WEBVTT NOTE language:en-US NOTE Confidence: 0.9729956984519958 00:00:08.160 --> 00:00:10.575 We don't really feel when the kidneys are not doing NOTE Confidence: 0.9729956984519958 00:00:10.623 --> 00:00:13.559 well until the kidneys are essentially not functioning at all. NOTE Confidence: 0.9571967124938965 00:00:15.560 --> 00:00:18.720 Many patients are unaware that they have chronic kidney disease. NOTE Confidence: 0.9585742950439453 00:00:20.200 --> 00:00:23.290 Up to 90% of individuals that have some variety of NOTE Confidence: 0.9585742950439453 00:00:23.352 --> 00:00:26.938 chronic kidney disease, either mild or severe, and are not NOTE Confidence: 0.9585742950439453 00:00:27.000 --> 00:00:27.680 even aware. NOTE Confidence: 0.9623745083808899 00:00:28.640 --> 00:00:32.255 Chronic kidney disease is a blanket term to describe when NOTE Confidence: 0.9623745083808899 00:00:32.319 --> 00:00:34.920 the kidneys are not functioning normally. NOTE Confidence: 0.9271422624588013 00:00:36.520 --> 00:00:39.661 It develops when the kidney is injured and that injury NOTE Confidence: 0.9271422624588013 00:00:39.719 --> 00:00:42.221 then heals into a scar and that part of the NOTE Confidence: 0.9271422624588013 00:00:42.279 --> 00:00:44.199 kidney is then no longer working. NOTE Confidence: 0.8266252875328064 00:00:45.760 --> 00:00:49.101 Chronic kidney disease and NSH kidney disease or kidney failure NOTE Confidence: 0.8266252875328064 00:00:49.154 --> 00:00:50.639 are really on this spectrum. NOTE Confidence: 0.9502360224723816 00:00:50.640 --> 00:00:53.543 And so we start with stage 1 chronic kidney disease NOTE Confidence: 0.9502360224723816 00:00:53.600 --> 00:00:56.560 where the kidney function is is very much preserved. NOTE Confidence: 0.9370427131652832 00:00:56.840 --> 00:01:00.177 And as we progress to stage 5 chronic kidney disease, NOTE Confidence: 0.9370427131652832 00:01:00.240 --> 00:01:03.704 the kidney function then falls below 15 and that number NOTE Confidence: 0.9370427131652832 00:01:03.767 --> 00:01:07.105 is essentially what we use to quantify how much blood NOTE Confidence: 0.9370427131652832 00:01:07.168 --> 00:01:08.680 the kidney is filtering. NOTE Confidence: 0.9382815361022949 00:01:08.680 --> 00:01:11.000 So as we fall below 15, that would be the NOTE Confidence: 0.9382815361022949 00:01:11.057 --> 00:01:13.999 time that we would refer somebody to start dialysis. NOTE Confidence: 0.8289107084274292 00:01:14.319 --> 00:01:16.327 That is when we would kind of label it as NOTE Confidence: 0.8289107084274292 00:01:16.376 --> 00:01:17.600 end stage kidney disease. NOTE Confidence: 0.926433801651001 00:01:19.880 --> 00:01:23.917 Chronic kidney disease is an incredibly unique disease compared to NOTE Confidence: 0.926433801651001 00:01:23.978 --> 00:01:27.159 other diseases of other organs because it is silent. NOTE Confidence: 0.9273127913475037 00:01:27.480 --> 00:01:30.012 And so we sometimes talk about high blood pressure as NOTE Confidence: 0.9273127913475037 00:01:30.060 --> 00:01:30.920 the silent killer. NOTE Confidence: 0.9485059976577759 00:01:31.080 --> 00:01:33.800 I think chronic kidney disease is really exactly the same. NOTE Confidence: 0.9711225032806396 00:01:34.000 --> 00:01:35.400 And so why is that? NOTE Confidence: 0.8678228259086609 00:01:35.400 --> 00:01:38.520 Our kidneys don't really feel pain unless there is a NOTE Confidence: 0.8678228259086609 00:01:38.580 --> 00:01:39.600 severe infection. NOTE Confidence: 0.9415143132209778 00:01:40.680 --> 00:01:44.046 I think as a nephrologist, what is most challenging is NOTE Confidence: 0.9415143132209778 00:01:44.108 --> 00:01:47.786 to communicate the gravity of chronic kidney disease and to NOTE Confidence: 0.9415143132209778 00:01:47.848 --> 00:01:51.463 really help patients understand how can this be so serious NOTE Confidence: 0.9415143132209778 00:01:51.526 --> 00:01:52.959 when they feel so well. NOTE Confidence: 0.921405553817749 00:01:53.440 --> 00:01:55.742 And we wish that, you know, the kidneys could tell NOTE Confidence: 0.921405553817749 00:01:55.788 --> 00:01:58.137 us that there was some injury starting or that, you NOTE Confidence: 0.921405553817749 00:01:58.183 --> 00:02:00.439 know, we could hear them screaming, but we can't. NOTE Confidence: 0.9505206942558289 00:02:02.000 --> 00:02:05.840 Chronic kidney disease is a major epidemic in our population. NOTE Confidence: 0.9384285807609558 00:02:06.320 --> 00:02:09.801 It still remains the 9th leading cause of mortality in NOTE Confidence: 0.9384285807609558 00:02:09.866 --> 00:02:10.640 our country. NOTE Confidence: 0.8800756335258484 00:02:11.600 --> 00:02:15.400 As individuals age, the risk of chronic kidney disease increases. NOTE Confidence: 0.9582640528678894 00:02:15.480 --> 00:02:19.081 Our kidneys, we know evolutionarily, are not built to last NOTE Confidence: 0.9582640528678894 00:02:19.143 --> 00:02:19.639 forever. NOTE Confidence: 0.9299505352973938 00:02:20.840 --> 00:02:25.451 Chronic kidney disease, unfortunately, does affect individuals who have diabetes NOTE Confidence: 0.9299505352973938 00:02:25.508 --> 00:02:29.428 and hypertension where they've struggled to take care of themselves, NOTE Confidence: 0.9299505352973938 00:02:29.486 --> 00:02:32.022 and it may be a lack of medical attention or NOTE Confidence: 0.9299505352973938 00:02:32.080 --> 00:02:34.040 lack of education in that process. NOTE Confidence: 0.9289741516113281 00:02:34.960 --> 00:02:40.508 Individuals often come from lower socioeconomic conditions with chronic kidney NOTE Confidence: 0.9289741516113281 00:02:40.579 --> 00:02:45.203 disease because of that inability to manage those chronic disease NOTE Confidence: 0.9289741516113281 00:02:45.274 --> 00:02:46.840 processes effectively. NOTE Confidence: 0.8964563012123108 00:02:47.760 --> 00:02:50.990 Unfortunately, we know that Black individuals are four times more NOTE Confidence: 0.8964563012123108 00:02:51.040 --> 00:02:53.724 likely to be affected by chronic kidney disease and NH NOTE Confidence: 0.8964563012123108 00:02:53.774 --> 00:02:54.520 kidney disease. NOTE Confidence: 0.9556286931037903 00:02:54.720 --> 00:02:57.508 And why that is the case is complicated and not NOTE Confidence: 0.9556286931037903 00:02:57.567 --> 00:03:01.245 related to their race alone, but rather social determinants of NOTE Confidence: 0.9556286931037903 00:03:01.304 --> 00:03:01.719 health. NOTE Confidence: 0.8704861402511597 00:03:01.880 --> 00:03:04.400 So for example, what is their access to healthcare? NOTE Confidence: 0.8948246240615845 00:03:04.480 --> 00:03:07.784 What is their access to preventative and primary care, their NOTE Confidence: 0.8948246240615845 00:03:07.839 --> 00:03:11.583 access to healthy foods, their environmental exposures that they may NOTE Confidence: 0.8948246240615845 00:03:11.638 --> 00:03:12.520 or may not have. NOTE Confidence: 0.8944583535194397 00:03:12.520 --> 00:03:14.906 So I think there's a lot of factors there that NOTE Confidence: 0.8944583535194397 00:03:14.958 --> 00:03:17.914 are contributing to this disparity and who is impacted by NOTE Confidence: 0.8944583535194397 00:03:17.966 --> 00:03:19.159 chronic kidney disease. NOTE Confidence: 0.8235139846801758 00:03:19.520 --> 00:03:22.066 And our system unfortunately has been built on waiting till NOTE Confidence: 0.8235139846801758 00:03:22.109 --> 00:03:22.800 the last minute. NOTE Confidence: 0.8976829051971436 00:03:22.800 --> 00:03:26.683 So many patients will go into dialysis emergently and with NOTE Confidence: 0.8976829051971436 00:03:26.750 --> 00:03:31.170 with very little education or very little understanding of chronic NOTE Confidence: 0.8976829051971436 00:03:31.237 --> 00:03:34.919 kidney disease or without even referrals to nephrology. NOTE Confidence: 0.9529222846031189 00:03:38.160 --> 00:03:40.630 I think it is our job as members of the NOTE Confidence: 0.9529222846031189 00:03:40.693 --> 00:03:45.127 nephrology community to be really intentional about how we communicate NOTE Confidence: 0.9529222846031189 00:03:45.191 --> 00:03:48.928 this, to raise public awareness, to empower patients to ask NOTE Confidence: 0.9529222846031189 00:03:48.991 --> 00:03:52.792 their their providers and their physicians what is my kidney NOTE Confidence: 0.9529222846031189 00:03:52.855 --> 00:03:56.720 function, particularly if they have these known risk factors. NOTE Confidence: 0.9242801070213318 00:03:58.000 --> 00:04:01.212 So it really takes someone astute to see the patient NOTE Confidence: 0.9242801070213318 00:04:01.274 --> 00:04:04.486 and think that they're at risk for kidney