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Priority #4: ACHIEVE EQUITY and eliminate disparities. Health disparities and the incidence of kidney diseases are undoubtedly connected. We need to address disparities and achieve equity not just in kidney care, but in health care overall.
Nephrology, more than any other specialty in medicine, was built on innovation. The artificial kidney-imagined, invented, and implemented by pioneers in our field-is nothing short of miraculous. In 1972, the US Congress changed federal policy to guarantee renal replacement therapy to anyone with kidney failure. With this change, dialysis "death panels" were disbanded.
Almost 50 years after the dialysis law was enacted, nephrology has taken the lead once again.
Asserting the value of nephrology
Physician productivity and compensation
Financial support of educational effort
Recruitment, retention, diversity and inclusion
Ensuring that Nephrology fellowship programs provide quality training in all aspects of kidney care
These topics are of primary interest to kidney professionals concerned about the future of nephrology. The interest of students and residents in pursuing careers in nephrology has waned over the past decade. With the increasing population of patients with kidney diseases, now approaching 40 million in the United States, these issues must be addressed immediately, in order to sustain a sufficient workforce to care for patients with kidney diseases. Furthermore, the success of exciting programs such as KidneyX and Advancing American Kidney Health, which are designed to catalyze innovation and transform patient care, depends upon establishing a robust pipeline of talented young physicians and scientists in nephrology. Key among the groups of leaders who regularly address issues concerning the field of nephrology are nephrology division chiefs and training program directors (TPDs). Whereas TPDs have successfully addressed many training program issues, there was a need to engage division chiefs to address other issues that extend beyond the purview of TPDs. Therefore, in 2018, the American Society of Nephrology convened a small group of division chiefs to discuss these issues in depth and design a blueprint on how ASN might work with division chiefs to promote positive advances.
“I wish he had a better death, but more than that, I wish he had a better life.”
This is the sentiment of a provider describing the life and death of an undocumented patient suffering from end-stage renal disease in the United States, as relayed by Dr. Rajeev Raghavan, MD, FASN and Associate Professor of Medicine/Nephrology at Baylor College of Medicine. Dr. Raghavan spoke to us about the difficulties in delivering nephrology care for the undocumented, particularly with the forced reliance on Emergency-only dialysis. Emergency-only dialysis is variable among location, but the unfortunate reality is that dialysis patients present to the emergency room and dialyzed on an emergency only basis, and if they are discharged without dialysis, there is a chance that their next visit they may be “crashing” right into dialysis. We are very much aware that emergency-only dialysis is associated with nearly a 9x higher hazard ratio of death and a considerably much higher cost with an estimate of $284,000 as compared to a cost of ~$60,000 for chronic dialysis, yet policy measures still only allow for this unfavorable approach in terms of medical, holistic, cost effectiveness and ethical care.
One thing I’ve noticed in the last fifteen years is how aware Americans have become of health policy issues. When I first told people as an undergrad that I wanted to pursue a career in health policy, I almost always received glazed looks in response. “What would that look like exactly?” Now, virtually everyone I meet (Lyft drivers, new friends at get-togethers, strangers on the plane, new colleagues) has an opinion, when they learn that I am a nephrologist and health policy researcher.