DocTalk Podcast: The State of Nephrology with Michael Spigler

There has been great progress in recent years in the field of nephrology with the advent of new treatment options.

For example, many investigators during the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., said that using SGLT2 inhibitors to treat chronic kidney disease could be a game changer in the field. The CREDENCE study also showed positive results in treating chronic kidney disease patients with diabetes who at a higher risk for a cardiovascular event.

During the meeting, Michael Spigler, vice president of Patient Services and Kidney Disease Education for the American Kidney Fund, explained to MD Magazine® what some of the major challenges are in the field and how the American Kidney Fund is working on improving patient outcomes in nephrology.

MD Mag: Hello and welcome to this special edition of the DocTalk podcast from the American Society of Nephrology’s annual meeting in Washington, D.C. Today, I'm joined by Michael Spigler of the American Kidney Fund to talk about the current state of nephrology in America. Mr. Spigler, if you wouldn't mind introducing yourself to our listeners and then we can dive into our discussion.

Spigler: Sure, my name is Mike Spigler. I'm the Vice President of patient services and kidney disease education and I'm with the American Kidney Fund.

MD Mag: My first question is, what do you think is preventing better patient outcomes in the field of nephrology?

Spigler: Inadequate diagnosis and early detection and early interventions in kidney disease patients. 37 million Americans with kidney disease, only 10% of them with advanced kidney disease even though they have it.

If we could find these patients earlier, and help deal with some of their comorbidities, maybe slow the progression of the kidney disease and also give them better choices for their options should they end up in kidney failure?

If they know that they're going to end up there they may choose a home modality they like home hemodialysis, peritoneal dialysis. They might be able to get a living donor transplant before they even have to start dialysis.

So, to us at the kidney fund, that is the main challenge that we have is finding these patients early enough.

MD Mag: Okay. How important is it in nephrology for doctors in different fields to work together and catch some of these diseases early?

Spigler: It's very important for specialists to work together but not only working together but really, really important is to work with the general practitioner. And actually, even the reverse of that, that general practitioner identifying to say, ‘you know what, this person has some signs of kidney disease, some comorbidities I'm having difficulty treating.

‘I've got to get them referred to an endocrinologist, just get them referred to a nephrologist, or cardiologist.’

That doesn't always happen. So that, to me is really an issue.

I’ll give you one example that I have in my own life. I'm the primary caregiver for my mother who has dementia, I went to her primary care doctor, and they're going through all the list of her blood test results and instead of creatinines little high not to worry and kind of moved on.

And luckily, I was in the room and said, ‘Whoa, time out you got the wrong guy in the room to kind of blow by that.’

And we stopped and talked about it and we made some changes to her medications. We got a different referral to a specialist, and we're able to keep her where she was in her kidney disease.

So, had we not by now, you know, four or five years later, she may have been on dialysis herself. So, it's really that GP, the general practitioner, family practitioner, making that referral to the specialist. I think it's actually even more important.

MD Mag: Is there any segment of the population, whether it is age, race, or sex that is overlooked or disproportionately harmed by some of these diseases?

Spigler: Yeah, so for chronic kidney disease, the people that are mostly harmed by it are minority populations. Primarily African Americans, who are the most at risk for kidney disease.

Hispanics, Latin Americans, Asian Americans, anyone over the age of 60 has higher risk for kidney disease as well, those with heart disease. All of those things play a role in it.

And just from a comorbidity standpoint, other disease state standpoint, those with diabetes and high blood pressure, a much higher risk for kidney failure as well, especially the diabetics. You look at a typical dialysis center, almost half of those in there are there because of diabetes, uncontrolled diabetes that have caused their kidney disease and kidney failure.

MD Mag: Ok, on a more positive note, what has you excited that some of the outcomes are going to start improving?

Spigler: Well, there's a lot of innovation in the space. So, I've been coming to kidney week, I guess this is my 10^th one now.

