Nephrology has constantly fought against, and sometimes succumbed to, a narrative of decline and stagnation. There is a complaint that new therapies are not being developed or approved, there has been a paucity of successful clinical trials, and in-center dialysis remains the standard of care for kidney failure. It is time to put this negative narrative to rest. Over the past year, I have had the privilege of leading the Kidney Health Initiative (KHI) and from that vantage point have seen firsthand that today is a new day for innovation in kidney diseases.
Physicians, scientists, and other health professionals are problem solvers. This reality is especially true in nephrology, in which complex diseases and co-existing conditions are often challenging and sometimes daunting. However, this very complexity provides so many of us lifelong career interest and opportunities, and profound satisfaction when we can provide and improve care for our patients with kidney diseases.
As ASN marks its 50th year, it is worth looking back at the landscape for kidney patients and professionals in 1966. Although we nephrologists sometimes bemoan the lack of innovation in our field, the advances made
In my last column I looked back at nephrology in 1966, the year ASN was founded, and marveled at the advances made in the past 50 years. In this column I’ve described my thoughts of what will be roles and activities of the nephrologist of the future, and the way in which kidney professionals will transform that future.
A Look into the Future
There will be an increasing reliance on “big data” to inform our understanding of underlying mechanisms of kidney pathophysiology, and we will have new and more precise tools to analyze the data
Looking back to this time last year, ASN was commending President Obama for his bold leadership in securing a budget increase for NIH and NIDDK in 2016. Regrettably, his 2017 budget proposal would short-change NIDDK and kidney research. Kidney disease affects more than 20 million Americans and costs Medicare $80 billion. The Medicare End-Stage Renal Disease Program alone costs $35 billion, more than NIH’s entire budget. Yet federal investments in kidney research are less than 1% of total kidney care costs.
There have been several major breakthroughs in the past several years thanks to NIDDK-funded research. For example, geneticists focused
Fifty years ago this year, a group of illustrious Nephrologists and prominent Internists met to form the American Society of Nephrology. Nephrology as a subspecialty had arisen both from studies of renal physiology and from studies and clinical activities related to metabolic and hemodynamic alterations related to kidney failure. As a field, it had clinical roots in cardiology. Indeed, the first renal society in the United States was the Renal Section of the Circulation Council of the American Heart Association. Although Nephrology was already an accepted subspecialty, the formation of the ASN signaled that in
Nephrologists have always been considered among the best educators in medicine. Our commitment to excellence in patient care and research extends to finding innovative ways to teach students, residents, and fellows about some of the most complex (and interesting) issues physicians and scientists face. Nephrologists also know how to provide complete care for a complex patient population in ways that most other specialties do not.
ASN has always honored its members’ focus on training the next generation of nephrologists by devoting resources to educational programs. In the last 18 months, this commitment has included restructuring
When I think back over the time that I have been in nephrology, I am struck by how many advances we have made in our understanding of kidney function and the pathogenesis of kidney disease. In no particular order, a (very) incomplete list includes: the enormous new insights into the biology of the podocyte and its importance as a target of kidney disease; the regulation of the renin-angiotensin system, its role in kidney diseases, and the effectiveness of its targeting in slowing progression; the role of inflammatory cells in kidney diseases; insights into the underlying
“It is one of the strengths and the appeals of our profession that we encompass so many aspects of medical science in our care of our patients and in our study of the mechanisms of kidney function and diseases.” Dr. Harris
Fifty years ago this year, a group of illustrious Nephrologists and prominent Internists met to form the American Society of Nephrology. Nephrology as a subspecialty had arisen both from studies of renal physiology and from studies and clinical activities related to metabolic and hemodynamic alterations related to kidney failure. As a field, it had clinical roots in cardiology. Indeed, the first renal society in the United States was the Renal Section of the Circulation Council of the American Heart Association. Although Nephrology was already an accepted subspecialty, the formation of the ASN signaled that in the United States, nephrology would no longer be considered only a branch or an offshoot of cardiology.
Nephrologists are leaders in medicine and science, but do we always define ourselves as such?
This “moment” in health care encompasses a huge amount of change, the kind of change nephrologists are incredibly well suited to lead. The skills that make us great nephrologists are the same skills that make us effectively pilot and implement new approaches to health care. Changes in government policies that focus on quality measures and team care, and the rollout of bundled payment mandates mean that clinicians must adjust their practice patterns. Nephrology is already a leader in these areas; we understand how to provide the highest quality care in a bundled payment environment, and we excel at leading medical teams that provide high-quality care for a complex patient population.
We are all aware that the landscape for the practice of medicine in the United States is rapidly changing. For Nephrology in particular, how we practice currently will be very different from practice patterns in 20, 10 or even 5 years from now. Three recent developments may have significant effects upon the practice of Nephrology:
1. MACRA. MACRA (legislation approved in 2015) repealed the Medicare SGR physician payment system and replaced it with two tracks for Medicare physician payments, MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models).