ASN in the Year of Advancing KIDNEY HEALTH

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The year 2019 has seen unprecedented developments in kidney care, research, and education for both patients and professionals. ASN and partner organizations have been at the forefront of these developments.

In July 2019, the ASN Council finalized the ASN Alliance for Kidney Health: Proposed Vision in 2030. Through several areas of focus, the ASN Alliance for Kidney Health will aim to fulfill its mission to improve care, drive innovation, educate and inform, and generate policies that result in meaningful change. Also, ASN rolled out its new brand identity, featuring a new logo signifying the patient as the center of focus,

The year 2019 has seen unprecedented developments in kidney care, research, and education for both patients and professionals. ASN and partner organizations have been at the forefront of these developments.

In July 2019, the ASN Council finalized the ASN Alliance for Kidney Health: Proposed Vision in 2030. Through several areas of focus, the ASN Alliance for Kidney Health will aim to fulfill its mission to improve care, drive innovation, educate and inform, and generate policies that result in meaningful change. Also, ASN rolled out its new brand identity, featuring a new logo signifying the patient as the center of focus, interconnected with researchers, clinicians, educators, and kidney health professionals, as well as new logos for the other entities in the ASN Alliance.

Here, we present ASN’s accomplishments since Kidney Week 2018, grouped according to five of the Alliance for Kidney Health’s areas of focus.

Excellence in Patient Care

Transforming Dialysis Safety

ASN’s partnership with the Centers for Disease Control and Prevention (CDC) completed its third contract year in July 2019. During this time, the initiative reached over 1 million members of the kidney community and engaged with over 31,000 meeting attendees, encouraging them to take the lead in the cultural change necessary to transform infection prevention in dialysis facilities. NTDS is led by a Project Committee chaired by Alan S. Kliger, MD.

Key accomplishments include presentation of “Targeting Zero Infections: Hepatitis C Detection, Prevention, and Treatment”; the fifth webinar in the Targeting Zero Infections series; issuance of hepatitis C testing recommendations; publication of a NephSAP special edition on infection prevention; and development of recommendations for standardization of blood culture collection for patients receiving in-center hemodialysis.

In 2018, the contract with CDC was expanded to include the use of human factors engineering assessments to identify barriers and facility adherence to CDC-recommended infection prevention practices. This work included six site visits nationwide. A final report will be presented to the community soon.

Future work will include two additional webinars, an infection-prevention curriculum for fellows, presentation of research on methods of preventing C. difficile transmission in outpatient dialysis, four additional human factors observations, a Kidney Leadership Academy for the physician-nursing dyad, an online educational module for infection prevention and safety, a pilot study of vascular access electronic checklists, and continued presence at Kidney Week.

Putting Diabetic Kidney Disease in the Spotlight

In response to the recent development of new therapies for diabetic kidney diseases, ASN launched the Diabetic Kidney Disease Collaborative (DKD-C) in March 2019. With the recently reported results of CREDENCE, which demonstrated substantial kidney and cardiovascular benefits in patients with type 2 diabetes and DKD on top of standard of care, ASN has prioritized efforts to educate the nephrology community and increase collaboration across specialties about the use of these life-changing therapies.

The DKD-C Task Force, which is led by ASN Councilor Susan E. Quaggin, MD, FASN, has already produced a call-to-action editorial and a policy-related editorial. The former strongly encourages SGLT2 inhibitor therapy in patients with type 2 diabetes using the inclusion criteria of CREDENCE. The latter recommends that public policy is needed to support a change in focus from kidney failure to kidney preservation.

The Task Force is currently working to develop a series of meetings that will include representatives from industry and stakeholders from other specialties to address key considerations and major questions about DKD as well as increase awareness, engagement, and excitement about new therapies. These discussions are intended to result in concrete recommendations for ensuring that people with diabetic kidney disease benefit from the new therapies.

Improving AKI Care through AKI!Now

ASN has partnered with Baxter Healthcare to build a foundational program to transform how AKI care is delivered, reduce its morbidity and mortality, and improve long-term outcomes, thus promoting recovery and reducing the incidence of kidney disease and failure.

