Innovations in nephrology are taking place as the importance of kidney health is emphasized globally. Listen to this podcast, to hear how kidney care is transforming around the world, with insights from clinicians who share a passion for innovation: Jeffrey Giullian, MD, chief medical officer for DaVita Kidney Care; Janet Cowperthwaite, director of clinical operations for DaVita International; Sam Kant, MD, nephrology fellow at Johns Hopkins Hospital; Szymon Brzosko, MD, chief medical officer for DaVita Poland; Mandy Hale, vice president of nursing for DaVita; Francesca Tentori, MD, vice president of outcomes research and patient empowerment for DaVita, Wisam Al Badr, MD, chief medical officer for DaVita Saudi Arabia; and David Roer, MD, vice president of medical affairs for DaVita Integrated Kidney Care. Listen and read more DaVita Medical Insights here.

Podcast Transcript:

Ryan Weir: 00:32 Hello, everyone. This is Ryan Weir with the DaVita Medical Insights Podcast. The importance of kidney health is emphasized globally. I've recently caught up both in person and over the phone with nephrology clinicians from around the world to gather an international perspective on kidney care transformation, innovations they're looking forward to seeing within the next decade and more.

Ryan Weir: 00:52 In this podcast, we'll hear from clinicians in Poland, Saudi Arabia, England and the United States. We asked Dr. Jeff Giullian, chief medical officer for DaVita Kidney Care; Janet Cowperthwaite, director of clinical operations for DaVita International; and Dr. Sam Kant, nephrology fellow at Johns Hopkins Hospital, what they believe is the next big thing that will improve kidney care in their country. Let's hear what they had to say.

Dr. Jeff Giullian: 01:23 We are living through a time of great innovation expansion within kidney care today. I see really a few key innovations coming down the pike that will, I believe, likely change the way that we deliver care in the U.S. and really perhaps across the entire globe. So the first is, within chronic kidney disease, we are seeing innovation in artificial intelligence and predictive analytics, which will help caregivers segment patients based on their risk for renal progression.

Dr. Jeff Giullian: 01:52 Second big area is, for patients with end-stage kidney disease, we're seeing innovation that enhances their ability to choose a dialysis modality that best meets their personal needs. This includes items such as home-remote monitoring to all the way to new devices for home dialysis. Then the third thing is that there are mechanisms now to increase the number of kidney transplants. This category really includes everything from paired and chain donations, but also new types of organs and implantable devices that are really a little bit more distant into the future, but they are exciting nonetheless.

Ryan Weir: 02:28 Janet Cowperthwaite

Janet Cowperthwaite: 02:30 From my perspective, I think it's about patients' engagements and activation. Engagements in their treatment and choices, but also how we run and provide the services, and in other aspects involving them in things like in safety and quality forums within the clinic.

Ryan Weir: 02:49 Dr. Kant

Dr. Sam Kant: 02:51 I think one of the biggest things is that we so far only relied on one or two blood tests when it comes to diagnosing kidney disease and managing things. I think the emergence of biomarkers, especially, whether they're serum or a urine, any biomarkers, it will probably help us elucidate what kind of acute kidney injury someone has or what kind of disease you know is afflicting the kidneys. I think that would be something that you would see increasing utilization all throughout. Definitely I think has a lot of scope going forward.

Ryan Weir: 03:26 Dr. Szymon Brzosko, chief medical officer for DaVita Poland and Mandy Hale, vice president of nursing for DaVita based in the U.S., told us about the one thing that could help improve health care in their respective countries and worldwide.

Dr. Szymon Brzosko: 03:41 In Poland, I really would like to see more home renal replacement therapy options being available for patients. Especially I'm thinking about more peritoneal dialysis, it is a valuable one. We have many kinds of treatment options available in my country, but in parallel existing regulations and organizational issues with qualifying patients for being active on the waiting list a problem for potential donor or even social acceptance of these methods is still too low and this is the area where I would like to see you know, improvements and by that probably allowing patients to live better with the disease.

Ryan Weir: 04:38 Mandy Hale

Mandy Hale: 04:40 I'm going to answer the question as one thing that can improve health care in my community, my country, my world with two answers and that is awareness and preventative care. I think it is so important that, we, as nephrology clinicians, continue to put emphasis on the importance of creating awareness for individuals when it comes to chronic kidney disease, which is so many times and referred to as a silent disease. We must help people understand the risk factors and what type of tests and intervention can help when we refer to CKD and we must provide access to that type of care. I see a whole lot of focus on thinking creatively through helping patients access care or helping individuals understand the risk factor. For me that is just the largest hope I have that we can help read through the presence of chronic kidney disease.

