ICYMI: Buchanan Chairs Hearing on Improving Kidney Health Through Better Prevention and Innovative Treatment

"We've Got to Find a Way to Help People, Educate People ... To Make Better Choices Themselves."

Discusses Rise of Chronic Kidney Disease, Need for Prevention and Innovative Treatments

WASHINGTON - Yesterday, Congressman Vern Buchanan, Vice Chairman of the House Ways and Means Committee and Chair of the Health Subcommittee, chaired a hearing examining ways to improve kidney health through better prevention and innovative treatment options for patients suffering from chronic kidney disease (CKD) and end-stage renal disease (ESRD).

During the hearing, Buchanan emphasized the growing health and financial burden of kidney disease in the United States and the importance of preventing chronic diseases such as diabetes and high blood pressure, which account for the majority of new kidney failure cases.

Witnesses included Ashli Littleton, home dialysis patient; Dr. Suzanne Watnick, Health Policy Scholar at the American Society of Nephrology; Dr. Robert Taylor, Chief Medical Officer at DCI; and John P. Butler, President and Chief Executive Officer of Akebia Therapeutics.

Click here to watch Congressman Buchanan's remarks.

Here's what Buchanan said about improving kidney health in America:

On hearing from patients living with kidney disease

Buchanan: "Before I begin with my question, I want to thank Ms. Littleton for coming here today and having the courage to let us understand your story better. ... This is critical to a large community, including yourself. Thank you for your leadership on this issue. I mean that personally."

On preventing chronic diseases that lead to kidney failure

Buchanan: "Dr. Watnick, I was surprised to learn that many cases of CKD and ESRD are preventable chronic diseases. We keep spending more on health care, yet you could make the argument that we're getting sicker as a nation. We must reduce the cost and burden of chronic diseases in the United States. What can Congress do to support better kidney health care through chronic disease management?"

Dr. Watnick: "There's a lot we can do ... we need to start upstream. We want people never to walk through those dialysis treatment doors. So how can we make sure, first of all, that we even know people have kidney disease?

"We know that nine out of ten people with kidney disease aren't aware that they have it. Anything we can do to ensure that upstream care is recognized is a benefit. The second thing is that we have new drugs ... that slow down kidney disease and prevent end-stage kidney disease. ... Wouldn't it be wonderful if we were also able to provide research funding to specifically target kidney diseases? ... If we can ensure that we're slowing kidney disease by providing therapies through targeted research with appropriate funding, we can make sure patients are better treated to slow the progression of their disease."

On moving kidney care toward value-based payment models

Buchanan: "Dr. Taylor, I'm very interested in value-based care and how that can help reduce health care costs. We must move away from fee-for-service and look more toward paying for outcomes. I know there have been efforts to transition kidney care to value-based care, so I'd like to get your thoughts about moving in that direction."

Dr. Taylor: "First of all, it goes back to what Dr. Watnick was saying. With appropriate care, many patients don't need to end up on dialysis. Unfortunately, over time, payment and policy have primarily been focused on dialysis. As a nephrologist, one of the real benefits of what I do is my ability to walk with a patient as they go through the various stages of chronic kidney disease. We have participated in the CMMI models, including ESCO, which was the first demonstration model, and currently the CKCC model. We strongly support how policy and resources have been directed toward caring for patients with stage four and stage five kidney disease. In the demonstration models, there have also been incentives placed on transplantation, and there have been benefits that provide better care for patients at the end of life.

"From a value-based perspective, DCI strongly supports these initiatives. It doesn't look at the patient as someone who simply ends up on dialysis, it helps care for them along the entire journey."

On prevention, nutrition and empowering patients to improve health outcomes

Buchanan: "We're spending $5 trillion or more on health care. It's 20 percent of the economy. I'm very big on prevention. I happened to have someone give me a couple of books to read, and one book had an equation in it. At the top of the equation was the quality of the nutrition of the food. The bottom of the equation was calories. What's the most nutritional food, when you go up to the buffet, with the fewest calories, and you eat all you want.

"When you look at it, about 20 percent of kids are obese today ... a lot of 30 and 20-year-olds can't qualify for the military ... 50 percent of adults are obese. ... You've got to be the CEO of your own health. You can't rely on everybody else. ... I even see it with my 10 grandkids ... she's (daughter-in-law) so good about feeding the kids real food. If I go over there and sneak into the corner and try to get a Diet Coke, they'll (grandkids) find me, hunt me down, and say, 'Papa, that's poison. You can't drink that.' That's a true story. ... We've got to find a way to help people, educate people ... to make better choices themselves. Because I'm convinced a lot of the food that we eat isn't food. It's garbage. We need to do a better job of trying to get real food."

On diet, lifestyle and early intervention

Buchanan: "We need to take on the challenge of helping educate people who are interested in listening so they can make better choices. ... What do you think about what I said? Is that applicable? Do you feel like what we're talking about today is applicable in general? ... Let's not get heart disease and cancer in the first place. 90 percent of cancer, if you catch it early, you can nip it. ... Don't react, be proactive. ... We've got to give people full access ... to good information and knowledge."

Mr. Butler: "I'm going to defer to my medical colleagues here, but I know as a businessperson, the best way to bring down costs is to prevent people from having to go to dialysis. Focusing on prevention and treating chronic kidney disease is the best way to yield savings for the medical system."

Buchanan: "As we look down the road, the next five or ten years, how important is it that we take some responsibility ourselves?"

Dr. Taylor: "It's tremendous. The goal is to get older, but to get older healthily and well. There's no doubt that when you look at the two most common causes of kidney disease, diabetes and hypertension ... there is a nutritional component to increasing the risk for developing one of those. ... Anything we can do to increase awareness, increase education and increase access to healthy foods and healthy lifestyles decreases the risk that some of these diseases will develop and as a society will also decreases the amount of money we have to spend on health care, which is a win-win."

Dr. Watnick: "I'm going to get more specific to give some examples, because I agree 100 percent that thinking about treatment and diet first for high blood pressure and diabetes is the way to go. Rather than throwing medications, let's try to do this by diet and exercise. This includes things that are low in sodium for your diets, not processed foods and foods that are low in sugar. ... This is not about any one food. In fact, you don't only want to eat one food, you want a palette of colorful foods that are heart-healthy and kidney-healthy."

Ms. Littleton: "What would have helped me a lot is having that information beforehand, before it got to dialysis. ... Now I have a dietitian that I see regularly because I'm on dialysis. But if I had had them beforehand and gotten the knowledge I have now, maybe treatment could have been delayed, or I would have never been on dialysis to begin with if I had had the same access that I have now."

In addition to being the Vice Chairman and most senior Republican on the powerful U.S. House Ways and Means Committee, Buchanan is also the Chairman of the Health Subcommittee, which has broad jurisdiction over traditional Medicare, the Medicare prescription drug benefit program and Medicare Advantage.

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