fellow of the American Society of Nephrology, the past-president of the American Society of Nephrology and professor of Medicine at the University of Indiana School of Medicine.