Ryan Weir: 05:41 We wanted to hear about the one innovation in kidney care these clinicians believe would create a better future for people with kidney disease. So we asked Dr. Francesca Tentori, vice president of outcomes research and patient empowerment for DaVita, Dr. Wisam Al Badr, chief medical officer for DaVita Saudi Arabia, Dr. Giullian and Dr. Kant for their perspectives.

Dr. Francesca Tentori: 06:03 I'll be honest that this is the first time in my life as a nephrologist that I have seen something I'm super excited about. At the last ASN, for example, there were several new dialysis machines and just in general, technology platforms that I thought were really “cool and exciting” and I really envision them to come to fruition sometime in the near future and I think those are good to make a huge difference for our patients.

Ryan Weir: 06:39 Dr. Al Badr

Dr. Wisam Al Badr: 06:41 One of the most important innovations that we are looking at in the nephrology community today that would bring in the best results for our kidney population is a better screening measure for early detection of kidney failure. Currently, we rely on a blood test including the creatinine and the estimated GFR, but it presents the disease quite late. Finding this measure that presents an early detection of kidney disease would be the best innovation available.

Ryan Weir: 07:25 Dr. Giullian

Dr. Jeff Giullian: 07:27 I don't believe that there's one single innovation that's the silver bullet at least until we have the ability to provide true regenerative medicine. Rather, I think it's a combination of innovations that will help us slow the progression of kidney disease and then provide many more options for replacing renal function in the event that we can't halt progression of CKD.

Ryan Weir: 07:48 Dr. Kant

Dr. Sam Kant: 07:50 That's a very interesting question. I think one of the biggest things as a doctor looking after patients who have already undergone transplants, I always feel immunosuppression is necessary, but there's also associated with a lot of side effects and is expensive. There's a big push from centers all over the world to come up with ways by which we can avoid immune suppression all together. They're talking about various STEM cell infusions or modified immune cells infusions, to be more exact. That might help and look very promising in evading immunosuppression all together once patients are transplanted. I think that's of the things I'm really looking forward to. I really hope it works out and it’s certainly I've been going on and on about it, I think it would be a complete game changer.

Ryan Weir: 08:42 Dr. David Roer, vice president of medical affairs for DaVita Integrated Kidney Care, Dr. Giullian and Dr. Brzosko provided their thoughts on what the kidney care community is doing well and could impact the rest of health care.

Dr. David Roer: 08:55 I think the one thing that the renal care community can do and help as an example for the broader health care community is using robust analytics to organize and develop highly effective and efficient care delivery systems through integrated kidney care team. The kidney care community has been at the forefront of collecting important clinical demographic and financial metrics. Using this information to efficiently and effectively care for patients with chronic kidney disease will be essential in driving towards the goal of reducing chronic kidney disease and slowing the progression of chronic kidney disease.

Ryan Weir: 09:43 Dr. Giullian

Dr. Jeff Giullian: 09:45 The kidney community in the United States is working to break down silos and reduce fragmentation and care. Now, we're still very far away from achieving that goal. However, as we do improve care coordination and data sharing, I believe this will have a major positive impact on the care that we provide to our patients and will serve as a model for the rest of health care. Really, along these same lines, nephrologists and kidney care providers like DaVita are leading the country in integrative care and value based reimbursement from the ESCOs which were the ESRD or ESKD seamless care organizations to CSNPs, chronic special needs plans to other integrated care arrangements. Kidney care is ahead of the rest of health care in the movement away from volume-based payments and towards value-based payments and I'm very proud of the role that DaVita and our nephrology colleagues have played in this arena.

Ryan Weir: 10:37 Dr. Brzosko

Dr. Szymon Brzosko: 10:39 First of all, I'm really impressed how the nephrology community was able to take it on and successfully took advantage of the power of social media and other internet platforms for education and nephrology education, sharing knowledge and connecting the kidney community across the world. And by saying this, I mean including students, doctors, medics, scientists and organizing many activities to join like journal clubs, like NephJC to mention, which I really enjoy very much, Neph Madness by American Journal of Kidney Disease, a nephrologist podcast where our community's very active, e-learning activities like NTDS by ASN and smart use of social media like Twitter. It allows people to create a personal and professional social media network. When you start, you actually choose who you follow, it can be really enriching your expert knowledge and experience whatever professional career step you are in and actually many smart people are actually there.

