Chronic Kidney Disease Care

Safely reducing per capita spending on

Chronic Kidney Disease


People suffering from chronic kidney disease have higher rates of hospitalization and cardiovascular events, experience more disability, and often die prematurely. Americans with CKD incur roughly $315 billion in annual health spending and account for almost a quarter of Medicare spending — over $121 billion annually. Patients who progress to ESRD incur health spending in excess of $87,000 per person per year.

A conservative estimate of net savings from national implementation of the CERC CKD model is $63 billion dollars in direct health care spending per year. CERC’s CKD care redesign team found three addressable failure points in current care, which they address with three recommendations:

·      More proactive identification and treatment of patients with early-stage CKD to slow disease progression and its high costs.

·      Cost-efficient coordination of care for patients approaching ESRD to prevent costly, unnecessary hospitalization and emergency room visits, and to establish the least hazardous form of vascular access for those patients who prefer hemodialysis to treat end-stage diseases.

·      Assurances that patients have an opportunity to select a treatment for ESRD that best fits their personal preferences. This includes the opportunity to select home-based treatment options such as peritoneal dialysis, which are much less costly and exhausting than care in dialysis centers.

Team: Graham Abra, MD, Manali Patel, MD, David Moore, PhD, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein, MD, MPH

Publication by CERC Faculty and Fellows


Integrated Care in ESKD: A Perspective of Nephrologists.

Clinical Journal of the American Society of Nephrology. 14, no. 3 (March 7, 2019):451