Integrated Concepts for Chronic Disease Management
By Rice Powell, CEO of Fresenius Medical Care
If the coronavirus pandemic has taught us anything, it’s that good health does not come as a guarantee. But for those living with a chronic illness — like kidney disease — that lesson is a lifetime in the making.
Kidney disease isn’t uncommon. Globally, at least 500 million people suffer from the disease. That’s about one in ten adults — and the numbers continue to rise. Despite its prevalence, kidney failure is much less in the public eye than other chronic illnesses, like diabetes or cancer. In its most severe form – terminal kidney failure – the kidneys no longer filter the waste products from metabolism out of the blood. Excess water no longer is separated from blood to mix with urine for disposal. If those afflicted want to survive, they must select a kidney replacement therapy.
50 years ago, a diagnosis of terminal kidney failure meant a certain death. Dialysis therapy was in its infancy, and the treatment itself was expensive and not widely available. Thanks to medical progress, treatment for kidney disease has improved radically. We are proud that Fresenius Medical Care – the world leader in kidney replacement therapies – has played a decisive role in improving care. While the focus in the past has been on keeping patients alive whose kidneys stopped working, today, Fresenius Medical Care is pioneering a strategy for the future that focuses on integrated kidney care. This means supporting patients along their entire treatment journey, before and beyond dialysis. Our goal: better and more cost-effective therapies to guide people with chronic kidney disease through their life journey.
One option is a kidney transplant. However, the number of potential recipients far outnumbers the number of available donor organs. That’s why the vast majority of those with chronic kidney failure – currently around 3.5 million people – receive dialysis.
But dialysis, as it is currently, isn’t perfect. It’s tiring and physiologically complex, as blood from a patient is pumped to an external filter for cleansing and modification before it is returned to the patient. Dialysis also is demanding on a patient’s lifestyle. The procedure used most often, known as hemodialysis, traditionally requires visiting a dialysis center three times a week, with each visit lasting several hours. Not only that, but dialysis also requires patients to stick to a strict diet to limit the buildup of even more toxic substances.
Ultimately, the best treatment for kidney disease is to avoid dialysis entirely or delay it for as long as possible. To do this, we need to care for kidney patients or people with pre-existing conditions that could cause kidney failure, like diabetes or high blood pressure, much earlier than before – not just when their kidney disease reaches its worst phase.
Early detection is key to treating kidney disease – and digitalization and artificial intelligence tools are helping improve detection. Fresenius Medical Care already has the world’s largest data bank on advanced kidney disease. It is a constantly expanding repository of information on more than two million patients, more than a half-billion dialysis treatments and nearly two billion lab tests. With this data, we can search for biological markers that tell us how susceptible a person is to ravages of having kidney disease, or how they would react to different therapeutic measures. This helps ensure the right treatment for the right patient at the right time.
Our researchers and engineers work non-stop to improve our understanding of kidney failure interventions, dialysis machines, dialysis filters and related components. In addition to that, we are pursuing completely new and innovative approaches to therapy and investing in promising start-ups and young companies in the space.
One important innovation: dialysis treatment doesn’t always have to be performed in a dialysis clinic. More and more patients are opting for at-home dialysis, which gives them more flexibility on when to dialyze. They can better integrate dialysis into their professional and private lives. And as a rule, patients dialyze themselves more often and more regularly at home, which has a measurable impact on their health and life expectancy. Especially during a pandemic, at-home dialysis offers an added layer of protection against infection.
That being said, treatment depends on the patient’s circumstances and preference. And at Fresenius Medical Care, we cover the full spectrum of therapies and offer a seamless transition from in-center to at-home dialysis (and back again, if a patient chooses to return), all with high-quality standards of care.
How can we ensure that high-value care remains affordable? The answer lies in value-based care models. With this approach, we and other providers are no longer paid for a variety of individual services, as has been the case in the past. Instead, we take full responsibility for the health and well-being of our patients and all necessary treatments – and we receive a single payment to cover all the costs. This encourages efficiency in care and rewards good clinical performance and outcomes. If our patients do better thanks to our good care, it pays off for us.
We have many possibilities to improve the lives of people with kidney disease – with and beyond dialysis. All partners in dialysis and in the health care system should work closely together to exploit these possibilities for the benefit of patients. At Fresenius Medical Care, we have been providing exceptional care for patients for 25 years – and will continue to for many years to come. Our mission is and will remain: Creating a future worth living. For patients. Worldwide. Every day.
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