Introduction

Kidney disease is a major public health issue in the United States as it affects over 37 million Americans and current Medicare expenditures for people with chronic kidney disease alone exceed $130 billion annually. Kidney disease is characterized by significant racial, ethnic, and socio-economic disparities, and reducing the incidence of kidney disease will have a positive impact on health disparities in the United States. Due to the aging of the US population and the obesity epidemic, the number of patients receiving treatment for kidney failure is expected to increase, which will increase healthcare expenditures for kidney disease. The National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) historical and current investment in kidney-related research has lagged significantly behind the ongoing spending on kidney disease care. Increased investment in research would identify, develop and strengthen the implementation of interventions to slow the progression of kidney disease, reduce the incidence of kidney failure, increase survival, and improve quality of life. This perspective illuminates the urgent reasons why increased investment in kidney-related research is critical to US public health. The National Kidney Foundation and the American Society of Nephrology are working together to call for increased funding for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetes and Digestive and Kidney Diseases (NIDDK). The long-term goal is to reduce the burden of kidney disease in the US population and improve the quality of life for people with kidney disease.

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Scope of Problem

It is estimated that approximately 37 million American adults (15% of the U.S. population) have chronic kidney disease (CKD) and one in three American adults will develop CKD. kidney disease can progress to kidney failure, requiring kidney replacement therapy through dialysis or transplantation. Dialysis is the most common form of kidney replacement therapy and remains one of the most expensive treatments for chronic disease. Costs increase as kidney disease progresses, with the treatment of kidney failure being the most expensive, costing over $90,000 per year per elderly Medicare dialysis patient. Medicare fee-for-service spending for people with CKD (including kidney failure receiving replacement therapy [KFRT]) currently exceeds $130 billion per year.

Many people with CKD face significant financial burdens due to associated comorbidities, office visits, and medications. Out-of-pocket costs for patients with CKD who do not require renal replacement therapy can be twice as high as those for cancer or stroke patients. In addition to the high financial costs associated with treatment, there is a clear burden on patients. Patients with kidney disease have a poor quality of life, and many suffer from physical symptoms (fatigue, muscle cramps, insomnia, etc.) and psychiatric symptoms (anxiety, depression, etc.).

Because dialysis was costly but necessary, Section 2991 of the Social Security Act (Public Law 92-603) was amended in 1972 to ensure that people with kidney failure, regardless of age or social security disability status, would be eligible for Medicare and have access to dialysis. At that time, approximately 10,000 Americans were receiving dialysis Beginning in the 1980s, the incidence of KFRT increased rapidly, partly due to the obesity epidemic and the increasing prevalence of diabetes. From 1990 to 2006, the adjusted prevalence of KFRT increased from 256.3 per 1 million to 411.7 per 1 million, an increase of 60.6%. Since 2006, the adjusted KFRT prevalence rate has slowly declined to less than 375 per 1 million, but the total number of new KFRTs continues to increase due to population growth and an aging population in the U.S. In 2018, the total number of new KFRTs reached 130,000 for the first time, an increase of 325 percent since 1990.

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Approximately 800,000 Americans, including 10,000 children and adolescents, are being treated for kidney failure today. Without strong public health interventions to curb the incidence of CKD and its progression to kidney failure, the number of people requiring renal replacement therapy is projected to exceed one million in 2030. more than one million people will need renal replacement therapy in 2030. The majority of adults with kidney failure will never receive a transplant and will continue to rely on dialysis treatment. The five-year survival rate on dialysis is less than 50% and the quality of life is poor. A 45-year-old adult who starts dialysis can expect to live an additional 10 years, 22 years less than a 45-year-old in the general US population. The number of years of life lost to kidney failure in children ranges from 42 to 53 years, depending on the age at which dialysis is started.

Kidney disease is a strong risk factor for death in the U.S. population and is the eighth leading cause of death in the U.S. From 1990-2017, deaths due to CKD increased by 63% in the U.S. However, the impact of CKD on mortality in the U.S. population may be underestimated because kidney disease is a disease multiplier.

