ASN president outlines challenges, goals for 2021
Editor’s Note: Nephrology News & Issues recently interviewed Susan E. Quaggin, MD, FRCP(C), FASN, president of the American Society of Nephrology, about important issues her organization faces this year.
Currently the Charles Horace Mayo Professor of Medicine at Northwestern University in Chicago, Quaggin is chief of nephrology/hypertension and director of the Feinberg Cardiovascular and Renal Research Institute.
Nephrology News & Issues: You are leading 21,000 kidney professionals and representing their views when ASN takes position on policy and strategy, such as on workforce issues, COVID-19, health care disparities and research. Is it difficult to build a unified voice for nephrologists from diverse environments and varied patient populations?
Susan E. Quaggin, MD, FRCP(C), FASN: All kidney professionals and kidney organizations share a common goal, which is to provide the best possible care for patients and ultimately, cure kidney diseases.
But meeting that goal requires diverse voices. ASN builds the strongest approach by seeking input from members of the entire care team, patients and policymakers, and by incorporating different perspectives, practice challenges and regional differences.
So, I do not believe we need to create a single voice; we need a variety of voices and perspectives to solve complex challenges and meet that common goal.
One of the most complex challenges that nephrology, and health care generally, face involves social justice. If we are to achieve kidney health equity and equal access to best treatment for all patients (eg, access to kidney transplant and new powerful medications like SGLT2 inhibitors), then we must make the strongest possible effort to engage all those who can help address these challenges – critics and supporters alike.
Nephrology News & Issues: With COVID-19 vaccines now available, there are still caregivers in the kidney community, and in other specialties as well, who are first in line to receive the vaccine but are reluctant to take it. Do you think this is negatively impacting patients’ attitudes about taking the vaccine?
Quaggin: I have been taking care of patients with COVID-19 since March 2020, and development of these vaccines represents an incredible achievement and an opportunity to end this pandemic. The safety data outweigh the small risk for most people, and ASN encourages all patients to consult their physicians regarding the benefits of this vaccine.
Nephrology News & Issues: Both the Advancing American Kidney Health initiative and the new ESRD Treatment Choices model, which started in January, focus on increasing the number of patients on home dialysis. Are you in agreement with this approach, and is ASN working on projects to stimulate interest?
Quaggin: ASN strongly supports federal policies to advance American kidney health. ASN and other members of the kidney community have worked tirelessly for years on these policy priorities, and the federal government is finally committed to raising awareness, slowing progression, improving current treatment options, increasing access to transplants and promoting research, discovery and innovation.
In terms of improving treatment options, I trained in Canada, where many aspects of home dialysis were pioneered. It is used frequently there, and I saw the benefits for patients.
ASN has launched an initiative to expand home dialysis education, training and advocacy. We have received suggestions that include expanding training for fellows, improving education for patients, and aligning payment incentives for providers.
Nephrology News & Issues: One of (former ASN President) Anupam Agarwal’s messages during the presidential address at Kidney Week 2020 was about “reigniting” interest in nephrology and attracting more physicians to this specialty. What do you see as the role of ASN in bringing more students into nephrology?
Quaggin: This is an incredibly exciting time in nephrology, and it is up to us to make sure students and residents see the profound differences they can make in people’s lives as nephrologists.
When students have first-hand exposure to nephrology, they see the incredible breadth and scope of what nephrologists do, from diagnosing and curing rare conditions and building lasting patient relationships over years, to lifesaving procedures in emergency situations, such as during COVID-19. I know they will want to join the ranks of the best physicians in medicine.
It is also important to remember the subspecialty of nephrology was built on innovation. The impact of renal replacement therapy and obtaining Medicare coverage for this lifesaving treatment cannot be overstated and underscores the unique combination of passion, science and innovation that defines our field.
The subspecialty is now poised to take another major leap forward in our field. The acceleration of research discoveries in the past 2 decades paired with newest cross-disciplinary technologies has already provided potent new treatments for our patients and has armed researchers with powerful tools to identify new targets and develop additional new therapies for kidney diseases.
I am convinced that recognition of an unparalleled opportunity to make a significant impact in the lives of more than 37 million Americans living with some form of kidney disease will capture the attention of the next generation of nephrology superstars.
This spring, ASN is launching a loan mitigation pilot program, focused on trainees underrepresented in medicine. This program will encourage the best and brightest to pursue nephrology, and I am thrilled to help ASN launch such a groundbreaking initiative.
Many aspects that form the foundation of excellent medical practice in internal medicine have basis in nephrology; personally, I feel medical students and residents need more exposure to kidney medicine and nephrology should be a mandatory experience in residency training for board certification in internal medicine.
Nephrology News & Issues: You have said one of the most promising advances are the new classes of drugs, such as SGLT2 inhibitors, that potently protect the kidneys in patients with diabetes and/or chronic kidney disease. The new HIF-PH inhibitors are also showing promise to go beyond just treating anemia. Do you see a future where more drugs in the cardiology-nephrology-endocrinology area address multiple medical problems?
Quaggin: Since my time in this subspecialty, our knowledge of genes and pathways that cause kidney diseases and regulate healthy kidney physiology has grown exponentially and these “new targets” are now making it to drug development and into the clinic.
As nephrologists, we are particularly excited about a kidney-targeted therapy (the SGLT2 inhibitors) helping out the heart and improving metabolic consequences of diabetes.
It is also impossible to overstate the incredible results of several recent clinical trials showing the kidney protective effects of the SGLT2 inhibitors in patients with and without diabetes. In fact, these therapies received breakthrough status at the FDA, which is rare.
Nephrology News & Issues: Do you have some thoughts on how to increase the supply of kidneys for transplant to meet demand?
Quaggin: A transplant is truly a “gift of life.” A former colleague of mine once said, “there are two ‘joyful reasons’ to be admitted to a hospital – for delivery of a baby or to receive a transplant.”
A number of initiatives are ongoing to shorten the wait list, which includes improving referral of all eligible patients for transplant assessment, promoting living related donorship and improving organ procurement. To this end, CMS has recently announced changes to organ procurement organizations that should increase the number of kidneys for transplant and the Consolidated Appropriations Act that was passed by Congress and signed by former President Trump toward the end of 2020 included lifetime immunosuppressive drug coverage.
Perhaps, most exciting, is the possibility of artificial kidneys that are now a reality and on the horizon. KidneyX is a private-public partnership between ASN and HHS that is currently funding a kidney prize offering $10 million to accelerate the development of artificial kidneys which may be bioengineered, chimeric or approaches not yet conceived – toward human clinical trials.
Nephrology News & Issues: Tell us how you and ASN will address kidney health disparities.
Quaggin: This is an area I am passionate about – having moved from a country where there is better access to health care for everyone than exists in the United States. ASN has a number of initiatives to address disparities. For example, the new ASN Health Care Justice Committee, chaired by O.N. Ray Bignall II, MD, FASN, will lead the society’s efforts to identify and eliminate health disparities and inequities.
Nephrology News & Issues: You have a strong personal interest in genome editing techniques and proteomic approaches to develop new treatments for kidney and vascular diseases.
Will this impact how we detect kidney disease and manage it more effectively in early stages?
Quaggin: Kidney medicine is evolving at a rapid pace and genome editing has become a reality in some complex diseases, such as muscular dystrophy. I know this will become reality in the future of nephrology as well.
I feel incredibly lucky and privileged to lead ASN during this time of revolutionary change in kidney medicine. One way to join this exciting revolution is check out #850challenge on twitter.