Bridging the Gap

The Untapped Potential in Chronic Kidney Disease Monitoring

The medical community has witnessed a remarkable evolution in diabetes care, significantly attributed to the advent of Continuous Glucose Monitoring (CGM) technology. Companies like Dexcom, Abbott, and Medtronic have not only revolutionized patient care but have created expansive market opportunities, with their success reverberating through the healthcare sector. This triumph underscores the transformative power of continuous monitoring technologies in managing chronic conditions.

However, as we revel in the strides made in diabetes management, there lies a parallel narrative that has yet to be fully unveiled: Chronic Kidney Disease (CKD). The prevalence of CKD, especially among the Medicare-aged population, is a looming concern that parallels, if not surpasses, the diabetes epidemic. In the United States, 33% of adults older than 65 years have diagnosed or undiagnosed CKD compared to  29% with diabetes. Only 14% of Medicare FFS beneficiaries had formal CKD diagnosis, yet CKD patients accounted for 25% of Medicare spending. The annual healthcare costs per patient with CKD is around $26,000. This figure escalates drastically with the onset of hyperkalemia, a common comorbidity in CKD patients, pushing the annual costs to $46,000. This is primarily driven by increased hospitalization and ICU visits.  A patient in late stage CKD-5 and hyperkalemia costs nearly $100,000 per year. In the US commercial population, annual costs for patients with both diabetes and CKD were $35,649, CKD only was $25,010, and diabetes only was $16,121. 

Unfortunately, this high prevalence and high economic burden has not translated into innovation. A cursory glance at the medical device sector reveals around 345 companies focusing on diabetes, while a mere 118 are venturing into the CKD domain. This disparity is not just a reflection of commercial pursuits but an indicator of the substantial gap in tool availability for CKD monitoring and management. The existing tools for diabetes management, spearheaded by CGMs, have been around for decades, providing a robust framework for continuous monitoring and real-time data utilization. On the contrary, CKD patients and care teams are still heavily reliant on in-lab visits for monitoring and treatment, contributing to the higher costs and potentially poorer outcomes. There are no widely accessible, accurate CKD monitoring systems for at-home use. The lack of innovation in CKD management and monitoring starkly contrasts the evolution witnessed in diabetes care. 

In essence, the dialogue around CKD and the unmet needs within this space is not merely a call for attention but an invitation for disruption. A transition akin to the CGM evolution in diabetes could herald a new era in CKD management, opening avenues for optimized medication regimes, dietary management, and a proactive approach towards preventing complications like hyperkalemia. The diabetes narrative stands as a testimony to the transformative potential of continuous monitoring technologies. It's time we channel similar endeavors to unravel solutions that could propel CKD management into a new epoch of patient-centric care and cost-efficiency. 

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Additional References

1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007

2. Annual Data Report. USRDS. Accessed October 13, 2023. https://adr.usrds.org/

3. Bartelme A, Bridger P. The role of reimbursement in the adoption of continuous glucose monitors. J Diabetes Sci Technol. 2009;3(4):992-995. doi:10.1177/193229680900300449

4. Kidney Disease: The Basics. National Kidney Foundation. Published April 8, 2021. Accessed October 13, 2023. https://www.kidney.org/news/newsroom/fsindex

5. Statistics About Diabetes | ADA. Accessed October 13, 2023. https://diabetes.org/about-diabetes/statistics/about-diabetes

The Magic Word Is Empowerment

A Conversation with Dr. Mandeep Sahani

A Summary of Action Potential Podcast Episode #1

For more details, visit Action Potential on the Slice of Healthcare site.

In the inaugural episode of Action Potential, we are privileged to have a compelling conversation with Dr. Mandeep Sahani, Chief Medical Officer of TeleNeph LLC and a highly regarded figure in the world of nephrology. With over 20 years of dedication and expertise, Dr. Sahani brings to the table invaluable insights and a unique perspective on patient care, particularly emphasizing the crucial role of empowerment in managing kidney disease.

A Journey of Passion and Dedication

Dr. Sahani’s story is not just about his impressive career; it is a journey fueled by passion and dedication to nephrology. Initially drawn towards cardiology, his career path took a decisive turn when he began his residency under the mentorship of Dr. Bob Hedger, a nephrologist known for his Midwest ethics and strong emphasis on physiological principles. Dr. Sahani’s profound resonance with these values marked the beginning of his lifelong dedication to nephrology.

Patient Empowerment: A Cornerstone of Care

For Dr. Sahani, empowerment is not just a buzzword—it’s a central tenet of effective patient care. He passionately believes that when patients are equipped with knowledge and tools, they are better positioned to take control of their health journey, make informed decisions, and engage proactively in their treatment plans.

Bridging Gaps in Disadvantaged Communities

The journey to empowerment is particularly vital in serving underserved and disadvantaged communities. Dr. Sahani points out the disparities in access to specialist care, especially in rural areas, where the shortage of nephrologists is a pressing issue. In these settings, empowerment takes on an even greater significance, as patients are often left to navigate their health conditions with limited resources.

The Power of Telemedicine

Telemedicine emerges as a powerful tool in Dr. Sahani’s empowerment toolkit. By leveraging technology, patients in remote locations can access expert advice, receive timely interventions, and stay connected with their healthcare providers. This technological bridge not only facilitates better patient outcomes but also ensures that quality kidney care is more equitable and accessible.

Home Care and Patient Autonomy

Looking toward the future, Dr. Sahani is excited about the potential of home dialysis and other home treatment modalities to revolutionize kidney care. He sees this advancement as an opportunity for patients to gain more autonomy over their treatment, allowing them to integrate kidney management, including dialysis, into their daily lives seamlessly. Empowering patients with the knowledge and skills to manage their condition is a crucial step toward making this a reality.

Navigating Complex Treatments and Lifestyle Adjustments

Kidney disease management is undeniably complex, involving intricate treatments, strict diets, and significant lifestyle adjustments. Dr. Sahani emphasizes that empowerment is the key to helping patients navigate these complexities successfully. By fostering a sense of agency, patients are more likely to adhere to their treatment plans, make healthier lifestyle choices, and actively participate in their care.

Conclusion

In this inspiring episode of Action Potential, Dr. Mandeep Sahani reminds us that at the heart of effective kidney care lies the power of patient empowerment. His commitment to equipping patients with the knowledge and tools they need, particularly in disadvantaged communities and rural areas, highlights the transformative potential of empowerment. As we embrace the future of nephrology, with its technological advancements and innovative treatment options, Dr. Sahani’s message is clear: the magic word, indeed, is empowerment.

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Additional links

• To learn more about Dr. Mandeep Sahani: Dr. Sahani’s LinkedIn

• Action Potential Podcast Page

• Apple Podcasts Link