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Physician Spotlight

From Print Issue - Summer 2023
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Q: What does big data mean to you?

Nephrology is a data-driven specialty. The basis of our diagnosis for kidney issues is based on data. Data defines our clinical approach to that patient because either you have it, or you don’t. You either have chronic kidney disease or you don’t.

Q: You’re saying nephrology leans heavily on quantitative data?

Yes, as opposed to qualitative data. A cardiolo­gist’s patient could have chest pain coming from either the heart or from a musculoskeletal origin, whereas we do a blood test and discover variation in that patient’s grating. And then we conclude that there is chronic kidney disease or acute kidney disease. We could potentially come to a diagnosis even before we walk into the patient’s room. Having data presented in a format that we can use gives us a good idea of what conversation we’re going to have with the patient.

"Having Data presented in a format that we can use gives us a good idea of what conversation we're going to have with the patient."

Q: How often and what data is needed to monitor patients with kidney disease?

That would depend upon the stage of the chronic kidney disease, which has five stages. For stage 1, we’d want to see the patient and get the data maybe once or twice a year. For stage two to three, maybe every six months or so, and then stage 4 is every quarter. Stage five is every month and then once you’re on dialysis, it’s either once or twice a month. Once we get the data, we compare it to the trends. There are calculations to establish if that individual is going to progress downward towards worsening CKD, perhaps requiring dialysis or a kidney transplant. Data helps us to forecast, and risk stratify. They help us to see whether co-morbidities are causing or influencing a chronic disease like diabetes. One very important point is how we educate patients and empower them to understand what the data means in their continuum of disease progres­sion. Then, we discuss what interventions we can collectively put in place that will influence the disease progression.

Q: Do you find that most patients can easily understand it?

That’s up to us and how we break it down for them. Certain patients get it right away, like people who are tracking other parameters of health like steps, heart rate, blood pressure. We’re accountable to get them up to speed on recognizing that data is very important, especially relating to kidney disease.

Q: What impacts have you seen so far?

We just started last year. The challenges were getting the right data for the right population and, in this instance, the data was given to us by the CMS demonstration project called Kidney Care Choices or KCC, which takes in the patients who are at risk for CKD-4 and CKD-5 and are dialysis patients. We had some challenges identifying members, getting to those members, getting them to understand what this means for them, and why we’re doing these interventions. But towards the end of the year, we saw significant improvement in other metrics of how we measure one kidney care cohort versus another.

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