And starting last year, I think was the first time we really started to see some new innovation in the space, all the way from diagnostics to medication interventions, to the way in which we give dialysis the way in which we do transplant.

Last year was a really exciting year, this year is even better. The meetings that I've had with some of the innovators in the space, some of the pharma companies, some of the biotech firms, the diagnostic companies, genetic testing companies, all of them have really started to take an interest in kidney disease, because there's a huge unmet need that's there.

So, I think that is what is most exciting right now. You know, the new SGLT2 inhibitors that will hopefully help stop the progression of diabetic neuropathy for patients will go a long way towards that.

But I mean those drugs while they seem to be really kind of a miracle drug for these patients, I went to a talk where someone said that you know in 5-years from now not giving an SGLT2 inhibitor to someone with chronic kidney disease probably be viewed as malpractice.

I mean there it's really, really life changing, but you have to still give it to those patients early on in their kidney disease before they get deep down into their stage 4, stage 5 kidney disease. So again, back to what I think what I we've been saying it the kidney fund for so long, we've got to find these patients early.

MD Mag: Are there a lot of patients in the US currently waiting for transplants?

Spigler: So, you know, there's 100,000 people waiting for a kidney transplant, but we don't have 100,000 kidneys coming out, you know, available to people right now.

So that's why there's so many people on dialysis, part of the reason why. And there are some innovations coming out in that space.

There's some companies looking at how someone that may have particular characteristics about their body, their blood, that would prevent them from getting a good kidney match that are making some changes.

Now, there's lots of new innovation coming down the pike there, so that patients that you know, maybe have top the list and just sit there for a year after year because there is no available Can you for them, starting to have some hope now.

MD Mag: Are there enough people available for clinical trials to test all of the drugs currently in the pipeline?

Spigler: So, 1 of the challenges is getting patients in the clinical trials, especially those clinical trials that are working on chronic kidney disease.

So, the earlier stages of kidney disease, 96% of people in the earliest stages of kidney disease, have no idea that they have it, 10% or even advanced kidney disease know they have it.

You're taking already a difficult thing of getting someone into clinical trials, and then cutting the vast majority of them off because they don't even know they have it. Or they're going to a general practitioner that's not aware of a clinical trial and not getting them in or referring them.

And on top of all of that, because in kidney disease minorities are disproportionately affected and historically, minorities are underserved in clinical trials.

All of those things together, you've got a Venn diagram that shows no one getting in clinical trials, at least not enough of the right people in clinical trials. So, it is something we've taken on the American Kidney Fund to try to help educate patients about the faces of clinical trials. This can be a scary thing for people. So, we've worked really hard not only to do that, but to try to create materials that talk about the need for minority participation in clinical trials as well.

MD Mag: Is there anything you want to say?

Spigler: I think right now, there's a lot of great innovation in the space, but us as advocacy organizations, the professional organizations, we need the help from funding sources, including the federal government.

We need policymakers to help us get more funds into the space to do all this work. That's so desperate, we have the ability, now we have the innovation, we have the interest, we need the funding and people power to really make that happen.

So, 1 thing that we have the American Kidney Fund is Our Know Your kidneys program. We just launched it 2 days ago here.

So, it kind of goes in hand in hand with our screening program. We have the nation's largest screening program in the country.

So, we're in 25 cities, we're screening 13,000 people every year for early kidney disease, high blood pressure, diabetes, and we just launched this program called know your kidneys, which is this digital aspect of that program.

And it's really meant to say know, your kidneys know, life's possibilities. If you know that you have kidney disease early, he may know your grandkids, you may know that you can keep your job.

So, there's those kinds of things and we're really excited about the sponsorship of that program that we have by Jansen and we're really looking forward to continue to promote that program.

MD Mag: Thank you very much Mr. Spigler. For the latest from the American Society of Nephrology annual meeting check out mdmag.com. Thank you for listening.