The year 2020 brought unprecedented challenges to our nation and world. The emergence of the first pandemic in over 100 years and the social unrest following police killings of Black people required action from many quarters of society—including nephrology.
ASN responded on all fronts, advocating for resources for patients and professionals to improve kidney care during a global crisis and committing to dismantle systemic racism in nephrology and to overcome the barriers social determinants of health impose on kidney care.
ASN pivoted the world’s premier nephrology meeting to a fully online environment in order to continue to disseminate vital advances in care, research, and education despite the ongoing COVID-19 crisis.
And throughout 2020, ASN continued to honor the dedication and commitment of the kidney care team by supporting ongoing initiatives and programs.
Expanding ASN Efforts on Diversity and Inclusion
In 2020, ASN organized its efforts related to workforce and training, career advancement, and diversity and inclusion into one staff team: Leadership Development and Culture Change. Additionally, the society expanded its efforts related to diversity and inclusion to include equity, health disparities, and social determinants of health.
ASN’s current efforts to support diversity, equity, and inclusion focus on five signature initiatives:
1 Partnering with the Robert Wood Johnson Foundation to fund two ASN–Harold Amos Medical Faculty Development Program Scholars. For nearly 40 years, this program has increased diversity among future leaders in medicine, including nephrology, supporting the research and career development of scholars and future health care leaders from a historically disadvantaged background.
2 Providing travel support for ASN members to attend the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) Network of Minority Health Investigators Annual Workshop. In the past five years, ASN has supported nearly 100 members to attend this valuable program.
3 Exhibiting at the Latino Medical Student Association, Student National Medical Association, American Medical Student Association, and American Physician Scientists Association Annual Meetings.
4 Initiating efforts to support the LGBTQ community through an annual LGBTQ and Allies Members Reception at ASN Kidney Week, sessions at ASN Kidney Week on caring for LGBTQ patients, and editorials on caring for diverse patient populations (such as LGBTQ communities).
5 Expanding demographic data collection for ASN members to include sex and ethnicity. By better understanding its members, ASN will strengthen, target, and increase the likely success of its initiatives to increase diversity, equity, and inclusion as well as address systemic racism.
While ASN is proud of its efforts to date, this commitment is hollow if the society fails to oppose and address racism. ASN must intensify its efforts to achieve equality to reduce the adverse impact of racism, especially on health, health care and innovation, and the health workforce.
During the summer of 2020, the ASN Council unanimously approved a plan for how the society can address systemic racism in nephrology. In 2021, ASN will:
1 Launch the ASN Health Disparities Committee to improve the overall health of the entire population and identify opportunities to address health disparities and influence social determinants of health, particularly in populations at risk for and overburdened with kidney diseases. Additionally, the society will expand the ASN Diversity and Inclusion Committee to include equity.
2 Initiate the ASN Loan Mitigation Pilot Program. In 2021, ASN will fund six applicants, reducing the loan burden for each applicant by $50,000 over three years. Year 1 awards will center on individuals racially underrepresented in medicine.
3 Partner with the National Kidney Foundation (NKF) to reassess the inclusion of race in diagnosing kidney diseases. At press time, NKF and ASN were beginning to draft the task force’s initial recommendations.
4 Reevaluate every aspect of the annual process for identifying, nominating, and selecting candidates to run for the ASN Council and be nominated for ASN Lifetime Achievement and Midcareer Awards to ensure diversity, equity, and inclusion.
5 Increase engagement with Historically Black Colleges and Universities to reach potential health professionals, researchers, and scientists who are currently underrepresented in medicine.
To learn more about these efforts and ASN’s commitment to antiracism, please contact ASN Workforce and Training Associate Riley Hoffman at rhoffman@asn-online.org.
Responding to the COVID-19 Pandemic
In February, ASN launched the ASN COVID-19 Response Team. The team collaborates on COVID-19 education, recommendations, and support for dialysis facilities and the greater kidney community. The Response Team includes nephrologists, nurse administrators, and a patient representative.
Through the work of four subcommittees (Outpatient Dialysis, In-Hospital Dialysis, Home Dialysis, and Transplant), the Response Team has created a website, presented 14 webinars, published key recommendations, launched a COVID-19 toolkit, and expanded collaborations with key partners outside of nephrology to support professionals and improve patient care.
Partners have included the Department of Health and Human Services (HHS), Office of the HHS Assistant Secretary for Preparedness and Response, the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), the Department of Defense, the Centers for Disease Control and Prevention (CDC), the American Association of Kidney Patients, NKF, and the ASN Policy and Advocacy Committee.
As the COVID-19 pandemic continues, the Response Team will maintain its commitment to providing the best evidence-based resources and recommendations to the kidney community.
Advocating for Kidney Health
In March, ASN members quickly banded together to identify, advocate for, and implement policies to ensure health professionals have the flexibility and resources to meet the needs of the communities they serve during the COVID-19 pandemic. The murder of George Floyd in May brought the public health crisis of racism into sharp focus. ASN members testified before the US Congress about the intersection of racism and COVID-19 on kidney health, advocated for the Health Equity and Accountability Act, and developed a roadmap for action to address these deep-rooted ills.
