It can be a scary word: Dialysis.
It conjures up images and anxieties about hours each week spent hooked up to a buzzing, whirling machine, waiting as blood is taken from the body, cleared of toxins by the dialysis machine and then returned.
It’s the unfortunate prospect for more than 60 percent of Americans whose kidneys are failing. More than 37 million people in the United States suffer from a chronic kidney disease, with 800,000 of those patients considered to be in end-stage kidney failure. About 500,000 of the most severe patients end up on dialysis.
But kidney experts from Indiana University School of Medicine say they are working every day to change that.
For far too long, chronic kidney diseases have been treated with the same, one-size-fits-all approach. With quicker diagnoses and individualized interventions to slow disease progression, however, those living with chronic kidney diseases can avoid dialysis and have healthier, more fulfilling lives.
The Division of Nephrology in the Department of Medicine is at the forefront of a revolution in kidney care and research, said Division Director Sharon Moe, MD.
The division is comprised of a team of talented physician-scientists who take patients’ stories into research laboratories to discover treatments that will slow kidney disease progression and improve outcomes. These researchers combine analytical thinking with creativity, using precision medicine, pharmacogenomics and more to prevent illness and make advancements in patient care.
IU’s nephrology division is one of the largest in the country, providing clinical care at six major hospitals and treating around 25,000 patients annually. Its kidney transplant program is the largest in the state, performing nearly 300 transplants per year, and specializes in highly complex patients.
Its faculty members are active leaders in national organizations, such as the American Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and Kidney Precision Medicine Program, allowing them to collaborate with vast networks of fellow experts. The research efforts within the division often focus on the ways kidney disease intersects with other health problems, such as high blood pressure, diabetes and bone disorders.
Many people don’t understand the connection between the kidneys and other significant organs, such as the heart, said Kenneth Lim, MD, PhD, an associate professor of medicine. Lim studies the link between cardiovascular disease and chronic kidney disease. He likes to think of the heart and the kidneys as a married couple, he said.
“When one organ fails, the other organ is also affected,”
Kidney disease puts additional stress on the heart and can cause or worsen cardiovascular disease, which may be fatal. In his Cardiopulmonary Exercise Testing (CPET) laboratory, Lim uses state-of-the-art technology to conduct specialized exercise stress testing on patients enrolled in his clinical trials, measuring ventilatory gas exchange, cardiac output and more. The same equipment and technology are used on the International Space Station to understand how weightlessness affects the bodies of astronauts; used in his lab, the technology helps Lim better understand, and develop therapies for, cardiovascular complications in patients with kidney diseases.
Patients’ participation in clinical trials is essential to helping doctors understand the progression of disease and develop treatments, said Kausik Umanath, MD, MS,who serves as the nephrology division’s director of clinical trials and conducts his own research into the links between chronic kidney disease, hypertension and diabetic nephropathy.
When he talks with his own patients about volunteering to be participants in clinical trials, Umanath stresses the great impact they’ll have on the future of medicine. Often, the patient benefits from testing new drugs while joining in the legacy of scientific research. “The way we doctors learn to take care of patients better, is from the volunteers who participate,” he said. “They are helping themselves, but they are also helping care for humanity.”
Scientists like Michael Eadon, MD, take findings from these clinical trials to a molecular level.
Eadon combines clinical pharmacology, medical and molecular genetics, and nephrology to study the pharmacogenomics of kidney disease treatments. In his lab, he uncovers the molecular predictors of drug response using both genomics and transcriptomics — genomics being the study of the full human genome, or DNA, and transcriptomics being the study of RNA, which codes for proteins — to help ensure patients are using the best medications for their unique genetic makeup. Eadon's team is one of only a few in the country doing this type of research.
Eadon and his collaborators Pierre Dagher, MD, Tarek Ashkar, MD, along with their respective labs, are also members of the Kidney Precision Medicine Project, a consortium of researchers committed to identifying novel targeted kidney disease therapies by obtaining and analyzing biopsy tissue and developing software tools to visualize and share data.
Moe is incredibly proud of the important discoveries being made in her division every day. But she emphasized that public education about chronic kidney diseases is an equally important piece of the treatment puzzle.
Kidney diseases often progress quickly because symptoms — like high blood pressure, changes in urination and fatigue — go unnoticed or masquerade as the symptoms of other disorders, Moe said.
Luckily, testing is easy and inexpensive, often consisting of a simple blood test and urine screen to check protein levels. With this valuable insight into kidney function, doctors can intervene sooner, leading to better outcomes.
Moe encourages patients — especially those with a family history of chronic kidney disease or a personal history of high blood pressure, diabetes or heart disease — to monitor their kidneys by advocating for annual urine and blood tests.
