January 2025 marks a pivotal and exciting time for kidney care, research, and education. For the first time in my career as a nephrologist, we are witnessing an influx of new therapies in the kidney disease field, expanding treatment options beyond angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; the Advancing American Kidney Health Initiative has resulted in policy changes in which incentives are, for the first time, being aligned with value; and kidney health is now a key component of the cardiovascular-kidney-metabolic triad of chronic diseases.
True change in kidney care, however, will only reach our patients when all of us—as members of ASN—and the broader kidney community are a part of the change; when we all participate in creating a new future for people living with kidney diseases; and when we can truly cure kidney diseases and promote kidney health for all.
And while I will come back to the importance of all of us being a part of the change later in this piece, I want to start by telling you a little about myself—my story, if you will.
I was born in Ottawa, Canada, and grew up mainly in India. However, I had the good fortune to also go to school in Switzerland and Thailand and to spend a lot of time in Sri Lanka, Egypt, and Burma because my father worked with the United Nations for many years. After graduating from the Armed Forces Medical College in Pune, India, I spent almost 8 years in Aberdeen, Scotland, where I completed a master's degree in clinical pharmacology, became a Member of the Royal College of Physicians of the United Kingdom (internal medicine residency equivalent), and earned a PhD on “Adhesion Molecules in Glomerulonephritis.”
Aberdeen will always be special to me, not only because I married my wife Ashwini and had our first child there but also because it is where an amazing mentor, Professor James Petrie, guided and inspired me to become the best version of myself. I then moved to the United States for a nephrology fellowship at Beth Israel Hospital in Boston, MA, which included 2 years of research in a transplant immunology laboratory.
The next 5 years of my life involved a period of great uncertainty, not uncommon for international medical graduates, as I repeated a part of my internal medicine training in Cincinnati, OH, followed by a J-1 visa waiver position at the Cincinnati Veterans Affairs Medical Center. I was successful in being able to cross these barriers and stay in the United States, only because of the support and guidance of three inspiring role models and mentors: Terry Strom, MD, and Vikas Sukhatme, MD, PhD, in Boston and Roy First, MD, in Cincinnati.
Cincinnati was home for 19 years, during which time I worked as a transplant nephrologist, developed a translational program in dialysis vascular access, and most importantly, saw my three children grow up as Cincinnati Bengals fans in a wonderful midwestern environment. It was also during my time in Cincinnati that I came into contact with yet another mentor who shaped me midcareer. Past ASN President Ronald J. Falk, MD, FASN, introduced me to the world of ASN, in which I served as the founding cochair of the Kidney Health Initiative (KHI).
A public-private partnership between the US Food and Drug Administration (FDA) and ASN, KHI started with the goal of creating an innovation substrate that would facilitate the development of drugs, devices, and biologics for kidney diseases. KHI is now a mature organization and, just as Dr. Falk envisaged, has played a key role in the resurgence of new therapies for kidney diseases by validating new surrogate endpoints. For example, KHI's efforts to identify surrogate endpoints for immunoglobulin A nephropathy has resulted in a deluge of new drugs for this condition.
On a more personal level, KHI allowed me to interact with and learn from a diverse group of talented and dedicated people from federal agencies, patient organizations, industry partners, and other health professional organizations. It allowed me to grow my mind, to become a much more holistic person, and most importantly, to understand the significance of the patient perspective in every aspect of health care. For that, I will always be grateful to Dr. Falk, Patrick Archdeacon, MD (FDA cochair of KHI), and Melissa West (now senior director of Strategic Relations and Patient Engagement at ASN).
I am currently the codirector of the University of North Carolina Kidney Center at Chapel Hill. I am privileged to lead a wonderful group of physicians, scientists, staff, and trainees as we work together to leverage research, advocacy, innovation, clinical care, and public policy to improve kidney health. Within this larger vision, we have been able to create a vibrant kidney technology incubator within an academic institution so that our patients can actually benefit from the advances in biology, cell therapies, and material sciences that have revolutionized other specialties. We are excited about a host of potential technologies that we are developing, including microfluidic devices to risk stratify patients with kidney diseases, as well as a variety of instruments for the creation and maintenance of vascular access, including nitric oxide-releasing catheter locks and bioengineered vessels, new membranes for kidney replacement therapy, and novel perfusion technologies to preserve and use less-than-ideal kidneys.
As I reflect back upon my story, two things jump out at me:
First, I am extremely proud of having trained and worked in three countries on three continents. And although at times I feel a bit lost when people ask me where I am from, I also feel good about being able to say that I am a global citizen.
