Kidney Health Needs Radical Innovation and Nephrology Must Lead the Way

By David White

Focusing on the intensity of the executive branch’s sweeping proposals to radically change kidney care – and the transformational implications therein – the plenary session on November 9 at Kidney Week was far from ordinary. The State-of-the Art Lecture, “Perspectives on Innovation and Transformation in Kidney Care,” served as a crucible to distill down what should, and must, happen at this point to deliver a brighter future for people with kidney diseases.

Delivering a comprehensive vision of both the current and future challenges and potential outcomes, a trio of presentations about innovation and advancing the state of kidney care were given by Dean Kamen, Founder and CEO of Deka Research and Development Corp, Bruce F. Culleton, MD, Vice President and Chief Medical Officer, CVS Health, and Tod Ibrahim, Executive Vice President, American Society of Nephrology.  Kidney News will be covering these speakers in more detail in the upcoming December issue.

Setting a sober tone for the lecture, Mr. Ibrahim noted that during the course of that very day “13 Americans on a kidney waitlist will die, 77 usable kidneys will be discarded, and for those Americans who are not white, chances of starting home dialysis are less. A majority of Americans starting dialysis today will be dead in five years. That’s about 70,000 people. Even with a lifesaving treatment like dialysis, kidney failure is more of a death sentence than most cancers.”

Ibrahim framed the moment in nephrology as both unique and stalled – especially with this year’s White House Executive Order, Advancing American Kidney Health. Undoubtedly, despite challenges in kidney research, education, and innovation, nephrologists have saved the lives of millions of people with kidney failure.

However, in a room full of smart phones taking photos, tweeting, and surfing the internet during the plenary session, he noted that “dialysis —which currently defines nephrology—was invented the same year the original mainframe, the ‘prototype Mark I Colossus computer,’ was introduced. Seventy-six years later, we carry a more powerful computer in our pockets yet mostly still rely on the same technology to treat kidney failure: in-center dialysis.”

Acknowledging the gravity of the moment and the goals set forth, he noted that by Saturday, November 9, 2030, if nephrology has not seized on this moment and transformed itself for its patients, “millions of people will suffer and millions more will die. Such an outcome is unacceptable.”  He noted that the US government is committed to create a system that “pays for kidney health, rather than kidney sickness,” through the AAKH Executive Order.  He characterized the executive order as the “transformative change needed to reassert nephrology as a specialty and fundamentally reimagine every aspect of kidney medicine.”

Ibrahim predicted that kidney medicine is entering its version of “the Era of Moore’s Law, when progress in IT doubled every two years, turning the Colossus Mainframe Computer into the iPhone. KidneyX is already starting to accelerate the development of technical improvements, such as Outset’s Tablo, The Kidney Project, and MiroMatrix’s MiroKidney.”  In addition, he outlined the five pillars of kidney medicine for the future, should nephrology successfully re-assert and re-align itself.

  1. Nephrology will shift from a focus on kidney failure to a focus on kidney health by detecting, treating, slowing progression, preventing, and ultimately curing kidney disease.
  2. Nephrology will overhaul living and deceased donor systems, making transplant-first a reality.
  3. Nephrology will bring home, portable, and wearable dialysis to people with kidney failure, while moving ever closer to implantable “artificial kidneys.”
  4. Nephrology will attract unprecedented industry interest and new investors to develop and deliver better care and therapies, achieving the fastest pace of medical innovation of any specialty.
  5. Nephrology will change education, certification, recertification, and reimbursement so that the career paths for nephrologists are clearly delineated and, more important, aligned to guarantee people with kidney disease and kidney failure receive the absolute best care possible.

     

Should Ibrahim’s vision be the reality at the end of the next decade, then he rightly asserts that “the 850,000,000 people worldwide with kidney disease deserve a future where kidney health, not kidney failure, is the focus, and innovation is the mandate. They deserve the iPhone, not the mainframe computer, a future where prevention, transplant-first, the artificial kidney, and accelerated innovation join high-quality care as the pillars of our commitment to every person with kidney disease.”

Ibrahim left the audience with his favorite quote and his vision for nephrology: “To quote Lisa Bodell, ‘Innovation is the pirate ship that sails into the yacht club.’ By Saturday, November 9, 2030, nephrologists will be healthcare’s pirates.”

