March is National Kidney Awareness Month, a time to highlight the importance of kidney disease. 37 million Americans have kidney disease, yet only about 10% of these individuals are aware of the diagnosis. Kidney disease may develop from a myriad of conditions, including hypertension, diabetes mellitus, vascular disease, nephrotoxic medications, autoimmune disorders, and genetic conditions. These disorders require the provision of expert, patient-centered care, strengthened by the Division’s participation in multi-specialty collaborative clinics. Dr. Jerry Hladik, chief of the division of nephrology, provides some highlights below.
Nephrologists at the Center of Multidisciplinary Care
Multi-specialty collaboration, possible within the framework of the Department’s state-of-the-art Eastowne clinic, is making a real impact on the care of patients with kidney disease and multi-system disease. One such endeavor is
the UNC Amyloidosis program, led by Dr. Sascha Tuchman and Dr. Samuel Rubenstein and their group of outstanding malignant hematologists.
The Amyloidosis Clinic is comprised of a team that includes malignant hematologists, cardiologists, neurologists, gastroenterologists, hepatologists, and nephrologists. Amyloidosis is a complex multisystem disease that often incurs heavy symptom burden. Organ dysfunction and symptoms may persist months to years after hematologic response. Optimal supportive care requires the collaboration of multiple specialists who must carefully orchestrate supportive measures until organ function improves. Patients who are able to get thorough the most severe phases of organ dysfunction and symptoms may ultimately experience improved quality of life, exemplified by a recent message from an individual who has enjoyed one year of remission.
“ I’m feeling remarkably well, I’m sleeping well, eating well, all systems appear to be working just fine. And… I’m walking close to a mile a day, riding the stationary bike for about an hour. I went lap swimming today for the first time in a year and a half, it was awesome!!!! Thank you soooo much for saving my life!!”
Multi-Specialty Clinics with Nephrology Participation
|Kidney Transplantation||Abdominal and Transplant Surgery, Pharmacy|
|Glomerular Disease and Vasculitis||Rheumatology, Dermatology|
|Amyloidosis||Hematology, Oncology, Cardiology, Neurology, Hepatology|
|Palliative Care||Palliative Care|
|Sickle Cell Disease||Hematology|
|Women’s Kidney Health/Maternal-Fetal||Maternal-Fetal Medicine|
|Interventional Nephrology||Interventional Radiology|
Developing the Next Generation of Kidney Researchers
The Division has worked closely with the UNC Kidney Center and Department of Medicine to recruit and develop outstanding physician scientists to advance the practice of nephrology. Herein, we highlight two such individuals.
Dr. Dhruti Chen, Assistant Professor, recently joined the Division after completing a research nephrology fellowship at UNC in 2020. In the clinic, she enjoys taking care of patients from across our state with complex underlying disease pathology, which informs and motivates her research mission. She loves working in the multidisciplinary Glomerular disease and Vasculitis clinic, where she derives great joy in learning from her patients and colleagues every day. Her research is focused on understanding the genetic impact on glomerular diseases (including ANCA disease, focal segmental glomerulosclerosis, and other autoimmune conditions) as well as defining immunological remission in a subset of vasculitis patients. She contributes to a national glomerular diseases research consortium (CureGN), where she leads a manuscript writing group for minimal change disease.
Dr. Evan Zeitler, Assistant Professor of Medicine, recently joined the Division in January of 2022. Dr. Zeitler is developing a translational program targeting obesity, a condition that affects over 40% of US adults and is associated with an increased risk of developing kidney disease. Dr. Zeitler’ s research aims to decipher the complex interactions between diet, obesity, metabolism and kidney function. During his research fellowship, he collaborated with Dr. John Poulton to develop a zebrafish model of diet-induced obesity, which recapitulates the kidney changes seen in patients with obesity. Using this model, calorie restriction was found to reverse the changes in the kidney caused by obesity. In the long-term, Dr. Zeitler hopes to use findings from this model to inform investigations in people affected by obesity and kidney disease ultimately to improve both the dietary advice we give them and the treatments they are offered.
