The Kidney Care Team (Intro): Kidney Medicine Is a Team Sport

Susan E. Quaggin Susan E. Quaggin, MD, FASN, is with the Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL, and is ASN President.

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A silent public health crisis, kidney diseases affect approximately 10% of all Americans, or 37 million people. In addition to the burden of kidney diseases, management of patients with acute or chronic kidney diseases is complex and requires a dedicated team of experts to achieve the best possible outcomes.

In this month's ASN Kidney News, a series of articles highlight the key and evolving roles of advanced practice providers (APPs)—nurse practitioners (NPs) and physician associates (PAs; also called physician assistants)—as well as pharmacists, who are invaluable members of the kidney care team. The articles discuss career paths to specialize in nephrology, as well as opportunities and challenges that must be addressed to strengthen the multidisciplinary team and improve outcomes for the millions of people with kidney diseases.

Over the past dozen years or so, the role of APPs has moved beyond in-center dialysis units to inpatient hospital settings, outpatient chronic kidney disease clinics, kidney transplantation, and home dialysis. In all settings, education and care delivery redesign can be provided by APPs, who are ideally positioned to identify and overcome gaps in these areas.

Besides the value APPs bring to kidney care, data clearly show that nephrology teams with a dedicated pharmacist can dramatically reduce medication-related problems (MRPs). Like the role of the APP, pharmacists bring their unique skills, knowledge, and experience to the kidney care team, providing medication reconciliation and review, identifying gaps in insurance coverage, and delivering education, which are all time intensive.

Despite the clear benefit for patients of members of the health care team who are not physicians, the authors identify several challenges. While there are ~150,000 registered PAs in the United States, only 0.4% claim nephrology as their specialty. To increase this number, the American Academy of Nephrology PAs has initiated outreach programs. In addition, no accredited residency programs in nephrology for pharmacists currently exist. Furthermore, the Centers for Medicare & Medicaid Services does not provide reimbursement for specialty care or education provided by pharmacists, and health care systems are often slow to adapt holistic or multidisciplinary approaches to patient care because of funding restrictions and lack of innovation.

As the focus of our field has evolved from kidney failure to kidney health and to prevention and intervening earlier, the need for multidisciplinary teams has never been greater. As individuals and organizations, we recognize the need and must advocate for the expansion and support of all members of the kidney care team, who are invaluable, dedicated, admirable professionals.

Nephrology is a team sport with all members focused on a common goal: putting patients first…always.