The Effect of Care Plan Adherence on Chronic Kidney Disease Progression
And four ways to slow it down
March 5, 2021

March is upon us, which means it’s National Kidney Month.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Chronic Kidney Disease (CKD) affects 37 million people. And the National Kidney Foundation shares that 1 in 3 Americans are at high risk for developing kidney disease today, with diabetes and high blood pressure  being the most common causes of CKD.  

The cost of CKD progression 

Chronic kidney disease is categorized into 5 stages, which indicate the severity of the disease relative to percentage of kidney function. 


The below chart from the 2019 USRDS Annual Data Report, shows the cost increase for Medicare beneficiaries related to CKD stage progression, which shows that based on the 2016 FFS Medicare population, per-person-per-year expenditures were $19,799 for beneficiaries in with CKD stages 1 or 2 versus $30,640 for beneficiaries with CKD stages 4 or 5.

Progressing to End Stage Renal Disease (ESRD), which requires dialysis, reduces quality of life and expected life span. In addition to diminished patient health outcomes, according to the Diabetes Leadership Initiative “For each Medicare patient who avoids dialysis progression, an estimated $250,000 can be saved.”  

However, looking at the cost data alone doesn’t tell the whole story.

A 2019 Scientific Reports study shows the association between health related quality of life and progression of chronic kidney disease by looking at health-related quality of life (HRQOL). The study found  “End-stage renal disease (ESRD) patients showed lower HRQOL scores than the healthy population” and “It is well known that low HRQOL scores in ESRD patients are associated with higher mortality and hospitalization rates.”

So, based on the literature we know a key goal for patients with CKD is to avoid stage progression leading to ESRD and the need for dialysis, but how?

Managing CKD progression through care plan adherence 

The good news is, progression of the disease can be slowed. There are four care plan adherence key strategies to manage and slow progression of CKD: medication adherence, blood glucose & blood pressure control, nutrition & exercise, and appointment adherence. 

Medication Adherence

In a 2018 study “Self-reported Medication Adherence and CKD Progression” (Cedillo-Couvert et al, 2018), increased patients took, on average, 8 medications per day, self-reporting only a 66% adherence to their medication schedule. Among the most common reasons for non-adherence were cost, complex dosing schedule, and fear of adverse effects. The most common reason? 68% of patients were unaware of the importance of taking their medication. 

Why is medication adherence so important? Because the data shows, as illustrated below, that low medication adherence has a higher correlation with both CKD progression and death. 

Source: Cedillo-Couvert et al, 2018

Providing patients with education, motivational techniques to build habit formation, and the tools they need to help keep track of complex dosing schedules is key to improving medication adherence. 

Appointment Adherence

For patients who have progressed to dialysis treatment, one study showed that “missed appointments increase the risk of healthcare interventions. In the two days after a missed dialysis appointment, 5% of patients are hospitalized vs. 1.2% of those that attended the appointment.”

Blood Pressure Control & Blood Glucose Control

According to several sources, controlling blood pressure is one of the most effective ways to slow the progression of CKD. For patients with CKD and diabetes, controlling blood glucose levels can help to reduce the risk of developing albuminuria. Providers should ensure patients have the devices and supplies they need to check their levels and check them regularly. 

Learn more about how digital health is helping improve care plan adherence—as well as other healthy habit formation—in this month's feature article: 7 ways to improve care plan adherence through digital health and behavioral economics.

New CMS models 

CMS has put a huge attention and focus on CKD and ESRD, finalizing two new payment models: End-Stage Renal Disease Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Model.

The goal of ETC is to incentivize physicians to leverage home dialysis more frequently (where appropriate) and increase kidney transplants. The model incentivizes participating ESRD facilities and clinicians to work with patients and caregivers in choosing the method of treatment and getting the necessary resources and supports at home to sustain better quality of care. That being said, even with the right devices and medications available for home care, adherence to care plans remains bleak—with only 12 percent of individuals treated for ESRD successfully completing home dialysis and care.

The KCC was created to reduce costs and improve quality of care for patients with CKD and ESRD, ultimately delaying the need for dialysis and kidney transplant. The models were set to start in 2020, but were delayed due to the COVID-19 pandemic.

In both the ETC and the KCC models, behavioral economics can be leveraged to meet model requirements for improving quality of care through ensuring better outcomes with positive habit formation—whether those habits include medication or medical device adherence, exercise, or proper diet.

How can Wellth help?

Wellth understands the complexities of CKD and ESRD care plans. So, we have created a unique user experience for patients with these diagnoses that rewards patients for following their entire care plan, including medication adherence, low-sodium diets, exercise, appointment adherence and education about transplant options. 

To see how Wellth works, download Maria’s member journey here.