To achieve these goals, the AKI!Now Steering Committee, chaired by Jorge Cerda, MD, FASN, will study other AKI initiatives to determine knowledge gaps and potential areas of collaboration. The Steering Committee will also conduct a needs assessment among the medical community where AKI is first encountered: nurses, physicians, primary care providers, advance practice providers, and emergency room personnel. Educational tools will be developed to assist this broad group of healthcare providers in identifying and managing high-risk populations using evidence-driven practices.

Early deliverables include a white paper addressing “Identification and Management of AKI in High-Risk Populations” and a web-based compendium of the most up-to-date content on AKI available through ASN education and publications. Ideally, the web-based compendium will serve as a model for similar efforts in other areas, such as diabetic kidney disease.

Creating the Emergency Partnership Initiative

Natural disasters require wide-ranging and well-organized responses from medical organizations and volunteers. Post-emergency care of people with kidney disease, notably those on dialysis, as well as people who suffer kidney injuries during disasters, requires special expertise.

In recognition of the need for an organized approach to the provision of this specialized care and services, ASN launched the Emergency Partnership Initiative (EPI). Nicole Lurie, MD, chairs the Advisory Committee and Zaheeb Choudhry, MD, will lead the EPI Caribbean Steering Committee. Initiative partners include dialysis organizations, local leaders, emergency preparedness experts, and disaster relief entities.

Under the direction of Drs. Lurie and Choudhry, this initiative will address gaps in coordination and support of kidney-specific disaster care in the Caribbean and work with United States policymakers to review current processes.

Research, Discovery, and Innovation

Launching KidneyX

KidneyX, the public-private partnership established between ASN and the U.S. Department of Health and Human Services (HHS), was created to accelerate the development of drugs, devices, biologics, and other therapies across the spectrum of kidney care. The KidneyX Steering Committee is chaired by ASN Secretary-Treasurer John R. Sedor, MD, FASN.

In 2019, KidneyX received an overwhelming response of 165 submissions to its first prize, Redesign Dialysis Phase I. Fifteen outstanding recipients were chosen to receive a prize of $75,000 each. These recipients were highlighted at the first KidneyX Summit held in April 2019. Two additional prizes were launched in the third quarter of 2019: Patient Innovator Challenge and Redesign Dialysis Phase II. Recipients of these prizes will be announced in spring 2020. Learn more at kidneyx.org.

Expanding the Kidney Health Initiative’s Footprint

On January 1, 2019, Raymond C. Harris, MD, FASN, began his three-year term as ASN co-chair of the Kidney Health Initiative (KHI). Founded in September 2012, KHI continues to be the largest consortium in the kidney arena with more than 100 member organizations. As a public-private partnership with the U.S. Food and Drug Administration, KHI strives to catalyze innovation and the development of safe and effective patient-centered therapies for people with kidney disease. KHI’s Seventh Annual Stakeholders Meeting focused on “Collaborating for Innovation to Improve Patient Care and Outcomes.”

Two supplements to the Technology Roadmap for Innovative Approaches to Renal Replacement Therapy were published in 2019: a Patient Edition to the Technology Roadmap and Fostering Innovations in Fluid Management. Both the roadmap and the supplements are valuable to the entire community, including the winners of KidneyX’s Redesign Dialysis contest.

KHI also published Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy, bringing the total number of publications to 17. The Kidney Pediatric Accelerator Trial Clearing House (Kidney-PATCH) was launched, in partnership with pediatric trial networks and organizations, to optimize planning for pediatric kidney disease clinical trials. KHI continues to support the community with nine project teams, the newest titled “Patient Reported Outcomes for Muscle Cramping in Patients on Dialysis” and “Patient Reported Outcomes for Dialysis Vascular Access.” To learn more, visit www.kidneyhealthinitiative.org.

Renaming the ASN Foundation for Kidney Research as KidneyCure

In July 2019, the ASN Foundation for Kidney Research launched a major rebrand. The new name, KidneyCure, focuses all foundation efforts toward improving treatments and finding cures for the approximately 37 million Americans living with kidney disease.

