Revitalizing ASN's Excellence in Patient Care for Clinical Nephrology Today and in the Future

Alan S. Kliger Alan S. Kliger, MD, is chair of the EPC Advisory Committee and clinical professor of medicine at Yale University School of Medicine, New Haven, CT.

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The American College of Physicians defines nephrology as “…the subspecialty of internal medicine that focuses on the diagnosis and treatment of diseases of the kidney. Because the kidney performs so many critical functions, nephrologists maintain expertise in primary kidney disorders, but also the management of the systemic consequences of kidney dysfunction. Although the prevention and identification and management of early kidney disease is a large part of general internal medicine practice, nephrologists are usually called upon to assist and manage more complex or advanced nephrologic disorders” (1). This has been the picture for decades—in which a nephrologist was consulted in later stages of chronic kidney disease or to manage more complex or advanced disease.

However, our field is undergoing a major change. With the discovery of therapies targeting specific molecular or cellular processes that contribute to disease development or progression; with the growing opportunities to alter defective genes; and with agents such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and nonsteroidal mineralocorticoid receptor antagonists that prevent or ameliorate kidney diseases, nephrologists now have the opportunity to identify and intervene early in the course of many kidney diseases. Furthermore, many of these agents that are highly effective in changing the course of kidney diseases are also useful in reducing heart disease, diabetes, and possibly other diseases as well.

This complex specialty now requires new approaches to best address the vast array of circumstances, diagnoses, complications, and needs of the patient population for whom it cares.

ASN created Excellence in Patient Care (EPC) to help integrate the several clinical working groups aiming to improve patient care across the wide spectrum of nephrology care. EPC has overseen work done by AKINow [Acute Kidney Injury], the Adult Immunization Project, the Diabetic Kidney Disease Collaborative, and the Emergency Partnership Initiative. These efforts were fashioned after ASN's Nephrologists Transforming Dialysis Safety (NTDS) initiative. Launched in July 2016 as a partnership with the Centers for Disease Control and Prevention, NTDS’ mission, “engaging nephrologists as team leaders in transformational change that continuously improves the safety of life sustaining dialysis,” focused on infection prevention and patient safety.

In the years since 2016, the project progressed to include specific initiatives on:

  • Quality, Assessment, Improvement, and Education

  • Transforming Dialysis Access Together

  • Human Factors

  • Home Dialysis

  • Project Firstline

  • COVID-19 and Emerging Threats

NTDS’ and EPC's library of resources includes an Ebola gap analysis; an algorithm for treatment of hepatitis B; a leadership initiative; Targeting Zero Infections webinars on topics such as environmental decontamination; leading a collaboration to respond to hurricanes in the Caribbean; learning modules on antibiotic prescribing, COVID-19, optimizing vascular access planning, patient empowerment, and mental wellness; and over 20 webinars addressing the unique issues prompted by the COVID-19 pandemic.

New tools and new opportunities for nephrologists to transform the lives of our patients now dictate that EPC and its initiatives grow and change to better meet the needs of clinicians who treat kidney diseases. The world has changed, from new viruses and therapies to the rise of misinformation and artificial intelligence. As an example, SGLT2 inhibitors and GLP-1 receptor agonists, which are proven to be highly effective therapies to reduce kidney and cardiovascular risks in diabetic kidney disease, remain vastly underutilized (2).

Now is the time to move nephrology forward once again, embrace such new therapies, implement best practices, and search for like-minded professions with goals that intersect with and support those of clinical nephrology.

The close intersection of hearts and kidneys, particularly with new SGLT2 and GLP-1 therapies that link them, suggests that now is the time to welcome cardiology as a partner in improving the lives of patients who experience multiple and complicated comorbidities.

ASN is thrilled to announce that it is redesigning EPC to embrace the new and complex issues that nephrology care teams address on a daily basis. This redesign will unite NTDS and EPC with new initiatives, including Fostering Inclusivity in Dialysis, the development of an eGFR [Estimated Glomerular Filtration Rate] Toolkit, the Kidney Community Vaccination Collaborative, and a Glomerular Diseases Collaborative. Similarly, EPC will pursue collaborations to support collective efforts to save hearts and kidneys.

This collective of clinically focused initiatives is meant to be broad, recognizing the variability of conditions that nephrology treats, and nimble in acknowledgment of the constantly evolving environment in which today's clinician practices.

We invite you to partner with us as EPC strives to support the needs of nephrology clinicians today and in the future. To learn more about EPC, please visit https://epc.asn-online.org/ or scan the QR code.

Excellence in Patient Care

  • Acute Kidney Injury (AKINow)

  • Adult Immunization Project (AIP)

  • COVID-19 and Emerging Threats (C-ET)

  • Diabetic Kidney Disease Collaborative (DKD-C)

  • eGFR Toolkit

  • Emergency Partnership Initiative (EPI)

  • Fostering Inclusivity in Dialysis (FinD)

  • Glomerular Diseases Collaborative (GD-C)

  • Home Dialysis Project (HDP)

  • Human Factors Engineering (HFE)

  • Kidney Community Vaccination Collaborative (KCVC)

  • Nephrologists Transforming Dialysis Safety (NTDS)

  • Project Firstline

  • Quality, Assessment, Improvement, and Education (QAIE)

  • Transforming Dialysis Access Together (TDAT)

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