DaVita Medical Insights

Listen to this podcast, in which Sara Colman, RD, CDE, the manager of Kidney Care Nutrition for DaVita interviews Natalie Sexton, MS, RDN, CSR, LD, a dietitian for DaVita in Longview, Texas, on the importance of clinicians emphasizing moderation rather than elimination in a kidney-friendly diet. Natalie and Sara discuss the typical diets for end stage kidney disease patients on dialysis, including the different modalities of peritoneal dialysis, home hemodialysis and in-center dialysis. They examine how the kidney diet compares to some of the generally popular diets, what some of the biggest misconceptions are about kidney friendly diets, what some of the common barriers are that prevent diet adherence, how nutrition can affect quality of life, what overall goals dietitians have for their patients, how clinicians can advise patients to incorporate some of their favorite foods, even those that are not kidney friendly, in their diets and how to use the recipes on davita.com in meal planning and other nutrition resources available to patients and clinicians.

Podcast Transcript:

 

Sarah Colman, RD, CDE (00:43): Hello, and welcome to the DaVita Medical Insights Podcast. My name is Sarah Colman, RD, CDE and I'm the davita.com nutrition manager for DaVita kidney care. Over the past decade, we've seen a shift from a strict mineral based kidney diet to one that includes more healthy whole foods and even questioning the benefits of the old kidney diet. Today's can they diet continues to evolve with even more research. I'm excited to join on the phone today by Natalie Sexton, MS, RDN, CSR, LD, a dietician for DaVita in Longview, Texas, as we discuss the importance of clinicians emphasizing moderation rather than elimination and kidney friendly diet. Thank you for joining us, Natalie.

Natalie Sexton, MS, RDN, CSR, LD (01:28): Hi, Sarah. Thank you for having me today. I'm very excited to be here and to be able to speak on such an important topic.

Sarah Colman, RD, CDE (01:36): Great. Well, let's get started. Can you tell me about the typical diets for end-stage kidney disease patients on dialysis, including modalities such as peritoneal dialysis, home hemodialysis and in-center dialysis?

Natalie Sexton, MS, RDN, CSR, LD (01:52): Yes, I do have a little disclaimer first. The diet guidelines that I'm talking about today are focused on patients who have what we call end-stage kidney disease. So they are on some form of dialysis. Nutrition recommendations are very different for people with chronic kidney disease, stage one through four or those trying to preserve remaining kidney function. So just to be clear, these diet guidelines we're going to talk about are focused on patients who are receiving dialysis treatment. So the most basic diet guidelines,

Receiving the influenza vaccine has always been important for patients with kidney disease, but the COVID-19 pandemic makes influenza vaccinations even more crucial now. Listen to this podcast, in which Mandy Tilton, DNP, MSN, MBA, RN, CNN, chief nursing officer for DaVita Kidney Care interviews Jeffrey Giullian, MD MBA, FASN, chief medical officer for DaVita on why influenza vaccination is so crucial and whom he recommends be vaccinated during the pandemic. Dr. Giullian and Mandy also dispel some myths about the flu vaccine, state which form of the vaccine is most effective, discuss the benefits and safety concerns of getting vaccinated during spikes of COVID-19 prevalence in patients’ communities and provide guidance for clinicians in speaking with patients about influenza vaccination.

Podcast Transcript:

Mandy Tilton, DNP, MSN, RN (00:44): Hello and welcome to the DaVita Medical Insight Podcast. My name is Mandy Tilton and I have the honor of being the chief nursing officer for DaVita Kidney Care. I'm excited today to be joined on the phone with Dr. Jeffrey Guillian, who is our chief medical officer for DaVita, and today we will discuss the importance of influenza vaccination during the COVID-19 pandemic. Thank you for joining us, Dr. G.

Dr. Jeffrey Guillian (01:12): Hey Mandy, I'm glad to be able to speak with you on such an important and timely topic.

Mandy Tilton, DNP, MSN, RN (01:18): Timely it is. Receiving the influenza vaccine has always been important, but why does the COVID-19 pandemic make it even more crucial now?

Dr. Jeffrey Guillian (01:29): Well, Mandy, as I'm sure you can imagine, the flu season is going to be particularly complicated this year given the similarities in symptoms between influenza virus and COVID. And more than any other year, it's really important that all patients and teammates get vaccinated for the flu. Last season, unfortunately, less than half of all Americans got a flu vaccine and at least 410,000 people were hospitalized.

