for Medicare & Medicaid Services (CMS) has reviewed potential refinements to the ESRD-Prospective Payment System to facilitate Medicare beneficiaries’ access to certain innovative treatment options and, through the Center for Medicare and Medicaid Innovation (Innovation Center), is providing Page 6 | Advancing American Kidney Health financial incentives to help clinicians better manage care aligned with beneficiaries’ preferences regarding home dialysis and kidney transplantation. CDC is working to translate evidence-based recommendations into practical strategies to improve the quality and safety of care for patients undergoing dialysis. CDC formed the Making Dialysis Safer for Patients Coalition, through which it collaborates with partner organizations and patient representatives to implement core interventions proven to reduce dialysis bloodstream infections.12 Goal 3: Increase Access to Kidney Transplants To advance Goal 3, The Office of the Assistant Secretary for Health (OASH) is considering recommendations from the Advisory Committee on Blood and Tissue Safety and Availability regarding updating the U.S. Public Health Service Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission Through Organ Transplantation, which may increase available options for individuals who need kidney transplants. The Health Resources and Services Administration (HRSA) is working to provide additional support for individuals who are considering living donation by reducing financial barriers. In addition, new Innovation Center models include financial incentives for health care providers to help Medicare beneficiaries move through the kidney transplantation process. Given the substantial burden kidney disease places on patients and their caregivers, it is imperative that HHS continues to advance improvements and innovations in kidney disease prevention and care. This paper outlines HHS’ goals for improving kidney care, finding alternatives to current dialysis treatment, and increasing access to kidney transplants, and it describes agency initiatives designed to address these goals. Page 7 | Advancing American Kidney Health II. GOALS AND OBJECTIVES Goal 1: Reduce the Risk of Kidney Failure The number of people with kidney failure has been growing in recent years, afflicting more than 726,000 Americans in 2016.13 Yet, 90 percent of adults with kidney disease and nearly half in advanced stages of CKD are unaware they have the condition.14 Associations have been found between diabetes, hypertension, and CKD. For example, roughly 1 out of 5 adults with hypertension, and 1 out of 3 adults with diabetes, may have kidney disease.15 Moreover, among U.S. adults aged 18 years or older, diabetes and high blood pressure are the primary reported causes of ESRD. Kidney disease usually progresses slowly in most individuals, and blood and urine tests can be used to monitor the progression of the disease. Depending on the person and the stage of the disease, interventions can sometimes slow this progression. Lifestyle and medication treatment for risk factors including diabetes and hypertension are also important factors to address the progression of CKD. Two objectives for HHS’ efforts to reduce the risk of kidney failure are: OBJECTIVE 1. Advance public health surveillance capabilities and research to improve identification of populations at risk and those in early stages of kidney disease OBJECTIVE 2. Encourage adoption of evidence-based interventions to delay or stop progression to kidney failure Goal 2: Improve Access to and Quality of Person-Centered Treatment Options More than 100,000 Americans begin dialysis each year.16 Approximately one in five will die within one year, and half within five years.17 Those with kidney failure typically must undergo dialysis (often at a dialysis center) at least three times per week for three to four hours per session, or through daily home peritoneal dialysis or home hemodialysis, and maintain an extremely restrictive diet. Infections are a serious adverse outcome related to dialysis. Each year, approximately 29,500 bloodstream infections occur in hemodialysis outpatients, and as many as one in two peritoneal dialysis patients develops peritonitis.18 These types of infections can lead to sepsis and can compromise the patient’s treatment options, including ability to receive a kidney transplant. Eighty-seven percent of Americans with kidney failure start treatment with hemodialysis. Of those on hemodialysis, the majority (98 percent) receive in-center hemodialysis and only 2 percent use home dialysis.19 Up to 85 percent of patients are eligible for home dialysis,20 and in one study, 25 to 40 percent of patients reported that they would select home dialysis if given the opportunity.21 Higher survival has been reported among individuals in the U.S. receiving home dialysis when compared to individuals receiving in-center hemodialysis treatment.22,23,24,25 Supporting person-centered treatment options means increasing the number of treatment modalities available for individuals living with kidney failure, including home modalities, transplantation, and other alternatives to in-center hemodialysis still under development. Rapidly emerging technologies offer hope that new treatment options can improve patient outcomes and