Summit Brings Together Experts to Discuss Innovations in Kidney Care

The Department of Veterans Affairs (VA) and ASN co-sponsored the Kidney Innovation Summit on February 9–10, 2017, to advance innovation in kidney disease care through intense knowledge sharing, discussion, and networking. ASN Policy and Communications Specialist David White caught up with ASN President Eleanor D. Lederer, MD, FASN, and Crystal Gadegbeku, MD, Chair of the Policy and Advocacy Committee of ASN, to discuss their thoughts on advancing innovation in kidney disease care.

Eleanor D. Lederer, MD, FASN

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Crystal Gadegbeku, MD

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The Department of Veterans Affairs (VA) and ASN co-sponsored the Kidney Innovation Summit on February 9–10, 2017, to advance innovation in kidney disease care through intense knowledge sharing, discussion, and networking. ASN Policy and Communications Specialist David White caught up with ASN President Eleanor D. Lederer, MD, FASN, and Crystal Gadegbeku, MD, Chair of the Policy and Advocacy Committee of ASN, to discuss their thoughts on advancing innovation in kidney disease care.

DAVID WHITE

What can you tell us about the summit?

DR. GADEGBEKU

The summit provided a sort of meeting of lots of minds about innovating at the various stages of kidney health and disease. What I really enjoyed about the meeting was the diversity of thought, as participants came from many different perspectives—from clinicians and those taking care of patients to those interested in biotechnologies and the science end of things, as well as those involved in research.

DAVID WHITE

I think everyone knows that there is a large connection between ASN and the VA, and particularly a large number of VA patients who suffer with kidney diseases. What do you see regarding the partnership between the VA and ASN?

DR. LEDERER

The VA and ASN are natural partners. Seventy percent of trainees come through the VA as part of their training, and a large number of practicing nephrologists have had some contact with the VA at one time or another. Many of us, such as myself, continue to work at the VA full time or part time.

We can see the toll taken by kidney diseases in our veteran population, and we’re trying to grapple with the realities of the increasing number of individuals who have kidney diseases. This is emblematic of what is happening all over the country. We’re seeing costs rise, we’re looking for ways to prevent kidney diseases, to cure kidney diseases, and to make life better for those who have kidney diseases right now. This type of partnership between the VA and ASN is only natural.

DAVID WHITE

The summit showed just how significant the burden of kidney diseases is within the veteran population. About $18 billion a year is spent on kidney care just for veterans, and this figure does not even include those on dialysis.

Dr. Gadegbeku, you chair the ASN Policy and Advocacy Committee, which recently released a report from the Government Accountability Office (GAO) about the overall cost of kidney diseases and research spent on kidney diseases. What did the report find?

DR. GADEGBEKU

You are correct that this cost figure does not include the many patients who are suffering with earlier stages of kidney diseases. We know that there is a lot of morbidity among this population, so costs for treating these patients are quite high as well. The GAO report confirmed and reaffirmed for us that we need to put more effort and resources into research to prevent the suffering of patients and to stem the rising cost of kidney diseases.

DAVID WHITE

Is it correct that basically for the amount of investment the government puts into the Medicare ESRD treatment program for people on dialysis, that less than 1% of that entire amount is invested in research?

DR. GADEGBEKU

That is correct, and it reinforces that much more investment needs to be put into the research end, so that we can save costs on the other side.

DAVID WHITE

What is the role of the nephrologist in this dynamic of rising disease rates, costs, and the general burden on patients?

DR. LEDERER

I think nephrologists, to some extent, have taken a back seat in trying to address the actual rising costs. We all know that there are treatable risk factors, and we have certainly been proponents of actively addressing those risk factors both for the development and the progression of kidney diseases going on to ESRD. However, there’s no question that nephrologists have been generally brought into the picture—for the most part—near the end of the kidney disease process. That is to say, most of us are not brought in at the early stages of kidney diseases at a point where we might be able to intervene to prevent the development of ESRD. Most of us are brought in at the later stages and are preparing people for ESRD and taking care of people who are on dialysis and who have kidney transplants. In that regard, it’s actually pretty hard to effect any substantial changes in costs because the damage is done. These people already have a severe disease that is very costly.

DAVID WHITE

Are you saying that to really make a difference in the dynamic that is challenging so many healthcare systems, nephrologists are going to have to be brought in earlier and perhaps maybe even have a larger role?

DR. LEDERER

I would say absolutely, and whether that role ends up being fulfilled by nephrologists per se, or by other non-nephrology providers who are members of the healthcare team, such as dieticians, social workers, or community workers, all of these individuals can play an important role in getting to patients early, helping people to understand what their risks are, and what they can do to either prevent the development or progression of kidney diseases.

DAVID WHITE

In your years of practice at the VA, what would you classify as one of the biggest challenges of dealing with kidney diseases? What do you think are the biggest opportunities as well?

DR. LEDERER

Probably the biggest challenge of dealing with kidney diseases in the VA system is that there are so many individuals who have so many risk factors for its development. The prevalence of hypertension, diabetes, hepatitis C, HIV, family history, smoking … these are all very prevalent risk factors. Just trying to get your arms around the huge number of people who all have multiple risk factors is very challenging and difficult. How do you choose where to start? The individuals who get referred to my clinic are those whose creatinine has already gone up. I want to get them to the clinic before they reach a stage where it’s difficult for me to do anything for them.

In terms of opportunities, the VA has excellent electronic medical records creating mechanisms to identify people at risk and then reach out to primary care providers to let them know. Several different projects have been piloted and are in use in some VA systems to help identify individuals with chronic kidney disease and to help manage their disease. The ability of the VA to develop such an integrated healthcare system and to have available its massive amount of patient information in electronic medical records represents a tremendous opportunity to help veterans who have kidney diseases or who are at risk for kidney diseases.

DAVID WHITE

There was some lively conversation at the summit about whether or not some of the ways we measure and treat kidney diseases have advanced in the past few decades. Would you care to weigh in on that?

DR. GADEGBEKU

Even as a researcher, I would say that we have not seen the advances in the last couple of decades that other fields have seen. Part of the reason is that we need more investment in research—we need to have researchers able to do the experiments and testing they need to make the next developments happen.

DAVID WHITE

What do you want readers to take away from this conversation?

DR. LEDERER

From a patient standpoint, society needs to decide that there must be a bigger push to lead people toward healthier lifestyles. I think that the challenge comes in educating people that eating unhealthy foods all the time is detrimental. To never exercise more than your thumbs on a videogame is detrimental to your health in general, and the consequences can be dire and life-changing.

From my standpoint as a physician, I need people to help me in this educational process. I can sit down with a patient in my “20-minute allocation” for that clinic visit, but that’s not time enough to really educate people on what they need to do.

DAVID WHITE

The future. Do you think it’s on the move?

DR. GADEGBEKU

I think it is. There is a lot of ripe research right now, and our technological advances are basically in key with what we want to do, such as informatics and science translational research. We have a lot of tools now, and if we are able to get the investment that we need, it’s all about putting them together in a way that we can develop into new norms, new science, that will lead to better care.


April 2017 (Vol 9, Number 4)