Dr. Jeffrey Guillian (01:54): And remember, that although we don't yet have a vaccine for COVID, we do have a vaccine for the flu. And by getting the flu vaccine, you are also helping to protect the people around you. And this is something known as herd immunity. If the majority of the population is vaccinated against the flu, it then reduces the entire community's risk, particularly for vulnerable patients. And preventing the flu supports good stewardship of resources.

According to Leslie Wong, MD, chief medical officer for the Nephrology Care Alliance (NCA) and practicing nephrologist at the Cleveland Clinic, during the pandemic, “…It's really incumbent upon us to stay united as health care providers. Remain positive, not just for each other, but for our patients, and make sure that we also help and celebrate when things go right.” Listen to this podcast, in which Sarah Carpenter interviews Dr. Wong on how COVID-19 has affected health care, in general, and kidney care, in particular. Dr. Wong discusses the impact of COVID-19 on clinician use of telehealth, the need to move care upstream to patients with chronic kidney disease (CKD), the adoption of value-based care models, the roles of patient education and predictive analytics in managing kidney care, and the communities of patients, families, caregivers, and nurses and other health care professionals. He also provides information on how NCA can help nephrologists address some of these challenges.

For more information on NCA, including the latest news coverage, physician resources and thought leadership content, please visit https://nephrologycarealliance.com/newsroom/ (https://nephrologycarealliance.com/newsroom/).

Podcast Transcript:

Sarah Carpenter (00:45): Hello, everyone. Welcome to the DaVita Medical Insights podcast. My name is Sarah Carpenter. I'm a teammate with Nephrology Care Alliance and I'm joined on the phone today with Dr. Leslie Wong, the Chief Medical officer for Nephrology Care Alliance. Hi, Leslie. Thanks for joining.

Dr. Leslie Wong (01:00): Yeah, absolutely. Sarah, happy to be here.

Sarah Carpenter (01:02): So I have a few questions for you. The first is, what has been your focus during the pandemic?

Dr. Leslie Wong (01:08): Yeah, so while I am a chief medical officer for Nephrology Care Alliance, I'm actually, still a practicing Nephrologist at Cleveland clinic, so I kind of have a few different roles there. So it's been a very busy time as a physician leader. And in terms of interacting and orchestrating with teammates at DaVita, but also seeing my own patients and seeing the challenges that they've gone through as well as my colleagues at the hospital.

Sarah Carpenter (01:42): Yeah. Thank you for sharing that there has been an emphasis on telehealth throughout COVID-19. How can clinicians better leverage telehealth to engage with patients?

Dr. Leslie Wong (

“I would just really encourage folks to get upstream and get your patients the information early in their disease state, so that they can be more involved in their care and make good decisions for themselves,” says Josh Lowentritt, MD, a New Orleans nephrologist in private practice. Listen to this podcast, in which Martha Wofford, group vice president of DaVita Kidney Care, interviews Dr. Lowentritt on the importance of patient education, and empowering chronic kidney disease (CKD) patients to make active choices in their care. Dr. Lowentritt discusses his professional background, his passion for CKD education, like Kidney Smart, the patient’s perspective, the need for a CKD educator, the significant conversations related to diet, advice for nephrologists in providing education and the impact of COVID-19 on giving patients support.

Podcast Transcript:

Martha Wofford (00:40): Hello and welcome to DaVita Medical Insights Podcast. My name is Martha Wofford and I am a group vice president at DaVita Kidney Care, and I am excited to be joined today by Dr. Josh Lowentritt, he's a nephrologist from New Orleans. And just thank you, Dr. Lowentritt or joining us to talk about the importance of education for patients with chronic kidney disease.

Dr. Lowentritt (01:03): Well, thanks.

Martha Wofford (01:06): Yeah, thanks for being here.

Dr. Lowentritt (01:07): Yes.

Martha Wofford (01:07): First off, can you start by telling our listeners a little bit about your background and maybe why you're so passionate about CKD education?

Dr. Lowentritt (01:15): Sure. So first of all, call me Josh, and I'm delighted to be here today to chat. I did all my nephrology training here in New Orleans at Tulane and finished up 2001. And I've been in private practice since then. So I'm doing hospital work, office work, I go to dialysis clinics. I still see my post-transplant patients after they get released back to me. And also do quite a bit of medical director work and work in population health and value-based care, which helps fill out my day.

