ASN Executive Vice President's Update: A Commitment to Excellence in Kidney Care

Tod Ibrahim Executive Vice President, American Society of Nephrology, Washington, DC.

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Over its nearly 60-year history, the American Society of Nephrology (ASN) has approached the tripartite mission in phases, starting first with providing medical education, then advocating for research and innovation, and more recently, ensuring high-quality patient care. ASN's mission is to “elevate care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world (1).

Today, patient care is the tabletop, with education (undergraduate/graduate and continuing), research, and advocacy as the supporting legs. Diversity, equity, and inclusion are the joints that lock aprons (health care justice) to the legs, strengthening the table. As such, the first goal of the current ASN Strategic Plan emphasizes the need to advance the work of kidney medicine. More specifically, this goal requires ASN to commit to “creating a stronger focus on kidney health”; “intervening earlier to prevent, diagnose, coordinate care, and educate”; and “developing broad partnerships to address the health of the global population, promoting health equity, and advocating for high-quality therapies, including home dialysis and transplant.”

While having a mission and articulating goals are important, the significance of strategic plans is identifying opportunities and challenges honestly, setting priorities ruthlessly, and completing projects meaningfully. The current ASN Strategic Plan went into effect on January 1, 2021, making this a good time to assess progress in accomplishing the first goal.

Creating a stronger focus on kidney health

According to Merriam-Webster, the adjective “heart-healthy”—which means “conducive to a healthy heart and circulatory system”—was first used in 1980 (2). More than 30 years later, the term “kidney health” (conducive to healthy kidneys and renal system) was first used regularly in public by then-ASN President Ronald J. Falk, MD, FASN.

In his ASN President's Address, “Time to Cure Kidney Disease,” on November 1, 2012, Dr. Falk asserted, “We must challenge each other, all of us who care for patients, to ask our patients how we may restore their health” (3). Dr. Falk observed that the “focus on the stark realities of the sicknesses that we see and treat each and every day…has filled our vernacular with words overflowing with negative connotations: ‘end stage,’ ‘chronic,’ ‘progressive,’ ‘inexorable,’ and the ‘3 Ds’ of doubling of the serum creatinine, dialysis, and death.” These words “send powerful messages to our patients, our trainees, and indeed ourselves,” he emphasized. “Is it possible that we can no longer imagine a time when we can prevent or cure kidney disease? I am incurably optimistic about the infinite talent and spirit of our kidney community.”

During the past decade, the emphasis has shifted to kidney health from kidney diseases; the kidney community has made incredible strides toward improving kidney health, slowing progression of kidney diseases, preventing these diseases, and—ultimately—finding cures; and kidney-healthy has closed a 30-year gap with heart-healthy. As current ASN President Susan E. Quaggin, MD, FASN, declared earlier this year, “Why limit screening to the identification of kidney diseases? Instead, why not pivot the messaging to ‘screening for kidney health’?” (4). Knowing you have healthy kidneys “can provide peace of mind while expanding the eligible pool of living donors to help address the desperate need for kidneys,” she noted. “Why should knowing the status of your kidney health be any different than knowing your other numbers, such as glucose, lipids, and blood pressure?”

Intervening earlier to prevent, diagnose, coordinate care, and educate

In conjunction with the US Department of Health and Human Services (HHS) and the National Kidney Foundation, ASN's We’re United 4 Kidney Health campaign highlights this objective (5). To produce the campaign, in 2020, ASN hired Brodeur Partners (a public relations and communications services firm) and the Prime Group (a message research and development firm). Through a quantitative and qualitative process that included nearly 2000 nephrologists, other health professionals, and patients, Brodeur and Prime identified the campaign's four priorities and determined that the majority considered intervening earlier foremost.

As illustrated in Table 1 and Figure 1, ASN has launched several initiatives since 2016 concentrated on ensuring that the millions of people with kidney diseases receive excellent care. Intervening earlier to prevent, diagnose, coordinate care, and educate are key elements in each of these initiatives. For example, the Diabetic Kidney Disease Collaborative (DKD-C) held three strategy conferences and published related manuscripts; produced a comprehensive online educational module; and articulated a legislative and regulatory action plan for screening, prevention, and access to new therapies (6). These efforts are ongoing, particularly the advocacy.

