End-stage disease should not be the entry to kidney care

Dr. Robert R. Redfield argues that U.S. kidney care often waits until end-stage disease and that current payment policies and system design can discourage earlier treatments.

Dr. Robert R. Redfield draws on his early work during the AIDS epidemic to argue that kidney care in the U.S. is often accessed too late. He notes chronic kidney disease affects more than one in seven American adults—about 35 million people—and often progresses without clear symptoms. The piece contends that health systems and payment models tend to respond at the final stage, commonly leading to dialysis as the default entry point to care. It references a 2019 executive order aimed at rethinking kidney care and raises concerns about recent bundled payment approaches. What is reported: - Chronic kidney disease affects more than one in seven U.S. adults (roughly 35 million). - Kidney disease can progress quietly, leaving fewer treatment options once symptoms appear. - Five-year survival after starting dialysis is reported as below 50 percent. - The author says Centers for Medicare and Medicaid Services bundled payment models have discouraged some therapies and shifted care toward dialysis. - A 2019 executive order is referenced as seeking to emphasize prevention, home-based therapies, and innovation in kidney care. Summary: The article links late entry to care with poorer outcomes and increased costs for the health system. It reports that payment incentives are a contributing factor and that the author calls for recalibrating those incentives to support earlier, evidence-based treatment. Undetermined at this time.