The foundation granted nearly $3 million in support of 46 leading kidney researchers in 2019, including 27 new projects and 19 projects continuing from 2018. Established in 2012 by ASN, the foundation, now KidneyCure, will continue funding current grant programs, while exploring new avenues to support.

Cosponsoring APS Summer Kidney Research Conference

In June 2019, ASN cosponsored the American Physiological Society (APS)/ASN Conference: Control of Renal Function in Health and Disease (formerly the APS Renal Hemodynamics Summer Research Conference). The triennial conference “focuses on cutting-edge research presented by top investigators in the field of renal research.”

In addition to co-presenting the conference, ASN provided travel support for 28 participants to attend the conference, underscoring the society’s continued commitment to expand opportunities for ASN members interested in basic, or fundamental, science. The next APS/ASN Conference will take place in summer 2022.

Education and Information

Tapping Kidney360 Editorial Team, Selecting NephSAP 3.0

The open access, online-only journal Kidney360 hired Michael Allon, MD, as editor-in-chief, with Luis Juncos, MD, and Mark Perazella, MD, FASN, serving as deputy editors. The peer-reviewed, general kidney journal will begin taking submissions in fall 2019 and will begin publishing in January 2020.

In April 2019, ASN announced the appointment of Alice M. Sheridan, MD, as the Editorial Director for NephSAP 3.0. Dr. Sheridan will oversee the production of NephSAP beginning in January 2020. NephSAP is one of the most widely used educational programs in nephrology.

Maintaining High Rankings for JASN, CJASN

JASN remains the most cited nephrology journal publishing original research about the kidney and kidney disease. Under the leadership of Editor-in-Chief Josephine P. Briggs, MD, and a distinguished board of editors, JASN has continued its role as the flagship of nephrology with original articles, provocative perspectives, and important reviews. New this year is an Editorial Fellowship program that engages nine early career kidney researchers in the work of the journal.

CJASN continues to expand its offerings to the kidney community and will launch a series on genetics in winter 2020 under the leadership of Raj Mehrotra, MD, FASN. Recent initiatives for trainees include the annual CJASN Trainee of the Year manuscript competition and the CJASN Trainee Reviewer Program, which educates early career researchers in mastering peer review. The first-ever “Best of ASN Journals” session at Kidney Week 2018 had great turnout, and both JASN and CJASN look forward to another successful session at Kidney Week 2019.

Partnering with Renal Fellow Network

ASN recently established a partnership with Renal Fellow Network (RFN), an online forum where trainees can share posts that are open to the community to read and comment on. Currently led by Samira S. Farouk, MD, FASN, Sam Kant, MD, and Matthew A. Sparks, MD, FASN, RFN was one of the first nephrology blogs and was created by the late Nate Hellman in 2008.

RFN has grown over the past decade from a personal blog to a rich source of easily accessible information for current and future nephrology trainees around the world. The RFN–ASN collaboration marks the beginning of an exciting new chapter for the website that has allowed RFN to continue to have a positive effect in nephrology education, with over 40,000 page views in July 2019. Recurring series on the blog address high-yield topics for trainees including urine microscopy, kidney biopsy, landmark nephrology studies, interventional nephrology, kidney transplant, home hemodialysis, peritoneal dialysis, basic science, and pediatric nephrology. Published content also includes submissions from trainees and graduates.

Broadening ASN Communities, Social Media

ASN Communities’ outreach and impact continues to grow. Since Kidney Week 2018, there have been over 100,000 logins to Communities from 10,500 members from 115 countries, with 1500 members using the free ASN Communities mobile app released in January 2019.

In the Loop now publishes weekly “Community Minded” summaries highlighting recent “hot topics” from Communities. In mid-2019, the AKI Community was relaunched with one of the most popular discussions of the year: CRRT in the ICU. Popular discussions from the Open Forum included Calcium Channel Blockers, Uncontrolled Blood Pressure in an HD Patient, and Proteinuria/Nephrotic Syndrome in Pregnancy.

