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Chronic kidney disease in the United States: a public policy imperative.
Clin J Am Soc Nephrol. 2008 Nov; 3(6):1902-10.CJ

Abstract

BACKGROUND AND OBJECTIVES

In the past decade, a crisis in nephrology has slowly emerged in the areas of both clinical care and public policy. In 2003, the Council of American Kidney Societies (CAKS) identified 19 barriers to improved patient outcomes in chronic kidney disease (CKD).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Site visits and in-depth telephone interviews were conducted with 15 nephrologists focusing on current issues with identifying and treating patients with CKD. The qualitative analyses were considered in the context of CAKS-identified barriers to assess the present state of nephrology care and provide a foundation for a more detailed quantitative CKD project potential implications for advancing nephrology-related health policy.

RESULTS

Despite new evidence-based therapies to slow, stop, or reverse the progression of CKD to ESRD as well as premature cardiovascular disease, major systemic barriers continue to limit the implementation of this body of evidence at the level of the nephrology practice. Key factors include under- or uninsurance, unstructured medical care systems, and lack of enabling public policies.

CONCLUSIONS

The crisis of nephrology is embedded within the unresolved duress of the ability to provide quality early intervention juxtaposed upon inadequate reimbursement for clinical care and procedures, unfunded mandates for information technology systems, and organizational inconsistencies between nephrology and other specialties. We believe now is the time for the renal community and related stakeholders to unite in an effort to address the clinical, financial, and public policy issues that will enable the delivery of appropriate CKD care to this vulnerable patient population.

Authors+Show Affiliations

RAND Corporation, Santa Monica, California, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18922986

Citation

Rettig, Richard A., et al. "Chronic Kidney Disease in the United States: a Public Policy Imperative." Clinical Journal of the American Society of Nephrology : CJASN, vol. 3, no. 6, 2008, pp. 1902-10.
Rettig RA, Norris K, Nissenson AR. Chronic kidney disease in the United States: a public policy imperative. Clin J Am Soc Nephrol. 2008;3(6):1902-10.
Rettig, R. A., Norris, K., & Nissenson, A. R. (2008). Chronic kidney disease in the United States: a public policy imperative. Clinical Journal of the American Society of Nephrology : CJASN, 3(6), 1902-10. https://doi.org/10.2215/CJN.02330508
Rettig RA, Norris K, Nissenson AR. Chronic Kidney Disease in the United States: a Public Policy Imperative. Clin J Am Soc Nephrol. 2008;3(6):1902-10. PubMed PMID: 18922986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic kidney disease in the United States: a public policy imperative. AU - Rettig,Richard A, AU - Norris,Keith, AU - Nissenson,Allen R, Y1 - 2008/10/15/ PY - 2008/10/17/pubmed PY - 2009/1/7/medline PY - 2008/10/17/entrez SP - 1902 EP - 10 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 3 IS - 6 N2 - BACKGROUND AND OBJECTIVES: In the past decade, a crisis in nephrology has slowly emerged in the areas of both clinical care and public policy. In 2003, the Council of American Kidney Societies (CAKS) identified 19 barriers to improved patient outcomes in chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Site visits and in-depth telephone interviews were conducted with 15 nephrologists focusing on current issues with identifying and treating patients with CKD. The qualitative analyses were considered in the context of CAKS-identified barriers to assess the present state of nephrology care and provide a foundation for a more detailed quantitative CKD project potential implications for advancing nephrology-related health policy. RESULTS: Despite new evidence-based therapies to slow, stop, or reverse the progression of CKD to ESRD as well as premature cardiovascular disease, major systemic barriers continue to limit the implementation of this body of evidence at the level of the nephrology practice. Key factors include under- or uninsurance, unstructured medical care systems, and lack of enabling public policies. CONCLUSIONS: The crisis of nephrology is embedded within the unresolved duress of the ability to provide quality early intervention juxtaposed upon inadequate reimbursement for clinical care and procedures, unfunded mandates for information technology systems, and organizational inconsistencies between nephrology and other specialties. We believe now is the time for the renal community and related stakeholders to unite in an effort to address the clinical, financial, and public policy issues that will enable the delivery of appropriate CKD care to this vulnerable patient population. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/18922986/Chronic_kidney_disease_in_the_United_States:_a_public_policy_imperative_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=18922986 DB - PRIME DP - Unbound Medicine ER -