Table 1

Current ASN initiatives focused on excellent patient care

Table 1
Figure 1
Figure 1

Excellence in Patient Care

Citation: Kidney News 14, 9

After developing educational material for kidney health professionals, ASN's initiative focused on acute kidney injury (AKI)—called AKINow—is working to use augmented and artificial intelligence to improve diagnosis, treatment, and recovery (7). AKINow also seeks to build a data warehouse for greater accessibility to online research sources to improve the transition out of in-hospital care. Inspired by the success of AKINow, this year, ASN launched the Augmented Intelligence and Digital Health Task Force to guarantee that the kidney community improves kidney health by evaluating, adopting, and innovating augmented intelligence and digital health (8).

“To enhance the quality of life for people with kidney failure by engaging nephrologists as team leaders in transformational change that continuously improves the safety of life sustaining dialysis,” Nephrologists Transforming Dialysis Safety (NTDS) (9) supports several initiatives, including current and emerging threats (10); human factors engineering (11); and QAIE (quality assessment, improvement, and education) (12). This emphasis has resulted in online, case-based learning modules for clinical topics related to infection prevention; a micro-webinar infection-prevention series for nephrology fellows; and a Kidney Leadership Academy, aimed at fostering strong, effective leadership skills for the dialysis facility medical director–nurse manager dyad.

Responding to the COVID-19 pandemic in 2020, ASN established a team that has met regularly, virtually, and collaboratively with the chief medical officers (CMOs) of dialysis organizations. In addition to developing a community resource for nephrologists and other kidney medicine professionals, the ASN COVID-19 Response Team (13) helped establish a network administrator model to ensure direct access of COVID-19 vaccines and monoclonal antibodies to dialysis facilities in collaboration with the US Centers for Disease Control and Prevention (CDC) and the White House.

The response team has presented more than 20 webinars on COVID-19 and designed three online educational modules. These modules concentrate on preparing for a surge, maintaining mental wellness, and summarizing the lessons the kidney community has learned during the pandemic.

Developing broad partnerships to address the health of the global population

To ensure excellence in kidney care, ASN partners with every stakeholder possible, including:

  • Patients and patient organizations. At a leadership level, all of ASN's initiatives in this arena include people with kidney diseases. For specific projects, such as the Emergency Partnership Initiative (EPI) (14), ASN has partnered with patient groups, including the American Kidney Fund (which administers its own disaster relief program).

  • Other health professional societies. Project Firstline (15) is a partnership among ASN, the American Medical Association, and CDC; Improving Adult Immunization Rates for COVID-19, Influenza, and Routine Adult Vaccinations is a partnership among ASN, six other medical specialty societies, the Council of Medical Specialty Societies, and CDC.

  • Biotechnology and pharmaceutical industries. AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, and Lilly helped fund DKD-C.

  • Medical device companies. Baxter provided the funding necessary to launch AKINow and produce the initiative's initial educational material.

  • Dialysis organizations. In addition to the ASN COVID-19 Response Team's interactions with CMOs (13), NTDS has worked closely with leaders in the dialysis industry (9).

  • US government. CDC helped fund NTDS (9), the COVID-19 Response Team (13), the Home Dialysis Task Force (16), and Transforming Dialysis Access Together (TDAT) (17), and both EPI (14) and the COVID-19 Response Team (13) have worked closely with the HHS Administration for Strategic Preparedness and Response.

Finally, ASN is working with the European Renal Association and the International Society of Nephrology to publish a consensus statement seeking to address the World Health Organization's (WHO's) exclusion of kidney diseases as one of the top noncommunicable diseases driving premature deaths. The WHO's position is baffling because mortality due to kidney diseases jumped from the 17th leading cause of death globally in 1990 to the 12th leading cause in 2017 (18).

Promoting (and ultimately achieving) health equity

Earlier this year, the ASN Excellence in Patient Care Advisory Committee was established (19). Chaired by Alan S. Kliger, MD, the advisory committee includes leaders from key initiatives listed in Table 1, other experts, and a patient representative. From the beginning, the advisory committee agreed that promoting diversity, equity, and inclusion—as well as pursuing health care justice—must be core elements of every project ASN initiates to ensure high-quality kidney care.

