Nearly 50% of Americans with chronic kidney disease suffer from uncontrolled hypertension. Another 40% live with poorly managed diabetes, a new study has revealed. The findings were published just as President Trump issued a sweeping proposal to improve care for the estimated 30 million Americans with kidney disease. 

For people with CKD, managing chronic disease is the key to reducing the risk of kidney failure and heart attack, said researcher Sri Lekha Tummalapalli, M.D., in a statement. Yet while effective treatment is available, substantial gaps in care quality continue to exist.

The problems appear to fester at the primary care level, explained Tummalapalli, a nephrologist. She blamed a lack of quality measures, poor knowledge of current guidelines and low rates of specialist referral. In addition, payment models and care delivery systems do not support population-scale interventions, she said.

Improving the control of hypertension and diabetes will require supports for lifestyle modification and medication adherence. Building these systems “will be the task of healthcare over the next decade,” Tummalapalli suggested.

Responding to the national kidney care burden, Trump on Wednesday signed an executive order directing federal agencies to treat kidney disease in its early stages, ease access to kidney transplants and shift financial incentives away from dialysis.

CKD affects about 14% of the U.S. adult population and incidence is expected to grow. Among fee-for-service Medicare patients, total medical costs in 2016 exceeded $79 billion for CKD and another $35 billion for end-stage renal disease patients, according to the U.S. Renal Data System.

Read the study and McKnight’s recent story on dialysis outcomes