The emergence of sodium glucose transporter type 2 inhibitors has brought overwhelming optimism for those who treat chronic kidney disease. For the first time in decades, the nephrology community has been able to offer patients hope of a life without kidney failure. At the same time, we are faced with the harsh reality that many patients literally cannot afford these life-improving and lifesaving medications. A longer, healthier life free from dialysis is closer than ever, but still out of reach for a huge proportion of my patients.
This daily confrontation with the realities of unequal care is not new for nephrologists. Indeed, our field is one borne of and perpetuated by inequality. The chance to serve diverse and underserved populations was the earliest draw to medicine for me, but is a daily source of grief and frustration. Chronic kidney disease in the United States is largely a disease of inadequate access to primary and preventive care, socioeconomic barriers to lifestyle and environmental factors, and unequal allocation of transplantation. To work in nephrology is to witness disparities.
To that end, the National Kidney Foundation’s Spring Clinical Meeting 2023 features sessions to create a flexible and effective nephrology provider. I’m crafting my personal schedule for the week to help me meet my patients where they are at. Here’s what that looks like for me:
- “A Patient-Centered but Physiology-Rich Approach to Fluid and Electrolytes” precourse. I’ll be teaming up with Lynn Oehler, a registered dietician, to discuss diet counseling for patients with heart failure - not an easy task in the world of food deserts and skyrocketing grocery bills. This precourse session also features geriatric and liver/gastrointestinal disorders and I’m looking forward to learning about the unique challenges of each.
-The New Considerations for Lupus Nephritis workshop led by Shane Bobart and Gerald Appel. Objectives for the workshop include articulating the influence of social determinants on disease outcomes and identifying racial determinants influencing disease outcome and response to therapy. Lupus can be a vicious and disparate disease and I often struggle counseling patients or tailoring therapy.
-The three-part Caring for Latinx Patients with Kidney Disease session features resources and education for CKD, dialysis, and nutrition care for LatinX patients. It also includes a discussion of challenges and barriers to care, which is a regular source of frustration for me in my practice. Leticia Rolon and Lilia Cervantes do incredible advocacy and education work and I am excited to learn from them.
At the end of the day, though, to be a great nephrologist is to petition for change. The session I am most ardently anticipating is “Are Policymakers Adequately Addressing Health Equity?” The answer, of course, is “no.” But I hope to learn why and how we can change things.
I will be listening, I will be learning, and I will be planning for a more equitable future. You should be, too.
Dr. Gaddy has no conflicts of interest to report.
Image by Virinaflora / Shutterstock
