Life-Changing Options

CVS Health to Focus on Improving Care for Patients with Kidney Disease

FEATURE
April 4, 2018
Executive Vice President of Transformation for CVS Health

CVS Health is bringing its unique integrated model and holistic patient care to an area of significant, unmet clinical need — chronic kidney disease (CKD) and end-stage renal disease (ESRD). Our proven, in-market programs have enabled us to improve health outcomes — including for patients with complex, chronic conditions. Now we are utilizing our experience and expertise to help disrupt and reshape care for patients with kidney disease.

CVS Health's approach to this expensive, complex disease has two main components. The first is early identification through advanced analytics of patients with CKD before they require dialysis. Our highly trained AccordantCare nurses will work with these patients to help them with comorbidity management and nutritional counseling, which can delay the need for dialysis. Specially trained nurses will also provide the support needed for a smooth transition to renal replacement therapy. Given the scarcity of donor kidneys for transplantation this generally means some form of dialysis.

The second pillar of our approach is to make home dialysis the modality of choice for patients and nephrologists. Currently, most ESRD patients in the U.S. receive hemodialysis treatments three times a week in dedicated treatment centers. Unfortunately, these patients have relatively poor outcomes with high mortality rates and significantly lower quality of life.

The medical literature is clear that longer, more frequent hemodialysis treatments can improve outcomes in appropriate patients.Rocco MV et al. The effects of frequent nocturnal home hemodialysis: The Frequent Hemodialysis Network Trial. Kidney Int 2011;10:1080-91. For many reasons, this type of dialysis is best provided in the convenience of the patient's home. There are many current barriers to home hemodialysis and our program will be designed to mitigate nearly all of them. Central to our approach is the development of innovative new technology intended to make self-treatment with hemodialysis at home easy and safe. We expect this to allow more patients, for whom this treatment is appropriate, to achieve the better outcomes seen with longer, more frequent hemodialysis.

Our home hemodialysis device in development has:

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Fewer steps than traditional devices and a simple, animated interface to guide patients through set-up, treatment and cleaning

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Advanced technology intended to help reduce the likelihood of adverse clinical events

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Cloud connectivity to share treatment information between patients and nephrologists

Over the next few months we will be initiating a clinical trial intended to demonstrate the safety and efficacy of the new device to support U.S. Food and Drug Administration clearance.

Kidney Disease: The Silent Killer

Kidneys are the primary way the human body flushes toxins from the body. Every day the kidneys process about 200 quarts of blood to filter out about two quarts of waste products and extra water, which are flushed out of the body through urination.https://www.webmd.com/a-to-z-guides/function-kidneys#1.

Patients with CKD or ESRD lose kidney function, which leads to fluid retention, electrolyte imbalance, and accumulation of certain toxins. This often results in high blood pressure, heart disease, muscle wasting, general feeling of fatigue and weakness, and other symptoms and side effects which can be severe or life-threatening.

Unfortunately, in the early stages, CKD has no symptoms and so can go undetected until it is very advanced. That's why it is often called the "silent killer."

Current Treatments: Poor Outcomes, High Costs

There are two types of dialysis — hemodialysis and peritoneal dialysis. With hemodialysis, a patient's blood is circulated through an artificial filter outside the body, to "clean" it and then returned to the patient. While hemodialysis can be done at home, nearly all patients receive treatment in-center. Typically, patients receive hemodialysis three times a week with each treatment lasting three to four hours. This leaves a two-day interval each week without treatment, which has been linked to a significant increase in risk of hospitalization and death.Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ: Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol 2012.

Peritoneal dialysis requires a flexible catheter to be surgically implanted within the abdominal cavity of the patient with one end of the catheter brought through the skin overlying the lower abdomen. Sterile dialysis fluid is instilled into the patient’s abdominal cavity through the catheter, allowed to rest, then drained several hours later. This procedure removes waste products and normalizes electrolytes such as sodium and potassium. Peritoneal dialysis can be administered throughout the day, each day, or every night while the patient is sleeping. About 9 percent of ESRD patients in the U.S. utilize peritoneal dialysis.United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017.

Kidney transplantation is the gold standard of treatment for patients on dialysis. However the wait list is long — more than 3,000 patients are added each month — and not all patients are medically suitable to receive a transplant.https://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats Accessed March 8, 2018.

For a majority of patients on the waitlist, or those not medically eligible for a transplant, dialysis is a life-saving treatment that performs some of the activities of normally functioning kidneys.https://www.webmd.com/a-to-z-guides/kidney-dialysis#1-2. Treatment outcomes for in-center dialysis — currently the standard for a vast majority of patients on dialysis — tend to be poor. One in five dialysis patients dies in the first year after starting treatment — mainly from infection or cardiovascular disease.United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017. Overall mortality rates among ESRD patients are four- to 10-fold higher than the general Medicare population and hospitalization rates, six-fold higher.United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017.

Improving Outcomes

Eliminating gap days and enabling longer, more frequent dialysis, in appropriate patients, has been shown to improve outcomes, most notably lower mortality.Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ: Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol 2012. The risk of death from cardiac arrest is 36 percent higher and that from heart failure or arrhythmia is nearly double on the day after the two-day interval in treatment.Foley RN, Gilbertson DT, Murray T, et al. Long interdialytic interval and mortality among patients receiving hemodialysis. The New England journal of medicine. 2011;365(12):1099–107.

Patients who receive more frequent hemodialysis also have better metabolic and blood pressure control.Rocco MV et al. The effects of frequent nocturnal home hemodialysis: The Frequent Hemodialysis Network Trial. Kidney Int 2011;10:1080-91. Patients receiving more frequent dialysis report having a better quality of life. Logistically and economically the home is generally the best setting for these treatments.

Patients can opt for more frequent, shorter daytime or evening treatments or longer treatments overnight — all without traveling to a center or taking time off work. Patients receiving in-home dialysis report being more satisfied with their treatment.Fadem SZ et al. Satisfaction with renal replacement therapy and education: the American Association of Kidney Patients survey. Clin J Am Soc Nephrol 2011, 6:605-12.

In one survey, 63 percent of nephrologists said they would recommend at-home treatment for close friends and family.Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ: Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol 2012. A majority — 59 percent — agreed that increasing the frequency of dialysis beyond three times a week significantly improves clinical outcomes. However, only a small percentage of patients are offered home hemodialysis today.Fluck RJ, Foque D, and Lockridge RS. Nephrologists' perspectives on dialysis treatment: results of an international survey. BMC Nephrology 2014, 15:16.

Better for Patients and Payors

Our comprehensive patient care solution for kidney disease will address significant challenges to at-home dialysis treatment by:

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Helping identify and diagnose advanced kidney disease before urgent dialysis is required

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Educating patients about at-home treatment options before they start dialysis

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Providing comprehensive patient training to enable a smooth transition to home with ongoing support

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Developing a home hemodialysis device that is simple to use, as well as safe and effective

Caring for members with kidney disease is expensive for payors and can be highly complex. Payors need better patient care solutions, as well as effective cost management strategies to mitigate the trend impact. Our goal is to help make convenient, at-home peritoneal dialysis and hemodialysis a reality for as many patients with kidney disease as possible.

Want to learn more about how CVS Health plans to reshape care for patients with kidney disease? Ask Us
FEATURE
April 4, 2018
Executive Vice President of Transformation for CVS Health

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† Than general Medicare population.

The home hemodialysis device under development has not received market clearance from the FDA. The device will be studied in a clinical trial conducted by CVS Health. 

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