The second is that more than the science and more than the patient care, my story is really a story about people; a story about the mentors who opened opportunity doors for me and imparted wisdom about what to do as I walked through those doors; a story about all of my colleagues and trainees who influenced my thinking; a story about the patients who I cared for, who taught me about so much more than medicine; and a story about people at ASN and KHI who gave me the opportunity to grow my mind holistically.
And this is where my story and the story of kidney health intersect with each other….
Just as my journey reflects a global perspective, kidney diseases are also a global problem. Although there are nuances of kidney care in different countries for the 850 million people living with kidney diseases, the basic issues are the same:
We need more education and awareness.
We need better therapies to prevent and treat kidney diseases.
We need better implementation of the new therapies that are changing kidney care across the globe.
We need to address the disparities in access to kidney care as a result of socioeconomic factors, geography, education, race, and ethnicity.
Since I have gained so much from the opportunities provided through ASN and KHI, a key focus of my work at ASN will be ensuring that the society nurtures its members, provides professional growth opportunities for its members, and continues to support the larger kidney community. And by ASN members, I truly mean all of its more than 21,000 members in 142 countries, especially community nephrologists, early-career nephrologists, PhD researchers, and other health professionals like nephrology nurses, mid-level practitioners, and PharmDs. ASN must continue to mentor and enhance growth in people who will enable change in kidney care, research, and education.
Building on these themes of global kidney care and professional development of ASN members, I plan to focus on three important initiatives during my year as ASN president:
1. Demonstrate the value of nephrology. We need to leverage the incredible advances in new diagnostics, drugs, devices, and biologics in kidney care to demonstrate the value of nephrology to the health care system as a whole. To do this, we must break out of our small nephrology bubble and demonstrate the importance of kidney care within the larger bubble of the global health care system. This step is essential to ensure that there are well-defined reimbursement pathways for new therapies to continue to enter the kidney field; that these advances reach the most vulnerable of our patients; and that nephrologists are compensated appropriately for the immense value that they bring to health care as a whole.
For example, an initiative on leadership, economics, and access to quality care in nephrology is needed to promote professional growth and to provide nephrologists with the necessary skill sets in health care policy, quality improvement, advocacy, health economics, and data analytics. This effort should actively engage constituencies such as community nephrologists, division directors, dialysis organizations, and value-based care companies, as well as expand on ongoing initiatives and partnerships, such as ASN's Data Science Program, the ASN-Columbia University Nephro-Economics symposium, and the Nephrology Business Leadership University. Finally, it should leverage the common linkages in the context of cardiovascular-kidney-metabolic disease through ASN's focus on “saving kidneys, hearts, and lives.”
2. Address the linked ssues of the impact of climate change on kidney health and sustainable innovation in nephrology. When combined with ASN's Emergency Partnership Initiative, this focus should support patients with kidney diseases who are living in disaster settings, champion innovative ways to reduce power and water use in dialysis, and partner with other members of the kidney community and beyond to confront the reality of conditions like chronic kidney disease of unknown origin.
For example, KidneyX (Kidney Innovation Accelerator)—a partnership between the US Department of Health and Human Services and ASN—initiated a sustainability prize last fall to recognize cutting-edge innovative approaches that can reduce water use and power consumption for dialysis.
3. Highlight ASN's international footprint. As countries across the planet address the same challenges of education, advocacy, health economics, implementation, and access to care, I believe that there are lots of opportunities for ASN and its members to both partner with and learn from countries across the globe. I, therefore, plan to advance the already strong partnerships that we have with the European Renal Association and the International Society of Nephrology, while at the same time, develop direct country-to-country partnerships with the Japanese Society of Nephrology and the Indian Society of Nephrology.
For example, ASN should strengthen its overseas symposia, continue to identify country ambassadors at Kidney Week, and develop opportunities for early-career professionals to fulfill electives in other countries and vice versa. Similar to internal medicine as a whole, there are a large number of international medical graduates practicing nephrology in the United States who could be a conduit for connections and partnerships with other countries. Nephrology's diversity is a unique strength in this setting.
Serving as ASN president is by far the greatest honor of my professional career and a testament to this amazing country, in which I arrived 31 years ago. In particular, I consider myself truly lucky to be leading this amazing organization at a time of incredible positive change in kidney health. We are at a unique inflection point in kidney care with a plethora of new therapies and policy changes, but true progress will only come if each and every ASN member commits to grab this opportunity and, in some small way, be a part of this change. And if we can do that, then I believe that we will be able to cure kidney diseases, embrace kidney health, and achieve our dream of a world without kidney diseases.
…true progress will only come if each and every ASN member commits to grab this opportunity and, in some small way, be a part of this change.
Footnotes
To comment on Dr. Roy-Chaudhury's editorial, please contact email@asn-online.org.
