Sustainability of Chronic Kidney Disease Care

Strategies to contain the cost of chronic kidney disease (CKD) care and to improve patient outcomes were found across the continuum of care, from prevention and early disease management through later-stage interventions such as conservative management, dialysis, and transplantation. A variety of health system strategies, including funding reform, were identified to help support and enable sustainable CKD care. For those at risk of CKD or in early stages of the disease, public health interventions to support healthy behaviours and ensure access to primary health care seem crucial to preventing or delaying disease progression. For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option. From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.