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A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

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Kidney Disease Research Updates
Winter 2011

Report Calls for Increased Coordination of Federal CKD Prevention and Treatment Efforts

Federal CKD Matrix diagram showing federal agencies involved in CKD activities. The six-sided, wheel-like diagram clusters agencies according to function. Listed under 'Surveillance' is CDC, CMS, DoD, HRSA, HIS, NIDDK, and VA. Listed under 'Professional Education and Outreach' is CDC, CMS, DoD, HRSA, HIS, NIDDK, and VA. Under 'Delivery and Payment of CKD Care' is CMS, DoD, HRSA, HIS, NIDDK, and VA. Listed under 'Scientific Research' is CDC, FDA, HRSA, NIDDK, and VA. Listed under 'Quality Improvement/Evidence of Therapy' is VA, IHS, HRSA, DoD CMS, CDC, and AHRQ. Listed under 'Public Education and Outreach' is VA, NIDDK, IHS, HRSA, DoD, and CMS.

Increased coordination of federal health efforts would vastly improve chronic kidney disease (CKD) prevention and care, according to a recent report from the National Kidney Disease Education Program (NKDEP), part of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

“Current Federal efforts span a range of missions, including surveillance, professional, and patient education, outreach to high-risk populations, quality improvement, and delivery of, as well as payment for, CKD treatment,” wrote NKDEP Director Andrew S. Narva, M.D., F.A.C.P., and co-authors in the May 2010 issue of Advances in Chronic Kidney Disease. “However, Federal agencies do not function as a comprehensive system or, indeed, as a system at all.”

Medicare spends more than $49 billion annually to care for patients with kidney disease. The NIDDK, together with other National Institutes of Health Institutes and centers, currently funds a $523 million kidney disease research portfolio. Other federal organizations, including the Centers for Disease Control and Prevention, the Indian Health Service, and the U.S. Department of Veterans Affairs, also contribute major funds and resources directed at CKD prevention and care.

Despite these enormous efforts, the percentage of people with CKD receiving recommended care has remained unchanged for many years. Fewer than 35 percent of people with diabetes and CKD are getting eye examinations or tests to measure blood sugar control or blood lipids. Blood pressure control among CKD patients remains poor. And despite tests that show the kidneys are not adequately filtering blood, many people with CKD are not being diagnosed and therefore are not receiving care to slow CKD progression.

About 23 million Americans 20 years old and older have CKD. Associated with diabetes, obesity, and cardiovascular disease, CKD prevalence has dramatically increased during the past 30 years. CKD is enormously expensive to treat, representing more than one-quarter of Medicare expenditures.

The report cited Quality Improvement Organizations (QIOs)—tasked by Congress to improve the quality of Medicare services—as having the potential to make great strides in CKD care quality. Each state has in place a QIO that consists of a private contractor or nonprofit organization. A recent initiative, called Ninth Scope of Work, focuses QIOs on determining the rate of diabetes-related kidney failure, slowing CKD progression by ensuring CKD patients are getting high blood pressure medication, and encouraging the early placement of arteriovenous fistulas—the best long-term vascular access—for CKD patients starting hemodialysis.

Kidney Interagency Coordinating Committee (KICC)

The KICC, chaired by Narva, brings together representatives from nine Government agencies involved in CKD to communicate and coordinate activities across sectors.

“The barriers to achieving greater effectiveness begin with poor visibility,” wrote Narva and co-authors. “Federal program managers experience difficulty in learning about, and staying abreast of, what other Federal agencies do related to CKD.”

In response, the KICC developed an interactive, web-based tool that summarizes CKD-related activities from all nine KICC participating agencies. Called the KICC Matrix, the tool is available on the NKDEP website at


Among the report’s recommendations are the creation of a cross-agency initiative to define CKD-relevant improvement measures, an assessment of current CKD clinical guidelines, the development of better kidney failure prediction tools, and the coordination of efforts to strengthen CKD educational materials for health care providers. The report also recommends looking for successful models of federal collaboration outside CKD prevention and care.

The NIDDK has easy-to-read booklets and fact sheets about CKD. For more information or to obtain copies, visit


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NIH Publication No. 11–4531
January 2011


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