Dr. Szymon Brzosko: 11:54 Having my Twitter as an example, these people are willing to discuss, share and talk. Including DaVita teammates, like probably well known for all of us, Dr. Provenzano, Dr. Mahesh Krishnan or CMO for DaVita International, Dr. Partha Das. They are all present there. Oh yes, and to mention our current CMO for DaVita Kidney Care, Dr. Jeff Giullian, is also there. So indeed sometimes it is the field where you can interact with people you tried to contact during, for example, a conference but fail as they are busy or you are too, too far in the line. That's an approach that for sure, I would say, makes nephrology great again.

Dr. Szymon Brzosko: 12:39 But probably even more impactful to patients, I would like to mention how the kidney community is supporting educating patients and the patient empowerment idea, and nice examples of that is taking into consideration patient oriented outcomes as an endpoint in nephrology to try it out. This is so much an essential part of the change I see and feel is getting real value in the care we deliver to patients. It’s called patient-centered care, where after explaining the problems, current options, order for treatment, then patient goals, values and patterns to the very center stage.

Ryan Weir: 13:30 How do we see the nephrology community changing in the next year? What about within the next decade? Mandy Hale, Dr. Tentori, Dr. Roer and Dr. Kant provided their thoughts.

Mandy Hale: 13:41 I'm really excited about the transformation of nephrology care that I think we can expect over the next year and of course well into the next decade. There's so much focus and energy right now around, I would say, three things that I think are going to look a lot different. The first one is preventative care and the focus on really preventing and delaying chronic kidney disease, so I'm so excited for individuals who may have access to care who didn't before or access to different types of care to really look at preventing the need for further intervention as kidney failure progresses. That's one exciting thing.

Mandy Hale: 14:27 Secondly, I'm very excited about the focus, the intentional focus, around increasing the presence of home dialysis, home therapies, both peritoneal dialysis and home hemodialysis can be life changing for patients, both through improving their outcomes and their quality of life and the way they feel, but also will really dramatically change the way that nephrology care is delivered.

Mandy Hale: 14:56 Then thirdly, I'm also excited about the focus on transplants. I really look forward to further changes, particularly here in the United States that will help make transplant easier; easier for patients to obtain, easier for donors to donate and the increased coordination that will resolve with dialysis and kidney care providers and transplant facilities.

Ryan Weir: 15:22 Dr. Tentori

Dr. Francesca Tentori: 15:24 I didn't know that it's necessarily changing, but I think there's going to be more and more emphasis of the need to integrate a kidney care across the continuum of the kidney disease spectrum. So, from CKD into dialysis to transplantation towards end of life, integrating all of the stats. That means better communication across clinicians and providers. That's something that is really gaining traction and people are interested in.

Ryan Weir: 15:58 Dr. Roer

Dr. David Roer: 16:00 Let me start with the second question. I believe, as a nephrologist and part of the renal care community, we would all agree that improving the care of patients with chronic kidney disease to reduce the number of individuals suffering from chronic kidney disease and focusing on a cure rather than on renal replacement therapy is the ultimate goal. This is an exciting time in nephrology that this goal may be achieved within the next decade. The prevalence of chronic kidney disease in the United States is approximately 15% and two thirds of those suffering from chronic kidney disease and end stage kidney disease has concurrent comorbidities of diabetes, hypertension and cardiovascular disease. There are accelerating advances in innovation in the treatment of patients with chronic kidney disease. Recent research has shown evidence that new pharmacologic treatments for diabetes can slow or stop the progression of chronic kidney disease and reduce the cardiovascular risk, mortality and need for dialysis.

Dr. David Roer: 17:10 The advancing understanding of the pathophysiology of chronic kidney disease and precision personalized medicine will hopefully change the natural history of chronic kidney disease. The first part of your question, “how do I see nephrology care community changing in the next year?” With the end in mind to reduce or eliminate chronic kidney disease we are organizing the renal care community to achieve this goal. To begin, a focus on new efforts for early detection and treatment of patients with chronic kidney disease through patient education, clinician and caregiver education through building an integrated care delivery infrastructure.