For example, the presence of CKD increases the risk of cardiovascular disease events and cardiovascular disease mortality. In patients with type 1 or type 2 diabetes, the presence of CKD increases the risk of death threefold. Kidney disease also complicates the treatment of other chronic diseases due to the important role of the kidneys in eliminating drugs and their metabolites. Because of its impact on the immune system, kidney disease also impairs recovery from acute infections, as shown by the 4-fold increased risk of hospitalization and death from COVID-19. In fact, one of the first reported deaths due to COVID-19 in the United States was a patient on hemodialysis. The impact of kidney disease on mortality may also be underestimated, as more than 80% of kidney diseases are not identified, diagnosed, treated, or recorded as a cause of death.

CKD and Health Disparities

Of all chronic diseases, kidney disease may have the greatest racial and socioeconomic disparities and inequalities.21 Although the prevalence of KFRT has declined across all races and ethnicities, significant disparities and inequalities remain (Figure 1). There are differences in access to health services (including home dialysis), receipt of kidney transplantation, and kidney transplantation outcomes among patients of different races and ethnicities.

These disparities in kidney disease outcomes are due to multiple factors, including lack of access to health care, genetic factors, and systemic racism. The overlap of health disparities and inequities due to race/ethnicity is rooted in the strong association between the social determinants of health status and the risk and progression of kidney disease. Multiple studies have shown that adults who start dialysis are more likely to live in areas of poverty. Approximately 1 / 3 of patients initiating dialysis live in a ZIP code-defined area where ≥ 20% of the population lives below the poverty line. The COVID-19 pandemic highlights a significant interaction between ethnicity, ethnicity, and kidney disease outcomes. Between March 1 and August 1, 2020, there were more than 6,000 deaths among dialysis patients, of which more than 4,300 were among ethnic minorities.

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The United States has a tremendous opportunity to reduce health disparities by investing in kidney disease research. A better understanding of the natural history of kidney disease and its progression may lead to earlier detection and better treatment to prevent kidney failure. Kidney disease can be described as a complex disease because it may be caused by a combination of genetic, lifestyle, and environmental factors. One of the strongest genetic variants found in any complex disease is associated with African ancestry and risk of kidney disease. Research into why genetic variants increase the risk of disease may help us find new ways to prevent or delay kidney failure in people of African ancestry. Research into increasing the number of kidneys available for transplantation and better immunosuppressive therapies could help more patients receive transplants and thus move away from dependence on dialysis. However, without a strong investment in research into a chronic disease characterized by marked ethnic and socioeconomic disparities, inequalities in kidney health will persist and even widen further.

Lack of Research Funding Compared to Other Chronic Diseases

In 2020, the total investment in kidney-related research across the National Institutes of Health (NIH) is estimated to be only $704 million. Investment in kidney health research is less than 1% of what Medicare spends nationally on kidney disease care.

Historically, kidney-related research has been inexcusably underfunded compared to other disease states (Table 1), and the federal government must recommit to supporting advances in kidney medicine and science. The Congressional COVID-19 Emergency Funding Program demonstrates the tradition of underfunding kidney-related research, which does not include the National Institute of Diabetes, Digestive Diseases and Kidney Diseases (NIDDK), despite growing evidence of a link between COVID-19 prevalence and kidney disease. By investing appropriately in kidney-related research, particularly by providing strong and reliable funding for the NIDDK and other agencies and organizations that fund kidney research, the federal government can foster transformative innovations and breakthroughs to improve kidney health.

Cistanche Tubulosa extract is a herb that is extracted from Cistanche Tubulosa after a number of rigorous operations to benefit the kidney function of the human body. It contains a large number of active substances of Phenylethanoid total glycoside, Echinacoside, and Verbascoside, they can increase the proliferation rate of kidney cells up to 8-10 times; it can even improve the repair ability of damaged kidney cells and inhibit apoptosis of kidney cells.

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