Plenary Sessions

I must confess at previous Kidney Weeks I have not been fastidious about making it to the plenary sessions.

This Kidney Week was different I made it to each plenary session and was richly rewarded with some the most fascinating and future looking lectures on nephrology. The education committee did an excellent job choosing the speakers.

On Thursday Dr. Bruce Molitoris, President of the ASN, called the meeting to session with a rousing discussion of a need to reinvigorate the field.

He started off discussing the workforce issue in nephrology. People are no longer interested in becoming nephrologists. We are in danger of losing the next generation of nephrologists. Molitoris talked about nephrology’s long standing dependence on foreign medical grads to fill our fellowships. He said this life-line is coming to an end and he foresees more spots than applicants in this year’s match. He talked about the lack of research and medical advancement as root causes for the lack of interest. He warned that intensivists, hospitlaists, and anesthesiologists are increasingly being consulted on electrolyte problems and acid-base disorders narrowing our scope of practice. Outside of the hospital, CKD care is being absorbed by diabetologists and primary care.

He then discussed some of the things the ASN is doing to reverse this decline. He identified Dr. Mark Parker’s workforce committee and the KidneyTREKS and KidneyMAPS initiatives designed to attract medical students and residents to the specialty. This year travel grants were provided for 43 medical students and 117 residents. The most ever.

Depressingly, he noted that the decline in nephrology interest is a world wide issue and cited data showing a similar trend in Australia.

He then mapped out an action plan to save nephrology. The future of nephrology depends on four pillars: Awareness, innovation, partnership and measurement.

Awareness

Molitoris pointed the blame at nephrology itself for becoming too enamored with renal replacement therapy at the expense of all the other aspects of nephrology. We have ignored other innovations and they have been claimed by other specialties. An exasperated Molitoris asked how did we let the cardiologists take renal sympathetic nerve ablation? By narrowing our focus only on the tip of the CKD iceberg (ESRD) we are limiting the scope of practice to the point that we are creating a surplus of nephrologists in some cities. Some graduating fellows are forced to become hospitalists.

We are so focused on the highly visible ESRD burden that we are blinded to the much larger and intervenable problem of early stage CKD. If we want to stop this epidemic we need to look up stream. He then blasted the ACP for working against that goal by calling for the abandonment of CKD screening in patients without risk factors or symptoms. (http://www.medscape.com/viewarticle/812899)

Innovation:

Molitoris wanted innovation in nephrology, he wants us to dream big. He invoked Martin Luther King Jr’s image with the quotation “Innovation has no peer.” and then challenged us to make the three D’s obsolete: doubling of serum creatinine, dialysis, and death. Making death obsolete seems like a big ask. He blasted the NIH for spending $567 on research per cancer patient but only $28 per CKD patient. He wants the government to add $150 million dollars a year for kidney disease research.

Partnership:

He discussed the first year of the Kidney Health Initiative that partners providers, FDA and industry to advance nephrology.

Dr. Molitoris did an excellent job. Overall it was a wonderful and inspiring speech.

Post written by Dr. Joel Topf, eAJKD Advisory Board member.

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