From Intervention to Prevention: Getting Ahead of the Curve

Priority #1: INTERVENE EARLIER to prevent, diagnose, coordinate care, and educate. The scope of early intervention is so expansive that it touches every aspect of kidney health.

In August, ASN launched a campaign, " We’re United 4 Kidney Health ," inviting kidney health professionals to be part of a movement to shift our focus from kidney failure to kidney health, unified behind four priorities:

I am extremely proud that the nephrology community, through the leadership of ASN, is redefining how we look at kidney care. For years, we have been approaching the expanding kidney disease problem with the same lens: seeing one patient at a time. Despite our valiant efforts, the affected population continues to grow. I am hopeful the “We’re United 4 Kidney Health” campaign is a starting place for a larger community awareness to change our approach to positively affect kidney health.

I went into nephrology because of the diagnostic challenges, the patient relationships, and the variety of illnesses I could treat. Over my career, the unexpected alignment of my osteopathic training roots and the methods of nephrology practice have come to light. As in osteopathic practice, my job as a nephrologist is to strive for balance to allow the kidney to heal itself and to look beyond to see how other organs affect the structure and function of the kidney. I never expected to utilize osteopathic manipulative medicine (OMM) principles as often as I do when I treat people with kidney disease. Considering this training background, it is not surprising that the priority closest to my heart is early intervention. 

The first priority of early intervention gives me significant hope for the future of our field. This emphasis is so expansive that it touches every aspect of kidney health. It includes being mindful in the hospital setting to prevent acute kidney injury (AKI) from occurring; ideas such as earlier biomarkers or the Nephrotoxic Injury Negated by Just-in-time Action (NINJA) project have already started us on this path for change but there is so much more to do. 

Early intervention involves the education necessary to illustrate how other disease processes affect the development of chronic kidney disease (CKD); the importance of avoiding diabetes, and effectively treating hypertension. This priority also underlines how coordination between nephrologists, primary care providers, and the interdisciplinary team is essential for kidney health. The challenge for this priority is that its success is difficult to measure because it requires tracking health, not disease, which is a paradigm shift in medicine.  

In my practice among rural populations, the incarcerated, and in the Veteran’s Administration Health System, I see immense potential in prevention and welcome the day when we are focused on maintaining kidney health, not treating kidney disease. While care for the incarcerated population has made me more aware of society’s injustices and inequities, it has also shed some light on the power of prevention. 

In this clinic, more than any other, I see young patients who have falsely low eGFR levels or those with new onset hypertension. While these are simple visits, I have taken this opportunity to give specific information to maintain kidney health. We discuss the risks of nonsteroidal anti-inflammatory drugs (NSAIDs), the harm caused by lapses of blood pressure medication compliance, and how weight and diet can impact health years down the road. Many people are surprised to learn that the mortality rates for many incarcerated people are initially improved because it is the first time some have received proper healthcare. I hope my involvement will have a positive preventative impact on those I meet that is life-long. This is one way I’ve been able to get ahead of the curve through collaboration, better monitoring, early referral, and education. 

This campaign can be the catalyst for all of us to get ahead of the curve; for medical professionals to come together to practice in a way that is innovative. Nephrologists must become leaders and educators for the entire medical community in maintaining health instead of treating disease. 

As we redefine and broaden our role, relationships, and skill sets, I believe nephrology will also become a beacon to medical students and residents who will see the breadth and importance of our work and want to join our efforts to optimize kidney health.