Overhauling Kidney Care

This week, President Trump signed an executive order aimed at improving the care of kidney patients. Nephrologist Amaka Eneanya talks with Scott Simon about some of the new initiatives.

SCOTT SIMON, HOST:

Americans with kidney disease got some encouraging news when President Trump signed an executive order aimed at improving their care.

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PRESIDENT DONALD TRUMP: Those who suffer from kidney disease experience a significant toll on their daily lives.

SIMON: The administration wants to improve detection and diagnosis, increase the number of kidney transplants and move patients away from commercial dialysis centers by encouraging more in-home dialysis. Medicare now spends about $114 billion on kidney care every year, about a third of that on people who need regular dialysis or a transplant.

Dr. Nwamaka Eneanya is a nephrologist with Penn Medicine at the University of Pennsylvania. She treats patients with chronic kidney disease. Thanks very much for being with us.

AMAKA ENEANYA: Thank you for having me on, Scott.

SIMON: The scope of kidney illness in this country is enormous, isn't it?

ENEANYA: That's correct. So approximately 37 million adults have chronic kidney disease in United States. And the majority of those adults are unaware of their diagnosis, upwards of 90%.

SIMON: One of the proposals, and certainly one that a lot of people noticed, is encouraging patients to have dialysis at home...

ENEANYA: That's correct.

SIMON: ...Which I gather is common in some countries around the world, but not the United States. Why not so far?

ENEANYA: So there's a few reasons for that. So one, the training for clinicians who actually do provide care for patients with kidney disease is not very robust for home dialysis. Also, the payment incentives, as they are now, really favor doing dialysis in in-center dialysis facilities. Also, education for patients is still evolving for them to learn about home dialysis.

SIMON: How do you do home dialysis?

ENEANYA: Basically, what your kidneys do is to, on a regular, you know, 24/7 basis, clean the body of fluid and waste. And that's basically what your urine is. And so when you're doing home dialysis, you have machines that are actually doing this for you. So you're connecting to this machine, and it's removing fluid and waste from the body, just as your kidneys would do.

SIMON: And this works overseas?

ENEANYA: This works incredibly well. Countries - Guatemala, Mexico, Hong Kong have the majority of their patients using some type of home dialysis.

SIMON: I noticed some medical sources this week, in response to the president's plan, said, look; what we have is working now. Why endanger that?

ENEANYA: The question is who is it working for? If it's working for the patients and we have a resounding response from them that that's what the case is, then by all means, we should reconsider and look at things very closely. But that's not what research has shown, and that's not what my experience has been, and many others, in terms of caring for these patients. It's quite a burden to do things the way that they have been doing, which is most of the patients going to dialysis or receiving their dialysis in a facility.

SIMON: The administration wants to double the number of kidneys available for transplant. How do you do that?

ENEANYA: Part of what he was describing was incentivizing donors - paying them for lost wages and child care that they may have to use after doing a surgery. I think a lot of the time, there's a focus on the recipient because they have this chronic disease, and they're getting a fresh, new kidney, and great for them. But I recently had an experience where I spoke to a altruistic donor, so a person who just decided to donate a kidney out of the goodness of their heart. And she really remarked, you know, tearfully, how difficult the post-operative period was and how she really wasn't prepared for how long she would be...

SIMON: Yeah.

ENEANYA: ...Out of work and, you know, how difficult that was. And so I think actually educating donors and providing these incentives will really make a difference.

SIMON: Do you think the executive order signed this week is going to - has the hope of improving life for kidney patients in a couple of years?

ENEANYA: Absolutely. This was a phenomenal kind of monumental time for the field of nephrology and for patients with kidney disease. If the goal is to have 80% of patients with end-stage kidney disease to be on a home dialysis modality or to receive a transplant, that's a really big change. And so we know that quality of life will be - will improve. Patients will have kind of more choices in terms of what is best for them. It's really an exciting time.

SIMON: Dr. Nwamaka Eneanya, a nephrologist with Penn Medicine, University of Pennsylvania. Thanks so much for being with us.

ENEANYA: Thank you so much.

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