So, that CKD education, it's strange that it's such a novel idea. I was so lucky when I was in training. We actually had a dialysis CKD PD educator embedded in our clinic when I was a fellow.

“If self-care was important before the pandemic, it has become almost essential in everybody's life today,” says Usha Peri, MD, who is a DaVita medical council member and a SKY breath meditation instructor for the Art of Living Foundation. Listen to this podcast, in which Ryan Weir interviews Dr. Peri on self-care, with a focus on self-care for clinicians and during the pandemic. Dr. Peri discusses what burnout is and how to counteract it, what self-care means to her, how she became interested in the SKY breath meditation technique and why she became an instructor, and what tools she uses to help with her own self-care. During the podcast, she also demonstrates a couple breathing exercises that one can do in less than 5 minutes during a break in the day to unwind and reset before going back to work.

Podcast Transcript:

Ryan (00:40): Hello and welcome to the DaVita Medical Insights podcast. I'm your host Ryan. We're joined on the phone today by Dr. Usha Peri. Dr. Peri is on the medical council of DaVita and is a SKY breath meditation instructor for the Art of Living Foundation. Dr. Peri, how are you doing today?

Dr. Usha Peri (00:57 (https://www.rev.com/transcript-editor/Edit?token=dmIS-z3JwjDPaGfg5lFn6hEAb-cu7QuI_lfNQWa6n0IPi6DN5khw__HRYhXBXdIUVOD0cjQwFd4JhKNDjUlpPbEK-6k&loadFrom=DocumentDeeplink&ts=57.78)): Great. Thanks, Ryan.

Ryan (00:59 (https://www.rev.com/transcript-editor/Edit?token=5Evf7MpydCPc7jkGU4TFn_-AyCMd8ALD8C131w7yeYV8Kg1jR14y1TiPPMJMV0bA4WM4hJfjNSXdRTNuipDywJTsQLM&loadFrom=DocumentDeeplink&ts=59.32)): All right. Dr. Peri, we're talking about self-care today and as we all know, there's a pandemic going on. So can you talk about the timing of this topic and why self-care for clinicians is so relevant right now?

Dr. Usha Peri (01:11 (https://www.rev.com/transcript-editor/Edit?token=ZHj0pM3_JfX_Qx-uWbCe1OIV99xqZbNsD-Pjp6e6BekWvUAT8g40Pt1PSjV1EHYa131q_yekgc0MuPgMviaTakHciA8&loadFrom=DocumentDeeplink&ts=71.43)): Absolutely. Even before the pandemic physicians' burnout rates and health care professionals' burnout rates have been on the rise. Even though this word was coined back in the '70s, it has started becoming much more relevant recently with the rise of regulatory burden, as well as electronic health documentation burden that's being placed on the physician. Now, with the pandemic hitting, all of this has just gone exponentially high. Things are changing quite rapidly and they're asked to keep up with all the changes. As you know, regulations are changing, by the day, sometimes, and our telehealth visits, all of us had to transition to telehealth almost overnight. And the documentation rules around that keep changing as well. At the same time, our patients are also in this uncertain, anxious time. And so their demands on the health care professionals are higher and our ability to deal with the death and the grieving process, all of this is taking a huge toll on the health care professionals. If self-care was important before the pandemic, it has become almost essential in everybody's life today.

Ryan (02:42 (https://www.rev.com/transcript-editor/Edit?token=CzVbemhvQvwZefsiK1g2Bmg1VppI2Kv0rEI87IkqkWf9Yng2zPlp4TdwYWQ9yvNNGSb-dWmM_VtlSzA0TksEZbxJp0E&loadFrom=DocumentDeeplink&ts=162.4)): Yeah.

With the increased use of technology, such as telehealth and remote patient monitoring, during the COVID-19 pandemic and the overall shift to electronic health records and predictive analytics in health care in recent years, caring for patients from an individual, human perspective, rather than from a numbers or data perspective, is becoming more important. How can patient-centered care have an impact on patients who have chronic conditions like kidney failure? Dr. Francesca Tentori, vice president of DaVita’s Outcomes Research and Patient Empowerment team, discusses this with Ben Brown, senior manager of DaVita Clinical Enterprise team in Denver, CO, in this podcast. While this podcast was recorded before the COVID-19 pandemic was declared a national emergency in the United States, listen now to learn more about how integrated and coordinated care is delivered in DaVita centers.

