Taking on the Global Challenges of Nephrology

Kidney disease has become a condition of epidemic proportions throughout the world. Afflicted patients have high morbidity and mortality, and the costs of care to individuals, governments and society are staggering. I have had the fortune to see the discipline of nephrology grow from one where dialysis and transplantation were scarce, prior to 1972, to the present where the growing needs of aging populations are straining our ability to deliver high quality, cost-effective care. Over the next weeks, months and years, I hope that this blog will stimulate thought about how we can fulfill our mission as physicians, to always think of what is best for patients first, while being responsible stewards of the public trust and resources which enable us to carry out this mission.

The global nature of this challenge came sharply into focus to me on a recent trip to Singapore.  I went there to visit two large academic hospitals, Singapore General Hospital and National University Hospital, as well as to see some of the dialysis facilities in that country. I was struck by the highly sophisticated state of medical care in Singapore, the access to care for needy and wealthy citizens alike, and the insightful comments and questions after my presentations. I realized that I was guilty, as many of us are in the US, of having preconceptions that care was inferior elsewhere, despite statistics that would suggest the contrary. In fact, in Singapore, fewer than 10% of patients dialyze through a percutaneous catheter, and intermediate outcomes for anemia, dialysis adequacy, and so on are quite similar, if not better than ours.

The population in Singapore are aging and the prevalence of diabetes and hypertension are increasing.  The impact is already being seen in a renewed strain on the healthcare system, a rise in the appearance of CKD, and an increase in the incident ESRD rate. Older, sicker patients needing dialysis in a system with restrained resources. Sound familiar?

As author and NY Times foreign affairs columnist Thomas Friedman has pointed out in his bestselling book, “The World Is Flat,” our world is indeed becoming flat. For healthcare and its challenges this may be coming more slowly, but it is definitely happening. Re-energizing research into the causes and prevention of CKD/ESRD as well as accelerating current research to emulate the function of natural kidneys will become even more important as this global epidemic continues to unfold. The development of innovative, more cost-effective approaches to preventing and treating ESRD needs to occur so that not only the length, but the quality of life for these vulnerable patients can be enhanced.

“There is no substitute for face-to-face reporting and research,”
Thomas Friedman, author of The World Is Flat

I look forward to your comments, until next time.

Striving to bring quality to life,

Allen R. Nissenson, MD