NephTalk

Vida Goudarzi is an Expert Nephrology Dietician at Satellite Healthcare and her world has been upended by Covid-19, but her mission and that of her team remains the same: Keep it personal, stay engaged and insure that their patients live the best life possible.

CS: "Let's Stop Playing the Race Card in eGFR Reporting.” That's the provocative title of your article in the Clinical Journal of the American Society of Nephrology, and it certainly got our attention. Are you surprised?

VG: Pleasantly, no, not surprised. I was hoping for that.

CS: First, Dr. Grubbs, what is eGFR, and how does it relate to patients, especially Black patients, who could be diagnosed with declining kidney function?

VG: eGFR stands for Estimated Glomerular Filtration Rate, and that's all fancy medical language that simply means how well are your kidneys filtering your blood. We have an equation that uses a simple blood test, the creatinine, to factor into this equation and, and help us figure out how well the kidneys are filtering. 


CS: Why are you concerned, especially in the area of achieving an accurate unbiased patient diagnosis, that the current criteria for GFR testing is deeply flawed without a scientific basis and may even be racist? What are the consequences?

VG: I definitely think so because, when the equation was developed, the researchers were considering all the things that they thought might affect how the kidneys filter this creatinine, which is produced at a pretty steady rate in our bodies every day, and it comes primarily from muscle cells, like waste from our muscle cells. In determining what things might affect creatinine, they thought about, okay, a person's gender because men tend to have higher muscle mass than women and age because younger people tend to have higher muscle mass than older people. And race, this is where they made the big leap that Black people have higher muscle mass than white people.

Hello, I’m Christopher Springmann, and for patient Nieltje Gedney, her personal chronic kidney disease journey has been challenging, as she tells this month’s NephTalk about how she finally discovered and enthusiastically embraced home hemodialysis.

And I would have chosen to die, except that I was taking care of my mother, and the second was the fact that the nephrologist in the hospital who saw me on an emergency basis told me about home dialysis. And in all the years that I had been struggling against CKD, kidney disease, no one ever mentioned that option. Those two things really saved my life.

Nieltje’s experience compelled her to become an outspoken patient advocate for Home Dialyzors United - and she is ferociously independent.

Well, that is true. I dialyze to live. I don't live to dialyze. I have made it a point to live my life as normally as possible. I call it my “oil change.” The few times a week that I do my dialysis treatment, is when I relax. I kind of go into my zone. I totally chill out. And I am

revitalized.

Please click on the NephTalk link below, listen and watch, and share the program with colleagues, family and friends. Thanks for listening.

Debra Elmore: The sooner that they join when they find out that they have decreased kidney function, the better. Most of the people that come to our support group tend to be either they just found out that they have some sort of kidney problem, and they want to learn about dialysis and transplant.

Christopher Springmann: That’s Debra Elmore, Executive Director of the San Francisco Bay Area Association of Kidney Patients, a support group reaching over 1100 patients, family members and nephrologists. Debra is joined by Phillip Wyche, President of the BAAKP.

CS: You both have had exhaustive journeys with CKD, chronic kidney disease, and you both have had kidney transplants. You could have left the past behind, but you're looking forward with the Bay Area Association of Kidney Patients or BAAKP. What work do you need to do?

Phil Wyche: Well, there's our organization, we try to promote self-awareness, self-preservation, and continue the fight. When I first found out I was having kidney issues and kidney failure, I joined this organization to get educated, and the more I got educated and it helped me to receive my kidney, after an eight-year struggle. I remained on the board and to help educate those that come to our support group.

This is NephTalk. I’m Christopher Springmann and let’s get cooking!

Hi, I'm Dr. Shusterman, The Cooking Doc. Now, you're heard me say, "Change Your Buds" in my videos, but what does Change Your Buds actually mean? It means learning to change your taste buds so they actually enjoy healthy food. But this doesn't happen quickly. It takes time.

You have to teach your taste buds to like healthier things; whole grains, vegetables, fruit. And that's what The Cooking Doc is all about. It's about teaching you to make those things actually taste good. And once you make these changes, you won't have to fight as hard against your cravings for unhealthy foods. Your cravings will actually go away over time.

VO: This is an encore presentation of NephTalk from Satellite Healthcare.

CS: You’re suggesting that people become depressed, discouraged, and sedentary, not necessarily in that order? Am I exaggerating here?

SA: Once they start dialysis? No, you’re not exaggerating. We know that 50 percent of patients on dialysis can barely walk a block.

CS: Really?

SA: Yes. And so, if we can catch them before they have to go through that insult, we’re really hoping that we can keep them in a positive cycle, where they have more self-efficacy. They have more confidence in their physical and mental capacity.

(CS ) That’s Dr. Shuchi Anand, MD, who received a Satellite Healthcare research grant, inspired by provocative questions, like: What would happen if we, as nephrologists, intervened early in the patient’s chronic kidney disease journey before they started dialysis, by prescribing an exercise program? Would that better prepare patients for the physical, social and emotional challenges of the dialysis experience and ultimately make them healthier candidates for a transplant?

Dr. Anand, will be joined by several of her investigators, including fellow Stanford Medicine nephrologist Dr. Susan Ziolkowski, MD; and co-principal investigator Dr. Felipe Lobelo, MD, a medical epidemiologist at Emory University in Atlanta, Georgia, who’s also working with a diverse groups of patients, including a significant African-American population.

Dr. Tara Chang, MD, is a nephrologist and a Satellite Healthcare research grant recipient who possesses three qualities I really admire: Curiosity, asking the big “why not?” questions; creativity, the kind you apply to problem solving; plus she’s known as a great collaborator and an inspiring partner.

Dr. Chang is an Assistant Professor of Medicine at the Stanford University Medical Center in Palo Alto, California.

"I have this person whom I love very much, and he needs a healthy kidney, and I have two of them. So of course I'll give him one."

How would you define an act of love? What about donating a kidney to a person you deeply care about, one who is a dialysis patient? I believe this is one of the great acts of human kindness, one that brings empathy to a whole new level. Our guest today, Dr. Vanessa Grubbs, MD, a nephrologist, gave her heart and a kidney to her boyfriend, Robert, who is now her husband. It’s all documented in her very candid book, Hundreds of Interlaced Fingers, which is a love story, yes, but one with very useful information about kidneys and kidney disease, too.

Debra Elmore: The sooner that they join when they find out that they have decreased kidney function, the better. Most of the people that come to our support group tend to be either they just found out that they have some sort of kidney problem, and they want to learn about dialysis and transplant.

Christopher Springmann: That’s Debra Elmore, Executive Director of the San Francisco Bay Area Association of Kidney Patients, a support group reaching over 1100 patients, family members and nephrologists. Debra is joined by Phillip Wyche, President of the BAAKP.

“Doing Well By Doing Good” is a recurring theme for this month’s NephTalk guest, Dr. Graham Abra, MD, as he discusses the Executive Order on Advancing American Kidney Health, especially the key roles played by Nephrologists.