Kidney disease is a leading cause of death in the U.S., yet most people who have chronic kidney disease (CKD) don’t know they have it – until its latest stages, CKD is often symptomless. It’s preceded by other conditions, ones that can be prevented.

Chronic conditions like CKD cost employers in the U.S. $36.4 billion a year in employee absences, and as symptoms progress and create more health problems for the patient, the healthcare costs to employers increase exponentially.

CKD often flies below the radar for many HR leaders, said Scott Vold, chief commercial officer at Renalogic, a CKD care and dialysis cost-management program. “Yet dialysis consistently ranks as a top-five expense for self-funded plans, and year-over-year, commercial plans spend about $100 billion on chronic kidney disease–related care.”

During a webinar hosted by From Day One, titled “What Employers Need to Know About Chronic Kidney Disease: Its Rising Prevalence, Its High Cost, and How to Manage It,” Vold was joined by Eric Bricker, an internal medicine physician and chief medical officer at AHealthcareZ, and Alyssa McGonagle, PhD, associate professor of psychological science and organizational science at UNC Charlotte and the author of a forthcoming book on chronic health conditions in the workplace.

The group discussed the effects of CKD and other chronic health conditions on employees and companies and why it’s so important to encourage prevention, early intervention, and a culture that supports employee health. 

The Deadly, and Often Undetected, Threat of Chronic Kidney Disease

The Centers for Disease Control estimates that one in seven adults lives with CKD. Why so common? Three out of four cases are the result of type-two diabetes or high blood pressure (hypertension), and both are prevalent in the US. 

But most don’t know they have CKD until the disease has progressed to deadly territory. As many as 90% of people who have CKD are unaware because CKD itself is painless until it’s not. “It’s symptomless,” said Bricker. “Our bodies are so amazing that you can actually damage the vast majority of your kidneys before you ever realize it.” By the time symptoms are detected, much of the damage has been done – damage that is permanent.

It’s common for patients to be diagnosed in stage three, said Vold. Physicians don’t typically screen for CKD exactly, but they do screen for hypertension and diabetes. “In other words, a lot of people aren’t diagnosed until they’ve lost about 40% of their kidney function,” he said. By the time a person reaches stage five, or end-stage renal disease, they need dialysis or a kidney transplant just to survive. The National Institutes of Health estimates that two in every 1,000 Americans live with end-stage renal disease.

“More than two thirds of the time, someone who starts dialysis does it in an emergency context,” said Vold. It often follows a major event, like a heart attack or stroke, maybe a sharp blood-sugar crash. “The ambulance is called, and they start dialysis with a catheter in their neck in the intensive care unit for a few days, and then get discharged to an outpatient facility. It’s a wildly horrific way to start dialysis. It’s a terribly expensive way as well.”

What It’s Like to Live and Work with a Chronic Health Condition

Chronic health conditions like CKD pose a substantial obstacle to being present at work, physically and mentally. They can limit one’s daily activities, said McGonagle, and contribute to anxiety and depression, and the medical attention required to treat long-term conditions can cut into work schedules.

The diagnosis of a chronic health condition can lead people to reevaluate their careers or question their professional identities, and there’s the stigma too, McGonagle explained: “Some people fear that if they disclose a chronic health condition, they’ll be passed over for promotion, or they’ll be unable to continue being employed because their employer doesn’t want them to be costly on their medical plans or to take days off from work.”

The mental toll shouldn’t be underestimated. “Those with diagnosed chronic kidney disease are three to four times more likely than the general population to have depression,” said Vold, citing an article in Frontiers in Pharmacology. In fact, depression rates among patients with CKD can be as high as 100%, the article says.

Chronic Kidney Disease and Its Cost to Employers

In addition to the cost of lost productivity and retention of workers who live with chronic health conditions, such illnesses make a significant dent in employer health plans. Not only is dialysis a healthcare cost for employers, since 2008, the cost of dialysis to self-funded plans has increased by about 400%, according to numbers from the American Kidney Fund.

Yet some employers may not be aware that they have workers battling CKD. Before those patients go on dialysis, the treatments aren’t necessarily coded as kidney disease interventions but as cardiovascular disease interventions, according to Bricker. “Then all of a sudden, out of nowhere, you start getting billed $300,000 a year for somebody on dialysis and think, ‘Where did this come from?’ That person was always on your plan. It’s that their claims were being coded with cardiovascular disease, not dialysis and not kidney disease,” he explained.

The cost of treating CKD increases as the stages progress, but some costs grow exponentially. The price of outpatient care, for instance, triples between stages one and five, per a 2021 study.

Dialysis itself introduces complications, like infections and wide swings in blood pressure, and “dealing with those complications, not only on an outpatient basis but also on an inpatient basis, becomes hugely problematic,” Bricker explained.

How Employers Can Support Workers with Chronic Kidney Disease 

Chronic kidney disease, like most chronic conditions, is a disability and should be treated like one in the workplace, said McGonagle. Many who live with long-term health problems have common needs, like flexible hours so that they can attend doctor’s appointments and an environment that makes it possible and safe to do so.

McGonagle recommends coaching, mentoring, and training – “anything that can help them work through some of these issues around managing their time, managing their work and their health, and communicating with supervisors to get the accommodations that they need while being judicious about their health.”

Environment matters too, she said. “Leaders being non-stigmatizing and supportive can help workers feel comfortable disclosing that they have an issue for which they need support. It’s really a win-win for the company, when the employee gets the assistance they need, they can perform at their best.”

Emily McCrary-Ruiz-Esparza is a freelance journalist and From Day One contributing editor who writes about work, the job market, and women’s experiences in the workplace. Her work has appeared in the BBC, The Washington Post, Quartz at Work, Fast Company, and Digiday’s Worklife.

(Featured illustration of dialysis in process by Nadezhda Buravleva/iStock by Getty Images)