“I would just really encourage folks to get upstream and get your patients the information early in their disease state, so that they can be more involved in their care and make good decisions for themselves,” says Josh Lowentritt, MD, a New Orleans nephrologist in private practice. Listen to this podcast, in which Martha Wofford, group vice president of DaVita Kidney Care, interviews Dr. Lowentritt on the importance of patient education, and empowering chronic kidney disease (CKD) patients to make active choices in their care. Dr. Lowentritt discusses his professional background, his passion for CKD education, like Kidney Smart, the patient’s perspective, the need for a CKD educator, the significant conversations related to diet, advice for nephrologists in providing education and the impact of COVID-19 on giving patients support.

Podcast Transcript:

Martha Wofford (00:40): Hello and welcome to DaVita Medical Insights Podcast. My name is Martha Wofford and I am a group vice president at DaVita Kidney Care, and I am excited to be joined today by Dr. Josh Lowentritt, he's a nephrologist from New Orleans. And just thank you, Dr. Lowentritt or joining us to talk about the importance of education for patients with chronic kidney disease.

Dr. Lowentritt (01:03): Well, thanks.

Martha Wofford (01:06): Yeah, thanks for being here.

Dr. Lowentritt (01:07): Yes.

Martha Wofford (01:07): First off, can you start by telling our listeners a little bit about your background and maybe why you're so passionate about CKD education?

Dr. Lowentritt (01:15): Sure. So first of all, call me Josh, and I'm delighted to be here today to chat. I did all my nephrology training here in New Orleans at Tulane and finished up 2001. And I've been in private practice since then. So I'm doing hospital work, office work, I go to dialysis clinics. I still see my post-transplant patients after they get released back to me. And also do quite a bit of medical director work and work in population health and value-based care, which helps fill out my day.

So, that CKD education, it's strange that it's such a novel idea. I was so lucky when I was in training. We actually had a dialysis CKD PD educator embedded in our clinic when I was a fellow. And so I always included CKD education when my patients would progress further along in their kidney disease, or make referrals to CKD education as appropriate, for patients to get the information they need. I've never imagined nephrology without having a CKD educator. And so I've just really enjoyed that association throughout my career.

Martha Wofford (02:45): Oh, that's awesome. Yeah. I think not everybody probably had that advantage and that's a great way to shape your thinking about it. Just being core to what you do with patients. Maybe you can tell us a little bit more about what it's like from the patient's perspective, what their greatest needs are for education? And then when you encounter those needs, when and how you provide CKD education?

Dr. Lowentritt (03:11): Sure. Kidney disease, it's intimidating. It's scary for patients. We're talking about real serious stuff, and at the same time, a lot of times patients don't know enough about it to even know what to ask. So my use of the CKD educator and the health materials and the Kidney Smart materials, that really helps round out what I need the patients to know so that they can be empowered to take care of themselves. Because as we know, we're dealing with a chronic disease state and a lot of the care is what people do on their own time, not when they're sitting in front of the doctor. So I think it's really critical that we provide education that is in a relaxed setting, not in front of the doctor. They should be able to feel like they can ask any question.

And sometimes they're a bit intimidated to ask questions that might be personal, or they might think they're not really smart questions or something like that. And also because, when I'm talking to patients, there's the time limit. I have to keep moving on my schedule and patients may not remember to come back to ask the question if it slips their mind. So the educational piece is really critical in making sure patients understand what's going on with them. We're asking people to change their diet. We're asking people to manage chronic diseases, check their blood pressures, take care of their diabetes. We're asking them to pay attention to their feet. We're asking them to dramatically change their diet sometimes and they need support for that. So it's really a lot about empowering patients. Being sensitive to their needs. And really creating an educational space for them so that they can get the information and make the good choices for themselves.

Martha Wofford (05:19): Yeah, that makes total sense. And I bet the dramatic changes to the diet down in New Orleans must be particularly painful for patients.

Dr. Lowentritt (05:27): It's terrible. I have to tell people, "If you like it, you can't have it." Who wants to hear that? And, I'm not a dietitian. I have some thoughts about what you shouldn't eat. But I'm not able to quickly come up with substitutes. A trained renal dietitian, or a kidney educator who has experience in this, they are able to come up with good substitutes. Because obviously, we need people to have good nutrition. But again, I'm not trained for that. And I'm very happy to have folks on the team who are.

Martha Wofford (06:04): Yeah. And one of the things that I'm really proud of is, as we overhaul the Kidney Smart curriculum, is we did a lot of work on diet and presenting different options for people so they could swap out something healthier for something that they really like in their diet. So that's a really easy part of the educational material to use for sure. Josh, what piece of advice would you have for other nephrologists who may not be utilizing CKD education or Kidney Smart with their patients today?

Dr. Lowentritt (06:36): I would just ask nephrologists, "What is your goal for your patient?" If you want the best care for your patient and you feel like, as a physician you can do it all, by all means, keep doing it all. But, that's not the world that I live in. The world I live in is that kidney disease is a team sport. We need a whole team of people to take care of folks and give them the information they need so that they can make good choices.