Dr. David Roer: 17:58 Furthermore, treating the most common causes of chronic kidney disease including new proven diabetic therapy. Improving education for the broader medical community and patients is an important part of the strategy for early detection and intervention to prevent end stage kidney disease. This strategy will be facilitated by moving from a fee-for-service payment model, to a population value-based payment model. At DaVita, we have been providing integrated kidney care for patients with end stage kidney disease for approximately 20 years and for patients with chronic kidney disease for about 10 years. Through integrated kidney care, it's significant reduction in total cost of care while improving quality of care.

Ryan Weir: 18:54 Dr. Kant

Dr. Sam Kant: 18:56 In the last year there's been a lot of research that's been happening, especially in nephrology. If you name it, pretty much the SGLT2 inhibitors, the mentor trial, or back to that, you can see that the demand in a research and in nephrology is actually picked up quite a bit. I think that will really spur more studies and of course looking for further answers. I think just the application of what we found with the trials in the last year will really help patients and above all the community. I think that would be something that I would say at least over the next year for sure. I think, more importantly, with more changes that are being implemented in the U.S. for the next decade, I think long term, some good steps have been taken. The encouragement of home therapies is something which is a great step and above all to improve access to transplantation. That will be a game changer. With the way things are going in the communities embracing these changes, the next decade it's going to be extremely exciting.

Ryan Weir: 19:59 Our final question for clinicians went to Dr. Roer, Dr. Al Badr, Janet Cowperthwaite and Mandy Hale. We asked each of them to share general tips for their fellow nephrology clinicians.

Dr. David Roer: 20:10 I think what's important is to develop partnerships that will enable your practices to expand capabilities to impact the care of patients with chronic kidney disease such as the use of predictive analytics, robust chronic kidney disease, patient education and collaboration with the broader local care community for early detection and intervention with patients with chronic kidney disease.

Ryan Weir: 20:39 Dr. Al Badr

Dr. Wisam Al Badr: 20:41 The best tips that I would recommend for nephrologists within the Saudi community and the GCC countries would be to develop screening programs for the high risk population. Number two, initiate early vascular access planning for patients who reach a level four and five very close to dialysis to prevent the crashing patients to come into the ER. The third tip that I would really highly recommend is to create an integrated health care system where the patient is involved and is part of the planning and the management of his own personal care. That would bring in that level of buy in that we all recommend for the patient, his family and the treating team.

Ryan Weir: 21:48 Janet Cowperthwaite

Janet Cowperthwaite: 21:50 So I was lucky last week to have a chance to meet with a small group of patients in the non-clinical care setting and it really opened my eyes to some things. How thoughtful are we? How can we improve how our care team interacts with our patients? After listening to these patients, I've made efforts to better understand and then improve the patients’ journey.

Ryan Weir: 22:22 Mandy Hale

Mandy Hale: 22:24 I'm going to provide two general tips that I have for other nephrology clinicians. These are very consistent with what I share to nurses that I interact with every day. The first is I can't encourage enough for clinicians in nephrology to be well-rounded in nephrology. I always encourage nurses and other caregivers to really expand beyond the four walls and what's the work in. Don't only know in-center hemodialysis or don't only know the provision of peritoneal dialysis. Challenge yourself to understand in a more global fashion, what all aspects of nephrology care look like, including to take the different dialysis therapies, transplants, the whole general care that can exist for patients.

Mandy Hale: 23:20 The second tip that I would offer, is continue your education. I can't encourage clinicians enough to advance their professional practice. This could be of course, obtaining additional clinical education units that are required for licensure or certification, but also stretch yourself further. Obtain a certification in nephrology nursing, for instance which suggests that you are a subject matter expert. It's third party validation that you're an expert for in the field. Obtain additional certifications beyond that or take other classes, attend a conference, whatever that looks like. Advancing professional practice is so important, particularly as nephrology care continues to change.

Ryan Weir: 24:05 We want to thank all of the nephrology clinicians who provided their perspectives on kidney care transformation in this DaVita medical insights podcast episode. We hope this gave a closer look at the innovations taking place worldwide. Listeners, thank you so much for tuning in and be sure to check out other DaVita medical insights episodes for more kidney care educational podcasts. You can also find additional kidney care, thought leadership and industry news by following @DaVitaDoc on Twitter. Thanks for listening and we'll see you next time on the DaVita Medical Insights podcast.