RAND ReseARch AReAs ChiLDREN AND FAMiLiES EDUCAtiON AND thE ARtS ENERgy AND ENviRONMENt hEALth AND hEALth CARE iNFRAStRUCtURE AND tRANSPORtAtiON iNtERNAtiONAL AFFAiRS LAW AND BUSiNESS NAtiONAL SECURity POPULAtiON AND AgiNg PUBLiC SAFEty SCiENCE AND tEChNOLOgy tERRORiSM AND hOMELAND SECURity

F or nearly 40 years, kidney disease has been defined primarily in terms of end-stage renal disease (ESRD), i.e., kidney failure requiring dialysis or kidney transplantation. Recently, however, the disease has been redefined as chronic kidney disease (CKD), a progressive condition that culminates in ESRD and that often can be effectively treated in its earlier stages; prevention is now a realistic possibility. Clinical interventions at earlier stages of CKD can effectively slow, stop, or, in some cases, reverse the progress to ESRD. This development can be characterized as a “quiet revolution” in nephrology. The possibility of preventing early-stage CKD from developing into kidney failure has presented an opportunity to improve patient outcomes, but it also poses challenges for both practitioners and policymakers. For medicine, CKD represents a challenge in moving from a model focused on treatment for the end stage of disease (i.e., dialysis, kidney transplantation) to a model that balances the relationship between prevention and care. For policy, a key issue is who will pay for the range of care associated with the expanded definition of kidney disease. There is a need for both practitioners and policymakers to have a better understanding of what leading CKD clinics and practices in the United States are doing to address the challenges of CKD throughout the disease continuum. A 2006–2007 study conducted through the Health Policy and Outcomes Core of the Comprehensive Center for Health Disparities–Chronic Kidney Disease (CCHD-CKD) represents an initial step in developing that understanding. The CCHDCKD is composed of researchers at Charles Drew University, the David Geffen School of Medicine at the University of California at Los Angeles, and the RAND Corporation. The findings from this study highlight the benefits of CKD clinics, including the potential for early treatment, and point to several challenges facing CKD practitioners, such as limitations on reimbursement and the Key findings: