Meet ASN’s Next President: Innovation and Translation to Top 2013 Agenda

Bruce A. Molitoris

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What are your areas of expertise in nephrology?

The two areas I enjoy most are acute kidney injury (AKI) and the use of intra-vital imaging to understand renal physiology and pathophysiology. Both areas are experiencing rapid and tremendous strides making this a very dynamic and exciting time. We have now expanded our use of imaging out beyond AKI into other areas where it has the tremendous opportunity to enhance our understanding of cell biologic processes and therapeutic mechanisms.

What made you decide to become a nephrologist?

I had always wanted to be an endocrinologist. Because I had a master’s degree in nutrition from the University of Illinois, it was a natural progression toward endocrinology. I performed research with both endocrinologists and a nephrologist, Dr. Keith Hruska, during my medical school time at Washington University School of Medicine. I then went to the University of Colorado School of Medicine to work with a specific endocrinologist during my residency. However, after exposure to the outstanding nephrology faculty at the University of Colorado, I rapidly became enamored with both the acute care aspects of nephrology and also the tremendous opportunity to do the type of research I was interested in within nephrology. In particular, there was little going on in the cell biology of disease processes, and the physiology had been well worked out. This left an opening for a young nephrologist to create a career in an important basic science area with minimal competition, an opportunity I could not resist.

You have been on ASN Council for five years. How do the leaders of ASN serve all 14,000 members?

ASN’s goal is always to improve patient care whether through direct patient care, research, education, or public policy. An integrated network of MDs and PhDs comprise advisory groups, committees, strategic task forces, and the public policy board and provide expertise and guidance to the ASN Council on nearly all issues. The passion and dedication shown by these individuals exceeds my expectations. An incredibly energetic, talented, and well coordinated ASN staff direct, assist, and facilitate all matters involving clinical, research, education, communication, and public policy aspects of what the ASN does. The ability of these individuals, and the particular structure now developed within the ASN executive director Tod Ibrahim’s position, is an especially effective way to conduct an organization that interacts with all areas of nephrology. Since beginning on Council five years ago, the capabilities and contributions of all of these aspects of the leadership have been enhanced tremendously.

How were you able to advance within the society to attain this position of leadership?

Advancement within the society is a difficult question to answer. In no way did I try to “advance,” but I did try to serve ASN in a capacity in which I felt I could benefit the society. I was lucky in that my research had been successful and I was passionate about several areas within nephrology. My friend Dr. Norman Siegel invited me to be the Chair of the ASN Program Committee and I was identified as someone who could contribute. I would say the keys to recognition are to get involved in different ASN venues, do your job well, be positive, and be a consensus builder.

What do you think ASN’s primary focus should be over the next year?

It is hard to identify a “primary focus” for the ASN. I do like the way the Kidney Health Initiative (or “KHI”) can be used as a focal point from which to foster and develop areas primarily benefiting patient care. This can involve direct patient care in the line of developing therapeutics, devices, and foods. It can also involve research leading to breakthroughs and translation to patient care, and it can involve education of physicians, health care workers, and the public at large. In working with the FDA, industry, and the NIH, ASN has an opportunity to focus on improving patient care at multiple sites. KHI is extremely exciting to me.

What do you consider the most stimulating recent advances in nephrology?

There have been a number of recent advances in nephrology including the APOL1 susceptibility for focal segmental glomerular sclerosis (FSGS), anti-PLA2 receptor antibodies in membranous nephropathy, rapid advancement in AKI and CKD biomarkers, and the burgeoning therapeutic advances in preventing AKI and forestalling CKD. However, once an opportunity becomes a success, it is time to refocus on new opportunities and challenges that will benefit patients in either the short or long term. Nephrology is now experiencing a tremendous birth of excitement and interest by pharmaceutical companies as the opportunities listed above offer unbelievable prospects for improving patient care and halting the progression to end stage renal disease. To do this, nephrology, with the ASN’s help, must increase its scientific diversity and be open to scientific and clinical innovation and ideas.

The kidney is a vastly understudied organ when it comes to specific cellular and molecular processes because of the lack of public awareness of the importance of kidney disease and the lack of involvement of scientific disciplines outside of nephrology. We need to work hard to facilitate involvement of other scientific disciplines including immunology, cell and molecular biology, biomedical engineers, and many more outside the field of nephrology to apply their expertise to important processes that directly relate to kidney disease. This can take many forms including education but also should include research dollars for individuals working within these scientific areas to encourage them to study aspects of kidney diseases. Therefore, multidisciplinary educational and research programs and associated funding opportunities are necessary. Industry’s focus on nephrology and a growing involvement of widely diverse scientific disciplines will pay major dividends in therapeutic success in the future.