One of the most wonderful things about kidney care that I've enjoyed as a nephrologist is, I've always been doing care in groups. I'm meeting with my facility administrator and my nurses, my dietitians, social workers. But to be able to bring that upstream, bring that out of the dialysis clinic, why wait till someone has kidney failure to give them that level of care? Why would we not bring that upstream and give our patients the information and empower them to take care of themselves? Why would we wait for that?

Let's get upstream. Let's not wait until they go to the dialysis unit so they can get a dietitian or they get dietary advice. Let's take care of that in a relaxed setting. What if we did that and our patients didn't need dialysis for another year or two, or maybe never, because they got the education they needed? Or what if they were able to pick the modality that's most important to them? Or even better, that we send them to transplant. When we get them set up at the transplant center and perhaps have a preemptive transplant if needed. That's what I would tell the nephrology community is if we really want to give the best we can for our patients, we need to include the team earlier and get much farther upstream than the dialysis unit.

Martha Wofford (08:30): I love that Josh. I think you and I share, I know, a passion around trying to empower patients and really changing their trajectory, but what if really empowering them and getting them that information so that they don't progress is something that I know we're both spending a lot of energy, trying to make the reality for more and more nephrologists and more and more patients. Maybe if we just talked for a minute about what it's been like with COVID and how it's been to try to support patients and educate them and this period.

Dr. Lowentritt (09:09): Sure. And of course, you know how COVID hit New Orleans pretty quickly, and it was really 10 weeks of an ordeal. Currently, we're the one part of the Louisiana where COVID is not flaring so badly after the initial, really it was a terrible 10 weeks. And fortunately, the whole population, especially the vulnerable patients really get it. They really need to say to themselves, they really need to be very careful when they leave their homes. So, I've asked my patients about that. In fact, in the last two days, I've talked to four patients about peritoneal dialysis, people that are new-starts.

One patient who's already on hemodialysis. And one of the things I'm telling them now is, you don't have to come into a big group setting. You don't have to come in to the dialysis day clinic. You can do your dialysis at home and maybe reduce your risk of exposure from not having to get on transportation vans and not having to take buses and not relying on neighbors to bring you places. So I think, in the world, in our post-COVID world, we should be mindful of that. That, one of the ways we can help protect our patients is simply to give them their kidney care at home.

So if that's education, the Kidney Smart education program currently is doing all telehealth, which is actually giving my patients much more attention than the previous era, when they would come in for meetings and meet in groups. They're actually getting a lot of one-on-one time with the Kidney Smart educator. And for my patients who require dialysis, why wouldn't we want to treat them at home where they can control the environment and get their care in the most comfortable setting possible?

So I think post-COVID, it becomes even clearer. Oh, and don't forget, I live in a hurricane zone, and I tell my patients all the time, "If the hurricane comes, you pack up, you pack three days of supplies of peritoneal dialysis and you head out. And you don't have to set up dialysis when you get somewhere. And in our hurricane areas, I think they're also very important. It's pretty scary to rely on dialysis as a modality for life support, especially if you might have to evacuate for a hurricane or natural disaster.

Martha Wofford (11:56): Yeah. I think we're such fans of the flexibility that PD offers to patients, and a hurricane's just another example of that flexibility and being able to pick up at a moment's notice. So it's been amazing. We, as I think you know, have about 1,500 educators across the country. And, as you were saying, in New Orleans, we've heard tremendous feedback from many of those educators that the transition to going to telehealth has been just a godsend for patients, where they weren't always able to access all of the health care system.

But the ability to connect with an educator and then to follow-up and call them and ask all the questions that they have and get good answers, has been really important to helping them. And for many of them helping them start on PD. So, COVID's been a big push towards telehealth, which has been, in a way, a gift, sort of a silver lining, in the middle of this horrible crisis. So, we've definitely seen some of the advantages and we'll continue to offer Kidney Smart through many different modalities so that we can reach patients however they most want to be connected with. Whether it's in person with a group, or one-on-one over telehealth. So thanks for that.

Any other closing thoughts that you would want to offer to our listeners?

Dr. Lowentritt (13:25): Well, I would just really encourage folks to get upstream and get your patients the information early in their disease state, so that they can be more involved in their care and make good decisions for themselves. There's nothing better when a patient requires dialysis than a patient who is ready, trained, has an access, whether it's a peritoneal catheter, or a fistula. That they have already made dietary modifications. I like to joke, I have a small group of vegetarians out there among the meat-eating society. But, take advantage of the Kidney Smart program and get your patients involved in their own care. And actually, it allows us as physicians to give advice at a much higher level, and probably a more personal level than we might, if we're having to just really grind it out and have to educate on everything.

If we have a patient who's ready for treatment when they need it, is someone who's aware of their transplant options. And someone who is involved in their care, they do a lot better over the long run. And that's my goal for my patients.

Martha Wofford (14:46): Yeah. That's so well-said. Love it.

All right. Well with that, why don't wrap up? And I just want to thank our listeners for tuning in and be sure to check out other DaVita Medical Insights Podcasts. And you can also find additional kidney care thought leadership in industry news by following @DaVitaDoc on Twitter. So thank you so much Dr. Lowentritt. Really appreciate, it was a pleasure to talk to.

Dr. Lowentritt (15:11): Thanks Martha. I've really appreciated it. Thank you.