ASN’s initial 2020 policy priorities continue to be advanced, with ASN members working together to help build a better future for kidney health by:
1 Expanding telehealth services in response to COVID-19 to protect all patients—especially those with kidney failure.
2 Persuading CMS to issue a statement clarifying that vascular access placement and organ transplantation are defined as “essential” during the pandemic.
3 Developing kidney-based COVID-19 recommendations for the federal government, including prioritizing access to testing and personal protective equipment, funding for KidneyX, and equipping dialysis centers for telehealth to allow for transplant evaluations.
4 Opposing White House policies that would have negatively impacted immigration policy, the nephrology workforce, patients, and the nation’s research capacity. Ensuring the highest-quality care possible requires a well-trained and diverse workforce, including foreign trained physicians.
5 Increasing home dialysis payments after years of advocacy, with CMS agreeing to use payment policy to support home dialysis as well as overall increases in the monthly capitation payment for 2021.
6 Leading efforts to reform and improve organ procurement procedures and expand the ability of transplant centers to open access to transplantation without undue barriers and penalties.
7 Engaging in refining US payment models to support and help nephrologists succeed in them.
8 Advancing immunosuppressive drug coverage legislation.
9 Supporting the launch of the national “Are You The 33%?” campaign in partnership with NKF and HHS.
10 Securing funding increases for research and innovation to advance the state of kidney care. NIDDK received $2.11 billion in Fiscal Year (FY) 2020. ASN secured $5 million in federal appropriations in FY 2020 for KidneyX.
Transforming Dialysis Safety
ASN’s partnership with the CDC, Nephrologists Transforming Dialysis Safety (NTDS), encourages nephrologists to take the lead in the cultural change necessary to transform infection prevention in dialysis facilities. Key accomplishments include webinars and recommendations for standardization of blood culture collection for patients receiving in-center hemodialysis, as well as launch of a dialysis care checklist pilot.
In late 2019, NTDS partnered with the leadership of Northwest Kidney Centers to present a Pop-up Kidney Leadership Academy aimed at fostering strong, effective leadership skills for the dialysis facility medical director–nurse manager dyad. In 2020, this Academy was enhanced with a series of six podinars on core leadership concepts.
Collaborating on Diabetic Kidney Disease
Release of the CREDENCE trial results in 2019 ushered in a new era of investigation and discovery in the treatment of patients with type 2 diabetes and diabetic kidney disease (DKD). ASN launched the Diabetic Kidney Disease Collaborative (DKD-C) to educate the nephrology community about the new therapies and foster collaboration across specialties regarding their use.
Led by incoming ASN President Susan E. Quaggin, MD, FASN, the DKD-C Task Force has issued calls to action encouraging SGLT2 inhibitor therapy in patients with type 2 diabetes using the inclusion criteria of CREDENCE. The task force hosted in-person and remote conferences bringing together experts from nephrology, industry, and allied fields to help transform patient outcomes in this key area.
Improving AKI Care through AKI!Now
ASN partnered with Baxter Healthcare to help transform how acute kidney injury (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. The Steering Committee has produced “AKI!Now: From Recognition to Recovery” (ASN Kidney News, April 2020), “AKI!Now Initiative: Recommendations for Awareness, Recognition, and Management of AKI” (CJASN, October 2020), and a webinar on “COVID-19 Associated AKI Recognition and Management” (April 21, 2020).
In early fall 2020, the Steering Committee released a web-based compendium (https://aki.asn-online.org/home) of the most up-to-date content about AKI.
Focusing on Fellows and Workforce
To measure how the pandemic has changed training and the experiences for the next generation of nephrologists, ASN conducted the COVID-19 Nephrology Fellow Survey in August. ASN’s annual Nephrology Fellow Survey, which captures key leading indicators on the job market and demographics of the incoming workforce, was deferred in 2020.
Extramural research published through the ASN Data Analytics Program included a paper that examined how rounding during training may influence fellows’ educational experiences, core competencies, and improve patient care (CJASN, https://doi.org/10.2215/CJN.10190819).
ASN also launched the Data Resource Center, an online platform for communicating data-driven insights and sharing data resources developed for—and of interest to—the kidney community. Accessible at https://data.asn-online.org/, the site serves as a dedicated home for the society’s workforce research products and output.
Achieving the Vision of KidneyX
KidneyX, the public–private partnership of ASN and HHS, completed two prize competitions that awarded $70,000 to 25 winners of the Patient Innovator Challenge and $3 million to six winners of Redesign Dialysis Phase 2. The virtual KidneyX Summit convened representatives from government, investors, industry, academia, and people with kidney diseases to hear pitches by award winners and learn how KidneyX accelerates transformative advances in kidney care.
In October 2020, KidneyX announced the Artificial Kidney Prize competition. To highlight the innovations kidney care clinicians have made to ensure continuity and safety of care during the COVID-19 pandemic, KidneyX launched the COVID-19 Kidney Care Challenge in November. Learn more at www.kidneyx.org.