disease to NOTE Confidence: 0.9242801070213318 00:04:04.548 --> 00:04:08.007 say, let's look at your kidney health, let's check these NOTE Confidence: 0.9242801070213318 00:04:08.069 --> 00:04:11.467 labs, a really simple blood test, a really simple urine NOTE Confidence: 0.9242801070213318 00:04:11.528 --> 00:04:14.000 test and see how your kidneys are doing. NOTE Confidence: 0.9710832238197327 00:04:14.320 --> 00:04:16.280 But unfortunately, that's not being done. NOTE Confidence: 0.9439096450805664 00:04:16.839 --> 00:04:20.033 So even among high risk patients, like people who have NOTE Confidence: 0.9439096450805664 00:04:20.092 --> 00:04:24.408 diabetes and hypertension, only about 30% are actually getting completely NOTE Confidence: 0.9439096450805664 00:04:24.467 --> 00:04:25.000 screened. NOTE Confidence: 0.9496712684631348 00:04:25.000 --> 00:04:28.031 And this is happening when we know that kidney disease NOTE Confidence: 0.9496712684631348 00:04:28.087 --> 00:04:30.950 is increasing as a cause of mortality in the United NOTE Confidence: 0.9496712684631348 00:04:31.007 --> 00:04:31.399 States. NOTE Confidence: 0.9345610737800598 00:04:32.520 --> 00:04:37.339 Unfortunately, our healthcare system for chronic kidney disease exists in NOTE Confidence: 0.9345610737800598 00:04:37.405 --> 00:04:40.112 silos and so if we have a system by which NOTE Confidence: 0.9345610737800598 00:04:40.178 --> 00:04:43.876 we can truly rely upon the back and forth communication, NOTE Confidence: 0.9345610737800598 00:04:43.942 --> 00:04:47.771 by creating this network, you basically are able to create NOTE Confidence: 0.9345610737800598 00:04:47.837 --> 00:04:51.733 an efficiency and not have people crashing into dialysis or NOTE Confidence: 0.9345610737800598 00:04:51.799 --> 00:04:56.288 having critical emergence care provided for months and months before NOTE Confidence: 0.9345610737800598 00:04:56.354 --> 00:04:59.920 they are able to be considered again for a transplant. NOTE Confidence: 0.9161013960838318 00:05:01.400 --> 00:05:04.146 What I wish I could change is the public awareness NOTE Confidence: 0.9161013960838318 00:05:04.201 --> 00:05:07.057 of kidney disease and to try to really highlight the NOTE Confidence: 0.9161013960838318 00:05:07.112 --> 00:05:08.759 importance of the the kidneys. NOTE Confidence: 0.9621109366416931 00:05:08.839 --> 00:05:11.878 And when you're going to see a doctor being empowered NOTE Confidence: 0.9621109366416931 00:05:11.935 --> 00:05:14.916 to ask your provider, what is my kidney function And NOTE Confidence: 0.9621109366416931 00:05:14.974 --> 00:05:17.553 what can you do if you have kidney disease to NOTE Confidence: 0.9621109366416931 00:05:17.611 --> 00:05:20.420 try to slow the progression, to try to avoid ever NOTE Confidence: 0.9621109366416931 00:05:20.477 --> 00:05:22.999 seeing dialysis or ever seeing a transplant. NOTE Confidence: 0.9598819017410278 00:05:24.000 --> 00:05:26.491 And I think that really starts with being clear that NOTE Confidence: 0.9598819017410278 00:05:26.539 --> 00:05:28.119 chronic kidney disease is silent. NOTE Confidence: 0.8909511566162109 00:05:28.160 --> 00:05:29.200 It is out there. NOTE Confidence: 0.9270882606506348 00:05:29.400 --> 00:05:31.620 There are so many people that have it and that NOTE Confidence: 0.9270882606506348 00:05:31.668 --> 00:05:32.200 don't know. NOTE Confidence: 0.8688066601753235 00:05:32.200 --> 00:05:35.064 And if many of those people knew, we could potentially NOTE Confidence: 0.8688066601753235 00:05:35.117 --> 00:05:37.717 prevent them given the tools that we have to ever NOTE Confidence: 0.8688066601753235 00:05:37.770 --> 00:05:39.679 getting to end stage kidney disease. NOTE Confidence: 0.9557982087135315 00:05:40.320 --> 00:05:43.314 My overall hopes for the kidney care industry are that NOTE Confidence: 0.9557982087135315 00:05:43.370 --> 00:05:45.921 we have a cure for kidney disease, that we can NOTE Confidence: 0.9557982087135315 00:05:45.977 --> 00:05:49.471 diagnose kidney disease better, that we can screen for patients NOTE Confidence: 0.9557982087135315 00:05:49.526 --> 00:05:53.408 and identify really, really early chronic kidney disease and intervene NOTE Confidence: 0.9557982087135315 00:05:53.464 --> 00:05:55.959 if we can to try to prevent this progression.