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Physical Medicine and Rehabilitation

Kidney Disease Research and Treatment

Kidney Disease Research and Treatment

– One of the unique qualities
of Wake Forest Baptist, is the way in which we
fully integrate research and educational programs into our daily patient care activities. Ultimately, this is
actually to the benefit of our patients because
we can quickly bring discoveries from the laboratory
through clinical trials into improved patient care
literally on a daily basis. During this segment you’ll
learn a lot about how research is integrated into
patient care, for example, the discovery of how a
gene confers a higher risk of kidney failure in African Americans, and how our researchers
are hoping to leverage that discovery to actually lower the rate of renal failure in a very
vulnerable population. In addition, we have a
very large, academic based dialysis program, in fact
it’s the largest such program in America, we provide
kidney dialysis services at over 16 locations, that’s
a very important program, bringing patients into our medical center, then for transplantation,
but also for many clinical research studies, as well. I think you’ll be truly
amazed by the accomplishments of this great team of
faculty, staff, and others who contribute daily to the health of patients with kidney disease. Without question, one
of our most preeminent academic clinical programs is nephrology. It’s the combined excellence of research, education, and patient care
that typify this division and make it a model division
within the medical center. With me today is the division
chair, Dr. Barry Freedman, who leads one of the country’s leading research programs in
kidney disease, Barry, how did Wake Forest get so
preeminent in kidney disease? – Couple of things should
be stated at the outset, we maintain the largest,
academically owned and operated dialysis program in the United States. There’s more than 1,550 patients receiving end stage renal disease therapy in 16 dialysis programs in the region. We were one of the first
sections to outreach into the community and
we have nephrologists driving an hour in every
direction to see patients in their hometowns. – Right. – I have to tell you that
the things that we develop in the lab, the clinical
research that we do, has been brought to the
fore to try and help all the patients that we’re able to treat and interact with, I don’t view a mission as purely clinical, or purely research, or purely educational,
as you said, it’s that unique blend, and I
think that blend is what has brought us national attention. We have absolutely superb
clinical nephrologists giving us such a high
ranking, but every one of them has a research program
and clinical interests, and we’re able to bring that
right to the dialysis units. Our section maintains the
largest DNA sample collection for African Americans with
end stage renal disease, African Americans with type II diabetes, as well as European
Americans, we now have 17,000 DNA samples that have
been recruited through the section on nephrology
for widespread studies on kidney disease risk,
heart disease risk, brain disease, from high blood pressure and diabetes and bone disease. – So what does the future hold? What’s the next major research advance, and how do you visualize the care of kidney disease patients
20 years from now? – Well I have to say, one
of the most exciting parts of our research program
and highlights of my career has been working with
a couple of other teams in Harvard and at the
NIH to identify the APOL1 kidney failure gene,
well identifying the gene was a major breakthrough,
it taught us what was really causing kidney disease,
not necessarily just high blood pressure, but the
goal now is to find a cure, to be able to prevent kidney disease. We know this gene doesn’t act alone, there are environmental
triggers, viral infections certainly interact with this
gene, but we’ve just had a major breakthrough,
and I’m very optimistic that soon we’ll be able
to vaccinate people to prevent viral infections
or prevent other environmental exposures that can impact
how these genes work. I would like in the next 20 years for us to put a stop to
non-diabetic kidney failure in the African American
population, as well as other forms of kidney
disease in all people. – That’s a great vision, I bet you have a reasonable chance of hitting that. – [Dr. Freedman] Thanks Dr. McConnell. – Congratulations to you
and all your colleagues, and I know it takes a team,
but it’s also very clear to me who the orchestra director is, thanks for everything you do. – Thanks Dr. McConnell. – Today I have Dr. Don
Bowden, who’s the director of our diabetes research center. Don and his colleagues have provided amazing insight into the relationship between diabetes and kidney disease. But Don, not everyone
with diabetes develops kidney disease, could you give
us some insight into that? – That’s correct, in
fact, Barry Freedman and I have been working
together for over 20 years trying to understand the relationship of diabetes and kidney disease. We really don’t know at the most fundamental level what the difference is. It appears that long term exposure to high levels of glucose in your blood, which is really the
definition of diabetes, ultimately leads to
problems in the organs, in the vascular system,
especially small vessel disease which is where it ends up with kidneys, and damaging the kidneys,
everyone who has diabetes will not develop kidney
disease, and the goal of our research has been
to try to understand the genetics of what the
differences between people are, so it’s been a very powerful
interdisciplinary team of people with multiple
