LAS: How does one discover whether or not he or she has chronic kidney disease?
DVA: When you talk about chronic kidney disease, there are 5 stages. What chronic means is that I’ve measured your creatinine 2-3 times over at least three months, and it’s remained stable. Two to three times of a GFR measurement over about 3 months; if it’s stable, that’s “chronic.”
LAS: Due to the anti-bias efforts of the task force led by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN), the algorithm used to calculate GFR has been adjusted so that now there is no separate calculation for Black people. What effects will this have?
DVA: The fact that it’s being removed is a good thing on one side–Black people don’t have access to transplants. What that calculation did is change when someone would be referred for transplant. [Overall], if our GFRs were calculated higher, that would mean we’d wait longer to get intervention.
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Now, there will be an expansion of those who are labeled with kidney disease because there’s no racial calculation that puts us out of certain kidney disease categories, but we don’t really have a great infrastructure to manage what we’ve got right now because people are waiting too late to get referred. And those who do have chronic kidney disease are not following it up enough to reverse things, so that’s where the infrastructure comes in.
If we don’t have a supply of nephrologists who are culturally relevant, then we’re going to have a problem, because the pool is going to expand. The operational landscape of those taking care of kidney patients needs to be broadened to include cultural relevance.
[We must start] recognizing that less than 4% of all kidney specialists are Black, and that’s a shortage. We already have a shortage of kidney specialists, in general. But then think about the fact that only 4% are Black, and the number of Blacks going to medical school is dwindling.
LAS: What are factors that make the greatest difference in determining whether or not a person with Stage 2, 3 or 4 CKD will wind up going on dialysis?
When we say someone has stage 1 or 2, even if we call it stage 2, the statistics tell us that there is an increased risk of further progression, so it needs to be followed.
So, seeing a nephrologist earlier has always been the clinical mantra. The problem is, it seemingly doesn’t make financial sense because people look at a quarterly result, rather than the result over five years, in terms of finances. Again, that’s something that, in building these companies, we’re trying to change.
That’s number one. Number 2 is parameters such as making sure someone’s blood pressure is absolutely controlled, making sure that they’re consuming a diet full of antioxidants. Increasing certain types of supplements help the antioxidant properties along to slow that overall progression of kidney disease. And the minute that I see a little bit of protein in the urine or change in their blood sugar, blood pressure, or cholesterol, I’m all over that [to] slow the progression of kidney disease.
There are rarer things that go with that, which we do in the nephrology office, but those are the keys that people can do for themselves. Once you realize that the GFR is down, it doesn’t mean it has to go fast. My goal is to have people with functioning kidneys live a normal lifespan with functioning kidneys.
While I do dialysis and transplant, and I’m an expert at that, those are treatments for failure. I would rather see someone not fail. But if you already have dialysis, you still need to have a wellness mindset.
LAS: Are you optimistic about the future of kidney care on a broad scale?
My optimism is great; otherwise, I wouldn’t have been entrepreneurial about it.
The reason is two-fold—because one of the things that we do is try to manage disease in a vacuum. Doctors didn’t like business, businesspeople didn’t understand the clinical, but now with managed care, we almost have to work together to do this.
What I don’t want to see is more and more people needing renal care, and the government starts cutting services because they’re so costly. If you put doctors, patients, and the doctor-patient relationship back in the driver’s seat, it absolutely can work. We can manage chronic disease very well in this country.
The problem with the kidney disease patient is that the physiology is totally different when you get to those late stages of kidney disease. Now that we have a better genetic understanding, particularly in the Black community, of what’s going on, there are now going to be drugs that are specific to stopping APO L1-mediated disease, which will be huge in the African American community.
So, we have to have people who push that science…and show the health plans that they can make money, show the doctors they can make more money, show the health system that it can save money, and show patients that they can live longer and better lives if they adhere to what we’ve created. The primary doctor for a dialysis patient needs to be the nephrologist, and that’s what K.Care IPA is about.
Patients seeking a Primary Care physician, or a Chronic Kidney Disease (CKD) consultation can contact Kidney Care Institute directly at 213-484-3929.
Dialysis patients interested in hearing more about K.CARE IPA can inquire at [email protected] or contact Kidney Care Institute at 213-484-3929.
