Jennifer Cramer-Miller was 22 and finishing college when she went to a doctor because of puffiness in her eyes and came away with life-changing news. Her kidneys were failing and she would need dialysis, an exhausting blood-filtering procedure, to survive until she could get an organ transplant.
“It came out of nowhere,” said Cramer-Miller, who is now 52. “They call it the silent killer, because people don’t know they have it until they get to a very advanced stage.”
Today the Wayzata woman is a testament to the effectiveness of kidney care — which in her case included four transplants — but also the challenge of meeting a goal announced this month by the Trump administration: reducing the number of Americans who suffer kidney failure, or end-stage renal disease.
Meeting the goal, a 25% reduction by 2030, would spare thousands of people from time-consuming dialysis and conserve the desperately short supply of donor organs that leaves transplant patients waiting for years. It also would save lives and some of the $35 billion in federal spending on this population, which makes up 1% of Medicare recipients but 7% of the program’s budget.
Minnesota physicians and advocates praised last week’s challenge by President Donald Trump to improve treatment — noting that it was one of the first times a president has focused on kidney disease since the decision in 1972 to extend Medicare benefits to all kidney patients who needed dialysis or transplants.
“There hasn’t been a lot of innovation in this area,” said Dr. Mark Rosenberg, a University of Minnesota kidney specialist and president of the American Society of Nephrology. “It was sort of ripe for transformation.”
Better care of kidney disease will help reduce deaths and dialysis, but the nation also needs more screening to catch more cases before they reach desperate stages, Rosenberg said.
“So often, we’re called down to the emergency room because a patient has shown up with kidney failure and no idea that anything was wrong with their kidneys,” he said. “And all of a sudden we have to start them on dialysis. Its more of a crash landing start, and we don’t have time to educate them and prepare them.”
The White House announcement also comes amid predictions that kidney failure will increase anywhere from 29% to 68% in the next decade — on one hand because medical improvements will help more people survive, but on the other because the national diabetes and obesity crisis will result in more cases.
Fewer ER trips
Park Nicollet, the St. Louis Park-based health system, is proving, though, that it can rein in the cost of kidney failure and keep patients healthier at the same time. As part of a federally funded demonstration project, Park Nicollet reported more than $1 million in annual savings by providing 100 kidney failure patients with care coordinators, pharmaceutical consultations and home visits that reduced complications and resulting trips to the ER and hospital admissions.
Sometimes, the coordinators find that patients have simple barriers, such as lack of transportation, that prevent them from making dialysis appointments. That, in turn, causes their health to spiral downward, said Dr. Jesse Wheeler, a Park Nicollet kidney care specialist.
The approach also can prevent patients with milder levels of kidney diseases from digressing to kidney failure by making sure they have good diets or affordable medication that could prevent or delay their need for dialysis or transplants, Wheeler said.
“Every patient, dialysis dependent or not, has many issues in their lives,” Wheeler said. “It isn’t just a medical problem.”
A lingering question is how to catch more cases early. Simple blood and urine tests can detect levels of proteins that healthy kidneys should be filtering out, but the U.S. Preventive Services Task Force does not recommend them universally for all patients.
Cases such as Cramer-Miller’s might be impossible to prevent in people who are young and have no symptoms. Her problems were ultimately linked to an autoimmune disease that attacked her kidneys.
But other links to kidney disease are more common and easy to identify. Hypertension and diabetes, for example, are chronic diseases that are strong risks for kidney disease.
High use of certain medications, including common painkillers such as Advil, can damage kidney function and raise disease risks as well.
Duke Steenson, 85, was spending the winter of 2009 in California and put off getting medical attention even though his ankles were swelling and lips were turning blue. When he got back to his doctor in Minnesota, he learned that treatments for prostate cancer a couple of years earlier had wrecked his kidneys, which were filtering his blood at only 7% efficiency.
“The radiation did my kidneys in,” said the Wayzata man, who received dialysis and then a transplant of a donor kidney from one of his sons. “I wasn’t ready. I didn’t know the problem even existed.”
Screening rates in high-risk groups appear somewhat low, according to a 2018 report from the U.S. Renal Data System, a national data collection system that recently relocated to Minneapolis. Among a sampling of nonelderly adults with diabetes, fewer than half were screened for kidney disease, the report showed.
Data from the Minnesota Department of Health is more encouraging, showing a screening rate of 83% for people with diabetes who had Medicare managed-care insurance plans.
Either way, the rates show room for improvement, said Mallory Olson, executive director of the local chapter of the National Kidney Foundation, especially considering that nearly half of all new kidney failure diagnoses involve someone with diabetes.
The foundation responded with a series of free screenings, with the next one Aug. 10 at the Fiesta Latina in St. Paul.
Part of the challenge is simply communicating the hazards, or even explaining the role of one of the most misunderstood organs in the body, she noted.
“If you don’t know what your kidneys do,” Olson said, “you don’t even know what to be looking for.”