CKD Prevalence Unmoved Despite Billions in Virtual Care

In an interview with Pharmacy Times, Caroline Pearson, executive director of the Peterson Health Technology Institute (PHTI), discussed a new PHTI evaluation of virtual care companies managing chronic kidney disease (CKD). Pearson explained that PHTI took on the review because CKD is common but frequently silent: it affects roughly 1 in 7 adults, most of whom don’t know they have it, and symptoms often don’t appear until the disease has progressed too far to change its course. Left unmanaged, CKD can progress to end-stage kidney disease (ESKD), which requires transplant or dialysis and can cost more than $100,000 per patient per year. With traditional Medicare spending over $140 billion annually on CKD, Medicare Advantage spending a comparable amount, and substantial venture capital flowing into virtual CKD care companies and CMS payment models like the Kidney Care Choices model, PHTI set out to determine whether these interventions are actually working.

The findings were largely negative. Using blood and urine markers of kidney function, PHTI found no evidence that virtual CKD companies are slowing disease progression. The evaluation also looked at adherence to guideline-recommended medications—ACE inhibitors, angiotensin receptor blockers (ARBs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors—and found no systematic improvement there either, a pattern that held up in real-world Medicare data from the Kidney Care Choices model. The one positive finding: patients nearing end-stage kidney disease were more likely to start dialysis in a planned rather than emergency (“crash”) manner. But because dialysis starts are rare relative to the overall CKD population, this benefit doesn’t move outcomes for most patients.

For pharmacists, the findings underscore that virtual care vendors are not currently closing the clinical gaps that matter most and that medication adherence—clearly within pharmacists’ scope—remains the area with the clearest evidence of benefit.