For years, there has been a disconnect between the powerful impact of kidney disease and the scale of our nation's response. An estimated 26 million people in the United States are living with chronic kidney disease (CKD). And for more than 115,000 Americans each year, CKD will progress to its final stage, kidney failure, also known as end stage renal disease (ESRD).

Projections show that the number of patients living with kidney failure is expected to double over the next decade. Considering that treating ESRD currently costs Medicare $34 billion each year, government expenditures and tax burdens will only continue to grow. That is, unless we change course. As leaders from the kidney community's largest national kidney patient advocacy organizations, we believe there is no better time than now.

Bipartisan, bicameral legislation now pending in Congress -- the Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130/S. 598) -- promises meaningful, positive change in policy, and can be the catalyst for improving quality of life for individuals who constitute the diverse and growing kidney patient population. The bill's focus areas are care coordination, access to care and research.

Most ESRD patients today face much more than kidney disease. They must also manage the complex and challenging medical conditions, such as diabetes and hypertension, that contribute to kidney failure. When treating patients with myriad comorbidities, it's generally agreed the best way to improve health outcomes and reduce hospital admissions (while simultaneously cutting costs) is to coordinate care efforts among clinicians and assist the patient in navigating the health care system. Unfortunately, the fragmented fee-for-service Medicare program places providers in silos that made sense in 1965 but which today leave ESRD beneficiaries to juggle 12 weekly hours of dialysis treatment, transportation arrangements, co-insurance responsibilities, bird-dogging the transplant process, and compliance with rigorous medication and dietary regimens.

One avenue to addressing this problem would be for ESRD patients to enroll in Medicare Advantage (MA) plans, which many health policy experts argue are best able to serve the needs of complex populations. Ironically, ESRD patients are legally barred from enrolling in MA plans, a vestige of the long-past era when both dialysis and managed care were considered novel. The limited experience with MA plans serving dialysis patients (there are exceptions for dually-eligible beneficiaries to enroll in Special Needs Plans, and for over-65 MA enrollees to remain in their plans after kidney failure) demonstrates that plans can better coordinate care and dramatically reduce hospital days by avoiding complications. Therefore, the proposed legislation would repeal the anachronistic ban, granting ESRD patients equal access to much-needed care coordination and with it, the MA cost-sharing structure which is advantageous to seriously ill beneficiaries.

Despite the necessity of dialysis treatment, consistent access to care is not ensured for all patients. Reaching dialysis centers in rural or urban communities, for instance, may require lengthy commutes that only become more difficult with age. The proposed legislation targets this critical access issue, permitting expansion of home dialysis treatment options through the use of telemedicine. Importantly, the legislation would also create incentives for nephrologists and other dialysis professionals to work in traditionally underserved areas -- a "win-win" for patients and providers alike.

Moving forward, promising research projects, such as implantable or wearable artificial kidneys, represent a new frontier of hope for individuals with kidney failure since the advent of dialysis technologies and organ transplantations. Yet renal research dollars remain disproportionate to the cost burden of treatment. The bill would identify gaps in research and better coordinate efforts among government agencies. Importantly, it would also direct a study to help grasp the disproportionate impact of CKD on minority populations. In other words, proposed legislation will not only broaden the extent of our knowledge, but also extend optimism and much-needed willpower among those who need it most.

In the end, while individuals with kidney disease come from all walks of life, they are united in a single, powerful way. They are valuable members of American communities nationwide, battling each day for better, healthier lives. We invite our elected officials to join the fight and become true allies of the tens of millions of Americans facing kidney disease. And the first step is supporting legislation, the Chronic Kidney Disease Improvement in Research and Treatment Act, which could help make the dreams of so many CKD and ESRD patients an inspiring reality.

Three of the nation's largest kidney patient support and advocacy groups, the American Kidney Fund, Dialysis Patient Citizens, andthe National Kidney Foundation joined forces to promote the bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act, recently introduced in both the House and Senate. LaVarne A. Burton is the president and CEO of the American Kidney Fund.Hrant Jamgochian is the executive director of Dialysis Patient Citizens. Kevin Longino is the interim CEO of the National Kidney Foundation.

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INTROODUCTION:  Flexible ureteroscopy (fURS) is increasingly used in the treatment of renal stones. However wide variations exist in technique, use and indications. To better inform our knowledge about the contemporary state of fURS for treating renal stones, we conducted a survey of endourologists worldwide.

METHODS: An anonymous online questionnaire assessing fURS treatment of renal stones consisting of 36 items was sent to members of the Endourology Society in October 2014. Responses were collected through the SurveyMonkey system over a three-month period.

RESULTS: Questionnaires were answered by 414 surgeons from 44 countries (response rate 20.7%). U.S. surgeons accounted for 34.4% of all respondents. fURS was routinely performed in 80.0% of institutions, with 40.0% of surgeons performing >100 cases/year. Respondents considered fURS to be first-line therapy for patients with renal stones 2cm. To enhance stone-free rates, respondents frequently employ basket displacement, use ureteral access sheaths, high-power lasers, and dusting techniques.

CONCLUSIONS:  The overwhelming majority of endourologists surveyed consider fURS as a first-line treatment modality for renal stones, especially those < 2cm. Use of ureteral access sheaths, high power holmium lasers and dusting technique have become popular among practitioners. When defining stone-free status after fURS, the majority of endourologists used a zero-fragment or residual fragment (RF)

J Endourol. 2015 Jul 8. [Epub ahead of print]

Dauw CA1, Simeon L2, Alruwaily AF3, Sanguedolce F4, Hollingsworth JM5, Roberts WW6, Faerber GJ7, Wolf JS Jr8, Ghani KR9.

1 University of Michigan, Urology , 1500 East Medical Center Drive , Ann Arbor, Michigan, United States , 48109 
2 University of Michigan, Urology, Ann Arbor, Michigan, United States 
3 University of Michigan, Urology, Ann Arbor, Michigan, United States 
4 Fundació Puigvert, Department of Urology , C/Cartagena 340-350 , Barcelona, Spain , 08025 
5 University of Michigan, Urology, Ann Arbor, Michigan, United States 
6 University of Michigan, Urology, Ann Arbor, Michigan, United States 
7 University of Michigan, Urology , 1500 E Medical Center Drive , Ann Arbor, Michigan, United States , 48109
8 University of Michigan, Urology, Ann Arbor, Michigan, United States
9 University of Michigan, Urology, Ann Arbor, Michigan, United States 

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