At Kidney Week, stop by Poster PO0800-1, ASN Communities: A Growing Thriving Online Educational Asset, at 10 a.m., on Saturday, November 9, to learn more about how you can leverage the collective knowledge of ASN Communities.

ASN’s social media presence continues its strong pattern of yearly growth. ASN’s main Twitter page, @ASNkidney, experienced a 28% growth in followers since 2018; @ASNAdvocacy, @KidneyNews, @JASN_News, @CJASN and @Kidney_X experienced steady growth as well. In December 2018, the society launched a Twitter page for ASN’s newest online, open access journal, Kidney360 (@ASNkidney360), set to debut in January 2020. ASN’s social media users are mostly from the United States, the United Kingdom, Mexico, Canada, Spain, and India.

Leadership Development and Culture Change

Welcoming All

ASN membership shows continued growth. More than 21,000 kidney professionals in more than 130 countries now contribute to ASN as members. Since 2015, membership has grown 32%.

The first ever lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) and ally member reception, launched at Kidney Week 2018, will continue at this year’s Kidney Week. The reception offers a venue for networking and gathering to discuss ways of serving LGBTQ patients and members of the kidney community.

Establishing ASN Midcareer Awards, Continuing to Support Grants

ASN successfully launched the ASN Midcareer Awards Program, recognizing healthcare providers between 10 and 20 years from completion of their professional training who have demonstrated impact in nephrology in the areas of clinical service, research, education, mentorship, and leadership. The inaugural group of 10 recipients will be honored at ASN Kidney Week 2019 during the plenary session on Sunday, November 10.

ASN partners with the Robert Wood Johnson Foundation to administer the ASN-Amos Medical Faculty Development Program (ASN-AMFDP) award. The second scholar, Rasheeda K. Hall, MD, MS, started her grant this year. Interviews were held in July 2019 to fund a new candidate for 2020. ASN expanded Kidney TREKS (Tutored Research and Education for Kidney Scholars) to include PhD students.

KidneyCure, the newly renamed ASN foundation, funds the Career Development Grants Program (to be renamed Transition to Independence Grants in 2020), the Ben J. Lipps Research Fellowship Program, the William and Sandra Bennett Clinical Scholars Program, the American Society of Nephrology-Harold Amos Medical Faculty Development Program, and the ASN Pre-Doctoral Fellowship Program.

Setting New Directions for ASN’s Nephrology Fellow Survey, Data Subcommittee

The annual ASN Nephrology Fellow Survey successfully transitioned to a new principal investigator, Stephen M. Sozio, MD, FASN (Johns Hopkins University School of Medicine), who also chairs the ASN Data Subcommittee. The subcommittee retooled the 2019 survey to include more pediatric nephrology–specific questions and mechanisms to more accurately assess a wider array of nephrologist practice patterns, including starting salaries and educational debt levels for new nephrologists.

The retooling also streamlined the process for participants, resulting in the survey’s best response rate (50%) since its inception in 2014. An analysis of survey results, to be released before ASN Kidney Week 2019, found the overall proportion of fellows recommending nephrology to medical students and residents has risen to 80%, an all-time high.

The recently expanded ASN Data Subcommittee comprises the chair, as well as eight physician volunteers and nephrology fellows. The subcommittee has identified knowledge gaps and mechanisms for the ASN Alliance’s Data Science Program to quantify, such as assessing protected efforts for program directors’ educational activities. Future initiatives include assessments of the nephrology employment market and journey analyses to determine how programs can affect career trajectories.

Communicating New Understandings of Medical Career Choices

Insights from ongoing research collaborations with internal and external stakeholders were disseminated in several peer-reviewed articles. Results from the first phase of the ASN Best Practices Project—studying institutions graduating large numbers of future nephrologists and led by ASN Data Subcommittee Chair Dr. Sozio—underscored the importance of exposure to clinical nephrology experiences and nephrology faculty contact to instilling interest in the specialty (American Journal of Nephrology, https://doi.org/10.1159/000501058).