expertises working together to solve very complex
problems, that’s one thing I’d like to emphasize is,
having genes, and for these clinical diagnosis, such
as diabetic nephropathy, doesn’t mean there’s a
single gene that’s likely gonna be the change
whether you’re gonna be diabetic or non-diabetic, we
presume there’s a combination of genes that are contributing
and they’re interacting with your lifestyle and your environment to ultimately create risks, so, it’s a complicated problem, but attacking it from multiple levels gives us the best opportunity
to solve the problem. – We are very appreciative
of your leadership, and thanks to both you and your
team for everything you do. – Thank you. – As we all know, education and research is firmly embedded in our single
mission to improve health. Our overall kidney disease
program here is a great example of how research is embedded
in daily patient care to improve outcomes
and to prevent disease. I have with me today Dr. Amret Hawfield, who’s one of our leading
young investigators, could you tell us a little bit
about your research programs? – My main research
activity is being involved in the Sprint Study,
which as you probably know is an NIH funded, multi-center
randomized control trial. About 10,000 people are
expected to be enrolled nationwide, to date at
Wake Forest, we have 290 participants enrolled, we
have three clinical sites, together with Michael
Rocco, I run the nephrology clinical site where we have 87 patients, and what we do is we randomize patients to two different blood pressure targets. The patients all have
hypertension, and they are either treated to a treatment target of a systolic blood
pressure of less than 120, or less than 140, which is standard care, and we’re trying to reduce
cardiovascular events by using more intensive
blood pressure control. So it’s a great benefit to the patients. They are enrolled for four to six years, they receive free
medications for the study, which is wonderful for our community here, and what we learn from
the study will be helpful for future generations of doctors, and writing blood pressure guidelines, and how to manage these patients. Although I know as a
young assistant professor in nephrology, it’s very exciting to participate in research,
but you also have patient care obligations, how do you balance that? – Right, we have a very good
system here at Wake Forest which allows me to
participate in in-patient care about half of the year, and
the other half of the year that I’m not participating
in in-patient care, I have days assigned where
I work in the Sprint clinic and I meet with the study
coordinators once a week and other days where I have my own out-patient continuity clinic. – Well I wish you a
really amazing career here at Wake Forest, I know you’re destined to do great things, thank you. – Thank you. – Wake Forest is very fortunate
to have one of the country’s leading kidney transplant
programs, not just in terms of the tremendous volumes
of patients they transplant, but also in terms of the
quality of their outcomes, with me is Dr. Robert
Stratta, Professor of Surgery, who’s the director of
the transplant program. Tell us a little bit about
the nature of the program, and of our patients that are transplanted on a yearly basis, et cetera. – Currently there’s about
500,000 people on dialysis in the United States, and of
those 500,000, about 100,000 are on waiting lists for
kidney transplantation. In any given year in the
United States, we perform about 17,000 kidney transplants,
so only about one in five or one in six of the
waiting list actually gets transplanted in a given year,
so clearly it’s a numbers game and one of our biggest
challenges is improving access to the waiting
list for all of those dialysis patients and
then trying too get them transplanted in a timely fashion once they are on the waiting list, and we currently are
performing about 180 to 200 transplants per year, which
makes us the largest program in the state of North
Carolina, and arguably the largest program in the
southeastern United States. Like many of our marquee programs, I know your transplant center’s
heavily involved in research, can you tell us a little bit more about that aspect of your program? – Do a lot of clinical
research on, not only, of transplanting high risk
patients, for instance, the elderly patients,
we’ve transplanted more than 100 patients over age
70 with excellent outcomes, but also with expanding our
limits for acceptable donors. What we’ve been able to
show with our research is that we have excellent outcomes. – Dr. Stratta, you and your team make amazing contributions here
at the medical center, and we’re very grateful for
the great accomplishments of your team, and for the great care you provide our patients,
thank you very much. It should be obvious to
you what a great team of individuals we have working
at our Wake Forest Baptist kidney disease program, all the way from very basic research,
clinical trials, education, the integration of those functions into enhanced patient care,
our physicians and staff on a daily basis are
working on ways to improve the outcomes of dialysis,
developing new ways to actually treat and
prevent kidney disease, and to optimize the outcomes
of kidney transplantation, but I would say one of the
most interesting things that you heard in the last few minutes is the repeated use of the word team. Probably no finer example of
how a team of individuals, united around a single goal, in this case, to improve the outcome of
patients with kidney disease, allows us to accelerate
change and to be one of the leading institutions in America in this important area, thank you.

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