Advancing Solutions for Kidney Disease

Every day we see the potential technology provides to create better pathways of care—for the people delivering care and the patients they treat who are managing their own chronic disease(s). Rock Health reported that since 2011, $23B has been invested in thousands of digital health companies. Yet, historically, innovative solutions for kidney disease have been static at best and from a funding perspective, largely very quiet.

However, a slew of innovation and new initiatives created to encourage advancements in kidney disease management are aiming to change this cycle of inactivity, offering the potential of new solutions for patients where currently there are very few.

Bringing dialysis into the 21st Century

For people with kidney failure and end stage renal disease (ESRD), dialysis is often the only treatment option. While a kidney transplant is the gold standard to treat kidney failure, the waitlist is long, and most people die while waiting for a kidney. Yet, despite so many people being dependent upon dialysis, the technology has not fundamentally changed since the 1970s. And furthermore, the treatment is physically and emotionally grueling and patients who undergo dialysis are often unable to work and experience a compromised quality of life and shortened life expectancy.

According to Bruce D. Greenstein, the Chief Technology Officer for the Department of Health and Human Services (HHS), whose mother went through dialysis treatments for 14 years, “I saw almost no difference in how she was treated in the first year on dialysis and in the 14th year…there is not a lot of money being invested in this community.”

That may soon change. Outset Medical, whose focus is “on bringing dialysis into the 21st century” raised $76.5 million in 2017 to further its effort to innovate dialysis. Their device, Tablo, is smaller than traditional dialysis units, can purify tap water rather than having to rely on purified water which “requires a massive amount of infrastructure at hospitals” and device setup is simplified. Tablo also includes “a touch screen which displays instructions, as well as education and entertainment content,” reported MobiHealthNews.

Outset also received FDA approval for a dialysis machine with two-way data communication. Mobi said that “…not only can data on the treatment be sent directly to a patient’s EHR, but information about the patient that a technician used to have to enter manually to calibrate the machine can now be uploaded directly from the EHR. The two-way transmission also allows for software updates as the technology improves.”

Outset CEO, Leslie Trigg, explained that they “were able to eliminate over 50 percent of the steps involved in setting up a dialysis machine.” So what does this mean for the patient? A lot potentially. The end goal for all of these upgrades is to eventually enable the patient to operate the machine themselves. Outset is still waiting for the FDA to clear the device for home use however “it has been set up in some dialysis clinics as an “in-clinic self care” offering.”

The company is also developing “a patient app that will transmit a more basic snapshot of the treatment data that’s flowing out of Tablo out to the cloud, and send that back to the patient.” For the first time, patients will have more information and importantly, more control over their treatment and overall experience.

Technology to improve outcomes for transplant patients

For patients who receive a kidney transplant, managing their health efficiently after surgery is vital to a successful outcome. Programs that educate patients and help guide them throughout the process can be hugely impactful and lead to better outcomes.

Brigham and Women’s Hospital in Boston launched an innovative program with a company called patientMpower aimed at helping patients and care teams better manage the post-transplant journey by using an app.

“The app is deployed along with a connected weight scale and connected blood pressure monitor. It facilitates patients monitoring relevant vital signs, offering them medication and treatment reminders as well as educational content,” reported MobiHealthNews.

Once the patient is home, there is a significant amount of data that needs to be monitored and documented, such as patient weight, fluid intake, and urine output, to ensure the patient is on track. Yet, as the Mobi article explains, there is still an extremely “heavy paper burden” when it comes to managing this type of patient data post transplant.

The Brigham program aims to take out the middleman and enable a more proactive and efficient way to support the patient. The collection of real-time data and analysis, which the app affords, provides a more accurate overview of the patient’s health and progress, and importantly, the opportunity to spot any potential complications earlier before they become larger issues.

Initiatives to ignite innovation

The drought surrounding innovation and funding for kidney disease has sparked several initiatives in an effort to inspire the development of new therapies and improvements to existing therapies like dialysis.

In late 2017, the HHS announced it would establish a public-private fund called the Kidney Innovation Accelerator to help spur new technology forward. The fund will seed and accelerate “not just incremental improvements in treating kidney disease, but will foster real breakthroughs in dialysis and other treatments for kidney disease.”

The VA and ASN launched the Kidney Innovation Summit after research revealed that a disportionate number of U.S. veterans are affected by kidney disease. According to the study, an estimated 16% have CKD and 13,000 veterans develop ESRD every year, representing nearly 10% of the dialysis population. The summit aimed to advance innovation for CKD and also “incentivize collaboration” between different sectors across health care with skin in the game, including innovators, payers, providers, and so forth. At the summit, “participants were charged with thinking deliberately about the unmet needs of people with CKD, and creating solutions to improve the way in which affected people lived their lives.”

Keeping the spotlight on kidney disease

As of 2018, more than half a million Americans and an estimated 2M people worldwide are affected by ESRD and those numbers are increasing. Additionally, more than 100,000 U.S. patients are on the waitlist for a kidney transplant, yet, less than 20,000 are available each year.

Patients with comorbidities like diabetes, high blood pressure, and obesity—the prevalence of which are growing as the U.S. aging population surges—are more likely to suffer from kidney disease. If these patients receive consistent support and caregivers have actionable insight into their data, events like kidney disease can be mitigated.  

The progress that we’re seeing with devices like Tablo and programs such as what Brigham and patientMpower offer are encouraging. However, as we continue to see the big funding dollars roll in for digital health, there needs to be a large-scale investment in more innovation, resources, and research for kidney disease to curve health care spending and improve patient lives.