Another paper examined influencing factors for specialty choice among late-stage medical students and residents. Across both cohorts, lack of interest in and exposure to nephrology, as well as perceptions about earning potential and work-life balance, were key in their choice to not pursue a nephrology career (BMC Nephrology, https://doi.org/10.1186/s12882-019-1289-y).

Policy and Advocacy

Shaping the Advancing American Kidney Health Initiative

ASN worked with the White House and the Department of Health and Human Services (HHS) to shape the components of the Advancing American Kidney Health (AAKH) initiative. The initiative, created in July 2019 by Executive Order of President Donald Trump, will bring sweeping changes to care for people with kidney disease, including more focus on upstream treatment to slow the progression of kidney disease, choices for dialysis modalities, greater access to transplantation, and concerted support for development of innovative therapies, including artificial kidneys.

The executive order established three objectives as official U.S. policy: 1) reduce the risk of kidney failure, 2) improve access to and quality of person-centered treatment options, and 3) increase access to kidney transplants.

To accomplish these goals, efforts are underway to launch a nationwide kidney disease awareness campaign, streamline kidney transplantation and increase the supply of organs, provide consideration for “requests for premarket approval of wearable or implantable artificial kidneys,” produce a strategy for encouraging innovation in new therapies through KidneyX, and develop payment models both to identify and treat at-risk populations earlier in kidney disease development and to increase home dialysis and kidney transplantation.

Demanding Increased NIH Research Funding and Innovation through KidneyX

ASN’s advocacy efforts contributed to the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) experiencing a trend of significant increases after more than a decade of flat budgets. At press time, the House version of the appropriations bill that will fund NIH and NIDDK provided a substantial increase: $41.1 billion for NIH and $2.1 billion for NIDDK. The House also included $10 million for KidneyX in its FY2020 funding bill. The Senate had not released its funding bill for FY2020.

Advocating for Changes in Transplant Policy

ASN’s longtime policy priorities in transplantation saw significant movement. HHS released a report confirming the cost savings to Medicare that would result from extending coverage and an actuary appraisal of a proposal to extend Medicare Part B and Part D coverage of immunosuppressive drugs for ESRD beneficiaries indefinitely.

Following these developments, the White House announced it would act on two of ASN’s policy priorities: improving the data used to evaluate Organ Procurement Organizations and removing financial barriers to living donation. ASN also supported efforts by Representative Jaime Herrera Beutler (R-WA) requesting that the Health Resources and Services Administration (HRSA) change its policy to allow the National Living Donor Assistance Center to reimburse lost wages and other non-travel expenses of living donors as currently permitted under the National Organ Transplant Act of 1984.

Convening Kidney Health Advocacy and Kidney Community Advocacy Days

ASN convened the Seventh Annual Kidney Health Advocacy Day (KHAD) in Washington, DC, to urge Congress to fund and support legislation to improve care for kidney patients and accelerate innovation in kidney medicine. In partnership with the American Association of Kidney Patients, 49 patient and physician advocates met during KHAD with nearly 100 congressional delegations about the urgent need to provide funding for KidneyX.

During Kidney Week 2019, patients and health professional organizations will gather for the Fifth Kidney Community Advocacy Day to raise the profile of kidney health on Capitol Hill. On the heels of the historic executive order on Advancing American Kidney Health, advocates will unify under a call for Congress to support the goals of the executive order and pass priority legislation of the kidney community, such as the Living Donor Protection Act and Immunosuppressive Drug Coverage Extension for Kidney Patients Act.

In addition to these accomplishments, ASN hosted an invitational conference for Nephrology Division Chiefs in Dallas, Texas, in June 2019. More than 35 adult and pediatric nephrology division chiefs from around the nation attended to discuss asserting the value of nephrology; physician productivity and compensation; financial support of educational efforts; recruitment, retention, diversity, and inclusion; and rightsizing training programs. A white paper on the discussions and recommendations from the conference is being drafted.

Kidney health has become a national priority in the United States, and the ASN Alliance for Kidney Health looks forward to working with every member of the kidney community to create a world without kidney diseases. That work starts now.

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