The University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) is launching an initiative to support research on improving the management of chronic kidney disease (CKD), with a particular focus on addressing disparities including structural barriers and racial inequities.
The three-year research initiative is made possible by a $2.5 million gift from Tennessee-based Monogram Health, a value-based specialty provider of in-home nephrology, primary care, and benefit management services for individuals with chronic kidney and end-stage renal disease.
Among the more than 37 million people in the U.S. living with CKD, communities of color are disproportionately affected, with rates of CKD almost four times as high among African Americans. Penn LDI will rely on its substantial expertise in CKD and transplantation to focus on identifying drivers of CKD progression and addressing barriers to the adoption of optimal, evidence-based therapies.
The initiative will involve Penn LDI Senior Fellows and research teams that have been at the forefront of identifying drivers of CKD progression and barriers to the use of home dialysis therapies, transplantation, and palliative care.
“We are excited about this pairing and the opportunity and the public-private partnership to help advance research in this area,” said LDI Executive Director Rachel Weerner, M.D., Ph.D., in a statement. “LDI’s expertise and academic authority on innovating and improving health care delivery and Monogram Health’s commitment to measurably improving outcomes for individuals living with CKD complement each other. This research initiative provides the opportunity to generate rigorous and important new evidence to advance the field through effectively identifying, managing, and improving outcomes of patients with CKD, while also reducing health inequities.”
More than half a million people in the U.S. annually use dialysis to replace their failing renal functions. Only about 13 percent of these are engaged with dialysis-at-home systems, even though at-home treatment is now recognized for providing a higher quality of life, improved care, and better outcomes.
LDI Senior Fellows’ studies have previously revealed substantial racial and ethnic disparities in survival, cardiovascular comorbidities, and function of patients with CKD.
“Over the last five years, the federal government and providers caring for patients with kidney disease have asserted the urgency of improving access to care and breaking down barriers to home dialysis and transplantation,” aid LDI Senior Fellow and Initiative Director Peter Reese, M.D., Ph.D., in a statement “The White House pushed these initiatives with the Advancing American Kidney Health Initiative. This partnership with Monogram is going to drive progress on these issues with high- quality, pragmatic research.”
Reese is a Professor of Medicine and Epidemiology at the Perelman School of Medicine, an NIH-funded transplant nephrologist and epidemiologist, and past chair of the Ethics Committee for the United Network for Organ Sharing, which oversees transplant regulation in the U.S. He said the new Initiative’s research portfolio will focus on these three areas:
• Improving access to specialty providers because the lack of access to nephrologists is a major barrier to optimal care of CKD and management of its comorbidities, including hypertension.
• Improving the uptake of evidence-based treatment and preventing the progression of CKD because, despite a substantial knowledge base of diagnostic and therapeutic approaches for care, many individuals with CKD often do not receive evidence-based care.
• Improving the financing and delivery models for people with ESRD because care for advanced CKD patients is often fragmented, with providers working in silos that do not communicate well. There are also perverse economic incentives that prevent optimal care for the patient with in-center hemodialysis as a default pathway.