Podcast Transcript:

Ben Brown (00:28): Hello and welcome to DaVita's Medical Insights podcast. My name is Ben Brown. I am a senior manager in DaVita's clinical enterprise team based in Denver, Colorado, and I'm excited to be joined on the phone today by Dr. Francesca Tentori, vice president of DaVita's outcomes research and patient empowerment team. Hi there, Francesca.

Dr. Tentori (00:49): Hi, Ben. It's good to be with you.

Ben Brown (00:51): Well, I'm excited to have you with us today to talk about patient-centered care. Can you talk a little bit about how you define patient-centered care and what that means to you and how do you see it come to life in our dialysis centers?

Dr. Tentori (01:04): Yes, definitely. So to start with, let me give you the definition that the Institute of Medicine has given us on what patient-centered care means. Obviously it's a term that we hear more and more. The official definition is providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide our clinical decision.

Dr. Tentori (01:35): And that's the part that is really exciting to me. So to me, patient-centered care means we provide care that aligns with each of our patient's needs, whether they're clinical or whether they are emotional. Obviously we're not always able to address all of their issues, but just awareness around what's important to each individual patient I think is a huge step. Obviously a challenging one, but I am very proud of the progress that is being made in this area, in medicine in general, and in dialysis in particular.

With the increased use of technology, such as telehealth and remote patient monitoring, during the COVID-19 pandemic and the overall shift to electronic health records and predictive analytics in health care in recent years, caring for patients from an individual, human perspective, rather than from a numbers or data perspective, is becoming more important. How can patient-centered care have an impact on patients who have chronic conditions like kidney failure? Dr. Francesca Tentori, vice president of DaVita’s Outcomes Research and Patient Empowerment team, discusses this with Ben Brown, senior manager of DaVita Clinical Enterprise team in Denver, CO, in this podcast. While this podcast was recorded before the COVID-19 pandemic was declared a national emergency in the United States, listen now to learn more about how integrated and coordinated care is delivered in DaVita centers.

Podcast Transcript:

Ben Brown (00:28): Hello and welcome to DaVita's Medical Insights podcast. My name is Ben Brown. I am a senior manager in DaVita's clinical enterprise team based in Denver, Colorado, and I'm excited to be joined on the phone today by Dr. Francesca Tentori, vice president of DaVita's outcomes research and patient empowerment team. Hi there, Francesca.

Dr. Tentori (00:49): Hi, Ben. It's good to be with you.

Ben Brown (00:51): Well, I'm excited to have you with us today to talk about patient-centered care. Can you talk a little bit about how you define patient-centered care and what that means to you and how do you see it come to life in our dialysis centers?

Dr. Tentori (01:04): Yes, definitely. So to start with, let me give you the definition that the Institute of Medicine has given us on what patient-centered care means. Obviously it's a term that we hear more and more. The official definition is providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide our clinical decision.

Dr. Tentori (01:35): And that's the part that is really exciting to me. So to me, patient-centered care means we provide care that aligns with each of our patient's needs, whether they're clinical or whether they are emotional. Obviously we're not always able to address all of their issues, but just awareness around what's important to each individual patient I think is a huge step. Obviously a challenging one, but I am very proud of the progress that is being made in this area, in medicine in general, and in dialysis in particular.

Innovations in nephrology are taking place as the importance of kidney health is emphasized globally. Listen to this podcast, to hear how kidney care is transforming around the world, with insights from clinicians who share a passion for innovation:...

Jeffrey Giullian, MD, is passionate about his new—as of Jan. 1, 2020—role as chief medical officer (CMO) for DaVita Kidney Care. Listen to this podcast, in which Halie Peddle interviews Dr. Giullian on his priorities and vision as CMO for DaVita. He gives us some personal background on why he pursued a career as a physician, specifically in the field of nephrology, and what originally brought him to DaVita. Dr. Giullian also discusses his views on kidney care-related innovation and how kidney care is leading all of health care in the shift from volume- to value-based care. Listen and read more DaVita Medical Insights here (https://blogs.davita.com/medical-insights/?utm_source=blubrry&utm_medium=social&utm_term=display_organic&utm_content=dmi_podcasthost&utm_campaign=davitapulse20).

