Update from ASN Executive Vice President Tod Ibrahim

The American Society of Nephrology (ASN) in February cohosted a virtual Capital Markets Day for Kidney Health. After a series of exciting presentations outlining recent successes and ongoing challenges in kidney medicine, the financial community clearly recognized what we all know: we are creating tremendously positive change in conquering an overwhelmingly burdensome disease, leveraging emerging science and therapies, tackling health disparities and inequities, and raising awareness about the importance of kidney health.

In "Warp Speed: Nephrology Drug Development," Kenar D. Jhaveri, MD, FASN, underscores the "rapid rise in the number of novel therapeutic agents entering the kidney space" during the past five years. Moreover, KidneyX has launched Redesign Dialysis Phase 1 (in 2019), Phase 2 (2020), and the Artificial Kidney Prize Phase 1 (2021) to seek "solutions that enable and advance the functionality, effectiveness, and/or reliability of artificial kidneys." This groundbreaking effort aligns with the Kidney Health Initiative (KHI) Technology Roadmap for Innovative Approaches to Renal Replacement Therapy(2018).

We know kidney diseases are complex. Transforming care is simultaneously fast and slow but never linear. At a local level, the kidney community must embrace and advocate for earlier screening, diagnosis, and treatment through partnerships and collaborations. With a growing armamentarium of drugs and diagnostic tools--such as SGLT2 inhibitors, GPL-1s, MRAs, Sparsentan, and artificial intelligence--we are on the forefront of transforming how we care for people with kidney diseases, slowing and hopefully preventing kidney failure. Nephrologists and other kidney health professionals are best positioned to communicate this narrative shift from treating kidney failure to promoting kidney health.

Every year ASN builds its support of initiatives that expand the kidney community's knowledge and advance the kind of rapid change we see now: a cascade of therapies, diagnostics, and other innovations building a golden age of kidney research, discovery, and innovation. ASN leverages its national and international platforms to raise awareness about the public health threat posed by kidney diseases, about the need to intervene early to slow disease progression, and about the necessity of dramatically increasing access to transplants.

Across the world, the COVID-19 pandemic has accelerated change and heightened awareness of barriers to care. In Europe, approximately 20% of the people on dialysis or with kidney transplants who had the virus died, considerably higher than the 4% mortality rate for the rest of the people on the continent diagnosed with COVID-19. A persistent upsurge of mortality in dialysis care--attributed to documented SARS-CoV-2 infections, undocumented viral infections, and decreased access to necessary non-dialysis-related medical care--has highlighted the urgent need to improve treatment and accelerate change for people with kidney diseases. For example, the pandemic has rapidly expanded use of telehealth and interest in home dialysis. ASN held a "Home Dialysis Focus Group Session," in December 2020, identifying needed improvements to nephrology fellowship training, suggesting expansions to continuing education for nephrologists and other kidney health professionals, and clarifying opportunities for advocating changes in federal policy. This spring, ASN will launch an initiative to implement these recommendations.

While excited about how telehealth can improve kidney care, ASN also remains concerned about the "digital divide," where insufficient access to technology, undependable internet coverage, and less digital proficiency worsens health disparities and inequities on a global scale. "Access to broadband is, or will soon become, a social determinant of health," Douglas B. Fridsma, MD, PhD, correctly predicted in 2017. Creating telehealth access equity is essential to improve global kidney care. The pandemic also exposed systemic racism throughout the world. ASN is committed to doing more to identify, confront, and eliminate health disparities and inequities.

The new ASN Health Care Justice Committee--chaired by O.N. Ray Bignall, II, MD, FASN--will lead the society's efforts in this arena. Fulfilling this pledge will require a coordinated effort within ASN and between ASN and the rest of the kidney community. The next 10 years have been dubbed the "decade of the kidney." To realize this promise, we must improve care, expand research, and bolster education by 2030. The first step is recognizing the urgent need to translate innovation into reality for the more than 850 million people worldwide with kidney diseases, kidney failure, and kidney transplants.

Now, at the beginning of the decade of the kidney, we have the unique opportunity to align science, innovation, policy, and care as well as to transform lives and amplify the success and exceptionalism of this amazing specialty.

Tod Ibrahim

Executive Vice President, American Society of Nephrology