Pulse
Commonly Good Care
Fairview doctors are working to make early diagnosis and better management of chronic kidney disease routine and dialysis rare.
By Carmen Peota
Five years ago, Marc Weber, M.D., a nephrologist with University of Minnesota Physicians (UMP), began to realize that doctors could do better at caring for patients with chronic kidney disease (CKD). Growing evidence was showing that better management of patients with both early and late-stage disease resulted in better outcomes.
So when his boss, UMP CEO Bobbi Daniels, M.D., also a nephrologist, pitched the idea of developing a systematic approach to managing patients with kidney failure, Weber was more than willing to take the lead. Since then, he’s been spearheading an effort to overhaul the way he and his colleagues care for patients with CKD. The effort involves InterMed Nephrology Group, an independent medical group, along with UMP nephrologists and primary care providers, all of whom work at Fairview Health Services’ clinics. “What makes this unusual is that we are trying to link multiple nephrology practices, multiple primary care clinics, within a huge care system,” Weber said last year in an article in the newsletter Nephrology Times.
Working with Angela Dhruvan, M.D., a primary care physician at Fairview Hiawatha Clinic, Weber developed guidelines around issues such as when patients should be referred to specialists and how to better manage complications of CKD. They then got the protocols embedded in Fairview’s electronic health record (EHR). Now, when a patient’s glomerular filtration rate is below 30, for example, the EHR prompts the doctor to refer that patient for evaluation by a nephrologist. In the past, he or she may have waited until the patient was close to needing dialysis, thus missing out on the chance for a pre-emptive kidney transplant, which, he says, is the best way to treat end-stage kidney disease.
The goal, Weber says, is to get patients on track for a transplant sooner. “Dialysis is the last resort in my mind.”
Minnesota’s Registries
In September of 2010, the Minneapolis Medical Research Foundation (MMRF) won a multimillion dollar contract from the federal government to maintain and analyze data on solid organ transplantation in the United States.
Through the new Scientific Registry of Transplant Recipients, researchers from the foundation will conduct analyses that will support the development of regional and national policies regarding distribution of organs including hearts, lungs, kidneys, livers, pancrata, and intestines. They also will evaluate the current policies of the national Organ Procurement and Transplant Network, patient outcomes and transplant center performance, and transplant-related costs.
The registry is part of the MMRF’s Chronic Disease Research Group, which also serves as the coordinating center for the North Central Donor Exchange Cooperative, a collaboration between kidney transplant centers in the Upper Midwest designed to match a donor and recipient who are incompatible with each other to another donor-recipient pair in a similar situation; and the United States Renal Data System, which collects, analyzes, and distributes data about end-stage renal disease in this country.
Damage Assessment
A Mayo Clinic study of kidney transplant recipients shows progressive damage to transplanted kidneys may be less severe and less common than previously reported.
The study involved 797 patients who received kidney transplants at Mayo between 1998 and 2004 and were followed for at least five years post transplantation. A subgroup of 296 patients had biopsies done one and five years following their transplant.
Eighty-seven percent of those patients had mild or no signs of scarring to the transplanted organ one year after transplantation, and 83 percent had similar results five years out.
Reports from the early 1990s showed that a majority of patients had progressive scarring that ultimately led to failure of the new kidney. The findings were published in the April 2011 issue of the American Journal of Transplantation.