Podcast Transcript:

Halie Peddle: 00:33 Hello, everyone. This is Halie Peddle with the DaVita Medical Insights Podcast. Today we're joined by Dr. Jeff Giullian, newly announced chief medical officer for DaVita Kidney Care. Dr. G., Thank you so much for joining us. This is our first opportunity to sit down with you since you started your new role. I'm excited for our listeners to get to know you even better and hear your thoughts on innovation in the field of nephrology.

Dr. Giullian: 00:57 Well, thanks Halie. I'm really excited to be here and share some of my passion for taking care of patients with kidney disease.

Halie Peddle: 01:03 Great. Well, let's dive right in. Lots to talk about today. I want to start off just a little bit more personal. Would love to hear what made you decide to pursue a career as a physician?

Dr. Giullian: 01:16 That's a good question. Believe it or not. Growing up I was going to be a lawyer. Don't tell any of our lawyer colleagues. They won't believe it. Freshman year in high school, I got a chance to shadow some lawyers. And I have to tell you, I realized that day, the law was not for me. I didn't really understand what they were doing, and it really didn't appeal to me.

Dr. Giullian: 01:36 And right after that I had some biology classes where we were actually doing anatomy and physiology, and somehow it just clicked. The timing was right. And finally I found something that I could really sort of sink my teeth into from a passion standpoint. And that was the human body, the physiology of the human body. And from that point on I was dedicated to becoming a physician.

Halie Peddle:

Successful use of predictive analytics gives us the ability to minimize unwanted future events and maximize future health without unnecessary expenditure of resources, according to Vice President and Medical Director of DaVita Health Economics and Outcomes Research, Steven Brunelli, MD. Listen to this podcast, in which Ryan Weir interviews Dr. Brunelli on predictive analytics. Dr. Brunelli discusses why predictive analytics are so important; what makes patients with kidney disease well-suited to predictive analytics; how to take a dataset and make it beneficial for patients, physicians and health plans; how an ideal CKD model is defined; how predictive analytics support value-based care arrangements; and finally, how predictive analytics might be used in health care in the future. Listen and read more DaVita Medical Insights here (https://blogs.davita.com/medical-insights/?utm_source=blubrry&utm_medium=social&utm_term=display_organic&utm_content=dmi_podcasthost&utm_campaign=davitapulse20).

Podcast Transcript:

Ryan Weir: 00:34 Hello everyone, and welcome to the DaVita Medical Insights Podcast. I'm your host Ryan Weir, and I'm part of DaVita's communications team. Today, we'll dig into predictive analytics with Dr. Steve Brunelli, Vice President for DaVita Clinical Research. Dr. Brunelli, thank you so much for joining us today.

Dr. Steve Brunelli: 00:49 Thanks for having me. It's a pleasure to be here and I'm excited to talk about predictive analytics, which is something that I think is going to be transformative in health care and in kidney care, in particular.

Ryan Weir: 01:00 That's great. Let's dive right in. In health care, everyone is talking about predictive analytics. Could you tell me why predictive analytics are so important and why now?

Dr. Steve Brunelli: 01:11 All right, I'll take that question in two parts. So the first part is: why predictive analytics? The answer is that predictive analytics let us get the right treatment to the right patient at the right time, and that's critically important. As our armamentarium of therapies grow, it's important to be able to target those therapies in efficient ways and in ways that will maximize the benefit to patients. Predictive analytics give us an increasing sophistication in how we deliver those services to patients.

Dr. Steve Brunelli: 01:48 To understand why now, I think it helps to kind of get a historic perspective. So predictive analytics did not spring full form from the head of Zeus. They didn't fall from the sky or come down on stone tablets. They're really an extension and an acceleration in the sophistication of a paradigm that we've used for many years. I liken it to the origins of rock and roll in the 1950s or hip hop in the 1980s. Those didn't derive de novo. They were extensions of prior musical traditions that suddenly accelerated and became exciting and new. That's what we're seeing in predictive analytics.

Dr. Steve Brunelli: 02:29 So what are the permissive conditions that allow for that? The first is we have, by historic standards, an unprecedented amount of data at our fingertips. As electronic health records have increased in their size and their scope, doctors used to scribble notes on index cards and stick them in a drawer in their office, and now everything is on databases in codified fields where people can easily find and index them. Those systems are becoming increasingly interconnected. We have the ability to connect not only various points in health care, doctor's notes, but also labs, observations of the payers like claims. So we have at our disposal now a level of information that didn't exist in prior eras.

Dr. Steve Brunelli: 03:24 At the same time, there's been an explosion of computing power. So the iPhone 5,