Growth in Kidney Palliative Care
The Kidney Palliative Care Clinic (KPCC), launched in June 2020, is a collaborative effort between Palliative Care Medicine and Nephrology. The goal of this clinic is to improve the lives of patients with advanced kidney disease at high risk for progressing to kidney failure.
Heather Boykin, DNP, is the primary clinical provider for this clinic. She has over 10 years of experience caring for people with kidney disease. In that time, she learned a great deal about the specialized needs of kidney patients. Vowing to return to the field one day, she completed training in Palliative Care Medicine. Fulfilling her promise to her kidney patients, she eventually joined forces with Dr. Emily Chang from the Division of Nephrology to start the Kidney Palliative Care Clinic. Dr. Chang, who has always had a passion for Palliative Care, describes Palliative Care Medicine as an essential component excellent patient-centered care. With the support of leadership from both programs and clinical staff, Ms. Boykin and Dr. Chang have received over 50 referrals to date, have provided education for faculty, trainees, and staff, and continue to forge their mission to improve the lives of people with kidney disease.
Advancing Kidney Care and Health in North Carolina
Consistent with UNC Health’s mission to improve North Carolinians’ health in the 21st century, the Division is to expanding services to meet clinical needs underserved areas, particularly in Lee County. This is an area that was disproportionately affected by the COVID-19 pandemic, particularly during the early phases of the pandemic. The Division’s Sanford-based faculty, Akhil Hegde, MD, Roshni Radhakrishna, MD, and Saad Shariff, MD, Assistant Professors in the Division, were instrumental in keeping our vulnerable patients safe and well cared for during the pandemic. Since January 1, 2022, the group has provided care for a large cohort of individuals previously care for Dr. Ted Philips, who retired from practice this year after serving the community for over 30 years. The Division has recruited Lazarina Baez-Marinez, NP, and another outstanding nephrologist will soon join the Sanford team for the next academic year.
In January 2022, NC healthcare professionals and stakeholders met to discuss the high-level challenges in need of improvement to support children with ESKD. Dr. Keisha Gibson and Dr. Keia Sanderson led the meeting. The goals were to educate and collaborate with programs and caregivers caring for children with ESKD to identify key issues to target. The group identified issues with access to dialysis facilities and transportation, proper nutrition, mental health and psychosocial support, and systems reimbursement. Next steps are to formalize a small working group that will eventually expand to an NKF/NC Pediatric Kidney Disease Collaborative to tackle systemic issues requiring advanced partnerships and efforts between major NC agencies including CMS, Medicaid/Medicare, insurance agencies, large dialysis organizations, and clinical care facilities. Pediatric Nephrology will soon be launching services in Wilmington.
Finally, the Division is expanding operations to help support Geriatric Medicine, Family Medicine, Hospital Medicine, and Physical Medicine and Rehabilitation services at the UNC Hillsborough Hospital campus. Consultative care will begin in July 2022.
Bringing Research to the Patient: The UNC Interventional Nephrology Program
Kawan Swain, MD, Akhil Hegde, MD, and Josh Sadolf, MD, Assistant Professors in the Division, provide prompt interventional care for patients undergoing dialysis at Carolina Vascular Access along with colleagues from UNC Interventional Radiology and North Carolina Nephrology. Under the leadership of Prabir Roy-Chaudhury, MD, PhD, Professor of Medicine, an internationally renowned investigator in vascular biology and interventional nephrology at the UNC Kidney Center, the team recently enrolled the 100th patient in the Merit Medical WRAPSODYTM AV Access Efficacy Study (WAVE), an endovascular stent for the treatment of dialysis access stenosis or occlusion. In addition, the team is has launched innovative clinical and research program offering endovascular fistula creation, a minimally invasive alternative to surgical dialysis access creation.