Advancing Research and Discovery through the Kidney Health Initiative
The Kidney Health Initiative (KHI) expanded its efforts to emphasize the importance of technology development in bringing more people with kidney failure home for dialysis treatment, encouraged the inclusion of people with kidney diseases in clinical trials for COVID-19 vaccines and therapies, and coordinated with the kidney community to ensure the resiliency of kidney clinical trials through the pandemic. In 2020, KHI completed three projects and published four papers, as well as launching a roadmap for AKI biomarkers and producing a clinical trials supplement to the Technology Roadmap for Innovative Approaches to Renal Replacement Therapy. KHI continues to be the largest consortium in the kidney community, with 115 member organizations. To learn more, visit www.kidneyhealthinitiative.org.
Granting $3 Million for Kidney Research
KidneyCure (the ASN Foundation) awarded more than $3 million to support 47 leading kidney researchers in 2020, funding 25 new projects and 22 continuing projects. The foundation funds the Transition to Independence Grants Program, 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.
KidneyCure provided $50,000 in emergency support to grant recipients whose research was affected by COVID-19 lab closures.
Launching Kidney360, Prioritizing COVID-19 and Beyond
JASN, CJASN, and Kidney360 received a massive influx of COVID-19–related submissions, resulting in over 80 freely available articles published on the topic. All three journals prioritized peer review and production for these submissions, while maintaining the journals’ rigorous peer review standards.
Launched in January 2020, Kidney360 is a global, peer-reviewed, open access, online-only, general kidney journal with an outstanding editorial team helmed by Editor-in-Chief Michael Allon, MD. Kidney360 is the first nephrology journal to provide readers with commenting at the article level through Disqus, direct transfer from medRxiv and bioRxiv, and publication of articles within 48 hours of acceptance.
CJASN’s special article series, Genomics of Kidney Disease, recognizes that genetics and genomics have moved beyond geneticists and basic science researchers. The complete compendium of 17 articles will be available via pdf after series completion. CJASN continued to offer its CJASN Trainee of the Year prize competition and the CJASN Trainee Peer Review Program.
JASN was cited more than any other original research journal in the field. Topic highlights in 2020 include lifestyle factors’ influence on CKD and a genome-wide analysis that has advanced the biologic understanding of IgAN. Participants in the JASN Editorial Fellowship Program brought valuable expertise to peer review. JASN’s new podcast program successfully launched with nearly 23,000 users in the initial 3 months.
In 2021, new article series and features will be added to the journals, enhancing the print and online platforms—and the reading experience.
Reimagining Kidney Week 2020
A signature achievement of ASN was pivoting from an in-person Kidney Week in Denver, Colo., to the first digital annual meeting in its history, ASN Kidney Week 2020 Reimagined. More than 10,200 individuals participated, with nearly 27,000 ePoster views, more than 12,000 Chat postings, and record participation in Early Programs. The Digital Exhibit Hall included 81 exhibits. Women represented 45% of speakers and moderators, and the meeting stayed true to its international reach, with 42% participation from outside the US. Top international representation came from Mexico, Canada, Japan, the United Kingdom, Germany, and China.
Kidney Week’s educational programming included cutting-edge science and patient care, including sessions on COVID-19, race, ethnicity, and diversity:
Critical Illness and AKI in COVID-19: What Have We Learned?
Policy in a Post-COVID World
Race and Ethnicity Considerations in CKD
A Slice of Humble Pie: Enhancing Socioeconomic Humility in Nephrology
Growing ASN Communities, Social Media
With over 1000 new discussions each month, ASN Communities engages members from around the world. Popular topics include AKI in COVID-19 and CRRT, Hyponatremia, and Calciphylaxis in PD patients. ASN Communities was recently recognized by Higher Logic for top performance in activity, value, and reach.
A fully online Kidney Week meant Twitter took center stage in communicating with meeting participants. Impressions of ASN’s tweets rose by 37% during Kidney Week 2020 Reimagined, with a 7% increase in engagement. ASN added over 4600 followers from January through October. ASN rebuilt the society’s Instagram page, prompting a 37% increase in its Instagram following since January.
Addressing Ethics in Kidney Care
A kidney ethics webinar in November outlined 10 areas of ethical concern as priority challenges requiring collaborative action by ASN, the European Renal Association–European Dialysis and Transplant Association, and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology. The publication “Ethical challenges in nephrology: a call to action” also outlines these challenges.
Contributing to #FirstRespondersFirst
“This year, facing the challenges, stress, and ongoing burden of a global pandemic, kidney professionals have demonstrated the resolve and focus on excellence that exemplifies our profession,” stated ASN President Anupam Agarwal, MD, FASN, in October. In December, ASN contributed $50,000 to #FirstRespondersFirst to benefit Direct Relief. #FirstRespondersFirst provides essential supplies, personal protective equipment, medicines, and other resources for protecting frontline health care workers worldwide.
