Seamlessly carrying on the energy of change and transformation in the kidney sphere captured during plenary sessions at Kidney Week 2019, two sessions brought the potential for such transformation to life: Disruptors on the Move and Organs-on-Chips: Human Kidney Microphysiological Systems.
The panel of innovators and experts in healthcare innovation for the Disruptors on the Move session included current PCORI Interim Executive Director and CJASN Editor-in-Chief Josephine P. Briggs, MD, former Department of Health and Human Services CTO and current Kaiser Permanente VP of Medicaid Transformation Bryan Sivak, CVS Kidney Care CMO Bruce Culleton, MD, Cricket Health CMO Carmen Peralta, MD, FASN, and Outset Medical CEO Leslie Trigg.
Patient centeredness, which took center stage in the discussion on disruption, is important to the disruption of care for at least 3 reasons, Briggs stated:
1) Patients bring a sense of urgency and impatience to the discussion.
2) The questions change when patient centeredness is being evaluated on a continual basis.
3) A patient-centered approach will also bring innovation and better implementation into the process.
These sentiments were echoed by the other panelists.
“Everything comes to your phone—a taxi, food, even your friend. So why can’t the care (sic) come to you?” asked Cricket Health’s Peralta. “It’s not just all about reaching [patients] geographically but also psychologically.”
Meaningful disruption requires three things, according to Outset Medical’s Trigg: 1) an entrepreneurial ecosystem such as that provided by Kidney X, 2) an early adopter environment, and 3) capital flow.
Investors are less excited to provide capital flow if 1) and 2) are not present, she said.
In other fields, particularly with cardiac devices, a crucial ingredient to successful innovation was alleviating practitioners’ sense of fear regarding adoption of a new technology—although it may have flaws and imperfections—in order for users to learn through trial and error what could work, Trigg said.
The need to quell fear among practitioners in adopting new technology also came to mind during the session Organs-on-Chips: Human Kidney Microphysiological Systems.
Jonathan Himmelfarb, MD, FASN, spoke about “A Human Kidney-on-a-Chip for Precision Medicine” and Neil Lin, PhD, spoke on 3D Vascularized Kidney Tissues-on-Chip for Drug Toxicity and Disease Modeling.
The idea of a credit-card–sized chip that could mimic a human organ for use in precision medicine was born out of a partnership of the National Institutes of Health with DARPA and the Food and Drug Administration in 2012. The goal has been for utilization of such a chip for pre-clinical safety and drug testing with the benefit of genetic diversity and for conceivable use in clinical trials.
There is also the amazingly brilliant concept of a kidney organoid, “a multicellular unit in vitro containing nephron-like epithelial structures with podocyte and tubular segments,” and the capabilities are being developed to create human stem cells and organoids from urine samples. The potential for revolutionizing patient care is extraordinary with this technology.
“The tools that are becoming available are now allowing us to combine those technologies [CRISPR] with microfluiditics to allow us to create a field that is personalized,” Himmelfarb said.