As the newest ASN initiative, TDAT provides a good example (17). To increase the use of permanent dialysis access and improve the quality of care for all dialysis accesses (including hemodialysis, peritoneal dialysis, and in-home and in-center dialysis settings), TDAT will accomplish several goals. One of these goals is to create a unique educational program for nephrology fellows and early-career faculty from backgrounds underrepresented in the kidney and biological sciences. This program will include:

  • Didactic and experiential training in career development, leadership, and research.

  • Multifaceted longitudinal mentorship and networking.

  • Pathways to future participation in ASN activities and leadership.

Advocating for high-quality therapies, including home dialysis and transplant

The ASN Home Dialysis Task Force is charged with improving “awareness and outcomes of home dialysis therapies by enhancing education of nephrologists, kidney care professionals, and trainees; addressing disparities in access to home dialysis; and advocating for policies that improve patient-centered modality choice in order to promote safe and high-quality care” (16). To meet this charge, the task force is aiming at workforce and training, continuing education, and legislative and regulatory policy.

Earlier this year, the task force surveyed nephrology division chiefs and fellowship training program directors to determine the extent of home dialysis training currently and the barriers to increasing and improving training in the future. The task force also provided detailed recommendations to the ASN Task Force on the Future of Nephrology. In addition to recommending increased training in home dialysis for nephrology fellows, the Home Dialysis Task Force suggested designating fellowship programs that meet specific criteria as “Centers of Excellence in Home Dialysis Training.”

In terms of continuing education, the task force is pursuing several opportunities, including a weekend training program, a virtual case-based small group education series with mentorship opportunities, and a “one-stop” shop for home dialysis educational resources with multi-stakeholder collaboration. The task force also hopes to leverage the existing curricular content and ASN Communities, adding video-recorded presentations, and increasing the presence of home dialysis at ASN Kidney Week.

Historically, legislative and regulatory policy in this arena has focused on helping bring new products and therapies to market. More recently, however, the emphasis has been on addressing the unintended consequences of policies to promote home dialysis. These include, but are not limited to, unexpected poor outcomes for patients from marginalized communities, unanticipated shortages (of well-trained personnel and supplies), and inequitable access to care.

“Transform transplant and increase access to donor kidneys” is the second priority of the We’re United 4 Kidney Health campaign (5). A future update will summarize ASN's efforts in this arena, which include legislative and regulatory activities, Kidney Innovation Accelerator (KidneyX) Artificial Kidney Competitions, Kidney Health Initiative projects, the ASN Physician Compensation Task Force (which tackled transplant nephrology and will publish recommendations soon), and much more.

In the meantime, it is important to emphasize that the ASN COVID-19 Response Team prioritized issues related to transplantation (13). In addition to trying to provide updated information about COVID-19, therapeutics, and vaccines to people with kidney transplants, the response team advocated to include people with transplants in clinical trials for the vaccines and determine vaccine safety and efficacy in immunosuppressed patients. The response team also tried to determine the efficacy of monoclonal antibodies in immunosuppressed patients and highlight the need to treat patients and donors during a pandemic.

Closing thoughts

A decade ago, Dr. Falk ended his president's address with an encouragement: “As health care evolves from past to present, and as we look to the future, I hope we are not so removed by time, space, or practice pattern that we lose those precious moments of human interaction and understanding that permit us to listen to and learn the patient's definition of cure.” He used the word “cure” 23 times in his presentation.

In addition to Dr. Kliger, who served as the founding chair of the NTDS Project Committee in 2016, many ASN members contribute to these efforts to provide high-quality care to people with kidney diseases. To learn more, please visit ASN's new website directed entirely to excellence in patient care (19). Three members of the staff started with Dr. Kliger nearly a decade ago, and they deserve the community's thanks as well: ASN Vice President for Excellence in Patient Care Susan A. Stark; Nurse Consultant Darlene Rodgers, BSN, RN, CNN; and Senior Project Specialist Bonnie Freshly.