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Focusing on the intensity of the executive branch’s sweeping proposals to radically change kidney care – and the transformational implications therein – the plenary session on November 9 at Kidney Week was far from ordinary. The State-of-the Art Lecture, “Perspectives on Innovation and Transformation in Kidney Care,” served as a crucible to distill down what should, and must, happen at this point to deliver a brighter future for people with kidney diseases.

Delivering a comprehensive vision of both the current and future challenges and potential outcomes, a trio of presentations about innovation and advancing the state of kidney care were given by Dean Kamen, Founder and CEO of Deka Research and Development Corp, Bruce F. Culleton, MD, Vice President and Chief Medical Officer, CVS Health, and Tod Ibrahim, Executive Vice President, American Society of Nephrology.  Kidney News will be covering these speakers in more detail in the upcoming December issue.

Setting a sober tone for the lecture, Mr. Ibrahim noted that during the course of that very day “13 Americans on a kidney waitlist will die, 77 usable kidneys will be discarded, and for those Americans who are not white, chances of starting home dialysis are less. A majority of Americans starting dialysis today will be dead in five years. That’s about 70,000 people. Even with a lifesaving treatment like dialysis, kidney failure is more of a death sentence than most cancers.”

Ibrahim framed the moment in nephrology as both unique and stalled – especially with this year’s White House Executive Order, Advancing American Kidney Health. Undoubtedly, despite challenges in kidney research, education, and innovation, nephrologists have saved the lives of millions of people with kidney failure.

However, in a room full of smart phones taking photos, tweeting, and surfing the internet during the plenary session, he noted that “dialysis —which currently defines nephrology—was invented the same year the original mainframe, the ‘prototype Mark I Colossus computer,’ was introduced. Seventy-six years later, we carry a more powerful computer in our pockets yet mostly still rely on the same technology to treat kidney failure: in-center dialysis.”

Acknowledging the gravity of the moment and the goals set forth, he noted that by Saturday, November 9, 2030, if nephrology has not seized on this moment and transformed itself for its patients, “millions of people will suffer and millions more will die. Such an outcome is unacceptable.”  He noted that the US government is committed to create a system that “pays for kidney health, rather than kidney sickness,” through the AAKH Executive Order.  He characterized the executive order as the “transformative change needed to reassert nephrology as a specialty and fundamentally reimagine every aspect of kidney medicine.”

Ibrahim predicted that kidney medicine is entering its version of “the Era of Moore’s Law, when progress in IT doubled every two years, turning the Colossus Mainframe Computer into the iPhone. KidneyX is already starting to accelerate the development of technical improvements, such as Outset’s Tablo, The Kidney Project, and MiroMatrix’s MiroKidney.”  In addition, he outlined the five pillars of kidney medicine for the future, should nephrology successfully re-assert and re-align itself.

  1. Nephrology will shift from a focus on kidney failure to a focus on kidney health by detecting, treating, slowing progression, preventing, and ultimately curing kidney disease.
  2. Nephrology will overhaul living and deceased donor systems, making transplant-first a reality.
  3. Nephrology will bring home, portable, and wearable dialysis to people with kidney failure, while moving ever closer to implantable “artificial kidneys.”
  4. Nephrology will attract unprecedented industry interest and new investors to develop and deliver better care and therapies, achieving the fastest pace of medical innovation of any specialty.
  5. Nephrology will change education, certification, recertification, and reimbursement so that the career paths for nephrologists are clearly delineated and, more important, aligned to guarantee people with kidney disease and kidney failure receive the absolute best care possible.

     

Should Ibrahim’s vision be the reality at the end of the next decade, then he rightly asserts that “the 850,000,000 people worldwide with kidney disease deserve a future where kidney health, not kidney failure, is the focus, and innovation is the mandate. They deserve the iPhone, not the mainframe computer, a future where prevention, transplant-first, the artificial kidney, and accelerated innovation join high-quality care as the pillars of our commitment to every person with kidney disease.”

Ibrahim left the audience with his favorite quote and his vision for nephrology: “To quote Lisa Bodell, ‘Innovation is the pirate ship that sails into the yacht club.’ By Saturday, November 9, 2030, nephrologists will be healthcare’s pirates.”

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Wednesday, November 13, 2019