Pre-emptive transplants may save lives, time and money

Treating chronic kidney disease is expensive. A commercial health plan with 200,000 members may have about $16 million in costs. That averages out to about $260,000 per member.1

Along with inpatient admissions, the other main cost driver is dialysis. Many kidney patients never see a nephrologist before starting dialysis. Some don’t have symptoms in early and sometimes even late stages of chronic kidney disease (CKD).

Without support from a specialist, it’s difficult to preserve kidney function and delay progression of CKD. This means patients face the ordeal of multiple dialysis treatments every week — sometimes before they really know what hit them.

But when kidney patients receives a pre-emptive kidney transplant (PKT), they avoid dialysis altogether. According to the National Kidney Foundation, recent studies show that PKT has many benefits, including:

Lower risk of the body rejecting the kidney
Longer life and better quality of life for PKT patients
Less restrictive diet than when on dialysis
Staying healthier and avoiding health problems associated with dialysis

A pre-emptive transplant usually involves a living donor, which means less time on a waiting list. A family member or friend of the patient may be a willing and compatible donor. In addition to the health benefits, PKT patients save time and money.

CKD is complex. Before patients can consider whether PKT is an option, they need support and education — preferably as early as possible. A disease management program that specializes in CKD allows patients to work one-on-one with nurses who are specialized kidney care coordinators.

The program supports and educates members, leading to more informed decisions as their kidney disease progresses. A critical component of the program is encouraging members to follow closely with a nephrologist, especially with CKD stage 4 and 5.

We analyzed participants in a disease management program that specializes in kidney disease.

Participants in CKD stages 4 and 5 are:
9 percent less likely to transition to dialysis2
3.5 times more likely to be evaluated for a kidney transplant and
Evaluated 2 times faster than nonparticipants3

Participants with end-stage renal disease (ESRD) are:
7 times more likely to be evaluated for a kidney transplant
Evaluated two times faster than if a member was not participating in an ESRD disease management program.3

A CKD-focused disease management program helps educate members on the disease and their treatment options, including PKT. Every case is different, but specialized education and support can save lives, improve the quality of those lives and reduce costs for everyone.

Read more about managing the total cost of kidney disease.


1. LaCombe P. analysis of annual total spend for a payer client with 200,000 lives. Internal client book of business data. Analyzed in 2014.
2. Optum Health Care Analytics (HCA) CKD to ESRD Transition Analysis, 2016.
3. Optum HCA CKD and ESRD Transplant Analysis, 2017.


About the Author:

Dr. Ana Stankovic is a practicing nephrologist and a National Medical Director at Optum.

Dr. Stankovic earned a BS in Biomedical Engineering from Marquette University and Doctor of Medicine M.D. from Brown University. She did Internal Medicine at Georgetown University and completed Nephrology and Hypertension Fellowship at Harvard Medical School. Dr. Stankovic is Board Certified Nephrologist and Clinical Hypertension Specialist, Certified in Health Care Quality and Management, and Certified COLA laboratory director for moderately complex laboratory.

Dr. Stankovic is a fellow of the American Board of Quality Assurance and Utilization Review Physicians, American College of Physicians, American Society of Nephrology, and the American Society of Hypertension. Dr. Stankovic was awarded Howard Hughes Medical Institute Research Fellowship and NIH NRSA Postdoctoral Clinical Fellowship, and listed as Castle Connolly Top Doctors in Nephrology.

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