If you could change one thing about kidney care, what would it be?

This is an easy question and one that I have pondered for some time. I believe public awareness of the importance of kidney disease is extremely low and needs to be dramatically enhanced. Although many attempts are being made to improve the situation, I believe one of the best ways to do this is a grass roots movement involving the public. Think about the cholesterol or blood pressure campaigns and their success. Until we do this, we will not receive the recognition necessary for the funding required to enhance disease detection and therapeutics for improving kidney disease patient care. This type of campaign is beyond the ASN, but it seems to me professional societies, patient support groups, the National Institutes of Health, and industry should come together around this need.

My greatest desires are to be able to identify those patients likely to develop kidney disease early and to be able to monitor them in ways that will allow appropriate therapies to be administered earlier than we are capable of doing today. I believe this is well within our reach and that’s why the meeting will emphasize innovation, translation, and individualization as it relates to improving patient care at an early stage, thus minimizing the number of patients who require dialysis as a final therapy.

What do you tell young people who are considering whether to study nephrology?

First I tell them that nephrology is not as difficult as they have been led to believe by medical school physiology. Nephrology is an extremely exciting clinical field and an equally exciting research field. The opportunities in nephrology research are the greatest within medicine subspecialties and are waiting for young, dynamic, and bright individuals to take up the cause. Clinical nephrology is also an exciting and rewarding area: we tend to overexpose our students and residents to extremely challenging patients with many comorbidities and underexpose students to the many successes of the transplant and outpatient areas. This question is directly tied into the next question involving the ASN Workforce Committee.

You have been very closely involved with the creation of ASN’s Workforce Committee. What do you consider the major workforce challenges in nephrology?

The challenges facing the ASN Workforce Committee are enormous and difficult to get your arms around. Surveys have informed us that medical students and residents see nephrology as too difficult intellectually, too demanding clinically, and not as rewarding as other medical subspecialty areas in terms of patient-physician interactions. This has resulted in a steady decline over the last 10 years in the percentage of U.S. medical school graduates entering into nephrology fellowship programs from nearly 60 percent to almost 30 percent Although part of this percent decrease was due to an increase in the number of fellowship positions, it remains a concerning trend. To start to reverse this trend, an ASN taskforce was established to identify the areas requiring attention. Then the ASN Workforce Committee, under the outstanding leadership of Dr. Mark Parker and Dr. Sharon Silbiger, was established. They have identified four major areas of concern:
  1. Public awareness/web base activities

  2. Faculty development

  3. Curriculum coordination

  4. Workforce diversity

One exciting program being expanded by support from the ASN is the Kidney Disease Screening and Awareness Program (KDSAP) started by Li-Li Hsiao at the Brigham and Women’s Hospital. This program engages college students in a kidney disease screening program with the intention of exciting the students about a career in nephrology. This committee will continue to develop exciting opportunities in all of the areas outlined that will enhance the interest of and supply of future nephrologists.

Do you recall your first ASN meeting, and what your impressions were of the society?

What I can recall, and it was such a long time ago, is that there seemed to be more parties and the amount of basic science to clinical science of nephrology was way weighted toward basic science. I think the changes made in the last 30 years have been for the benefit of the society, but more importantly for the benefit of the patient. In my opinion, nephrology has suffered from limited translation of its basic science understanding to clinical application. This now needs to be the focus of our society. Therefore, the meeting for 2013 will emphasize the importance of any opportunities for innovation and translation for improved patient care.

What are your plans for the 2013 annual meeting?

This is an exciting and challenging time as one always wants to develop the best possible Kidney Week program. First and foremost, I selected Dr. Anupam Agarwal, Professor of Medicine and Director of Nephrology at the University of Alabama at Birmingham School of Medicine, as the program chair for the 2013 meeting. He has played the primary role in identifying talented members for the program committee and leading the charge to develop an outstanding program. The program committee will work synergistically with the postgraduate education committee to plan a balanced meeting. The emphasis of the program will be on refocusing on the patient and translating innovations to enhance patient care.