American Society of Nephrology president Bruce Molatoris, MD, FASN, kicked-off Kidney Week 2013 with a speech that addressed the current state of the field. Interest in nephrology among current medical students is at an all-time low, and has been declining for more than a decade, he said. And what once seemed like a surplus of nephrologists will quickly become a shortage.

(Where Medicare and the ESRD Program are headed)

But why is interest in nephrology declining? According to Molatoris, it is primarily due to a lack of innovation in the field. The small number of clinical trials related to kidney disease, compared to other major specialties, is the perfect example of this, he said.

(ESRD rate worldwide is growing faster than population)

Not only is interest in nephrology declining, but the field is also becoming isolated, Molatoris said, and the scope of work for nephrologists has become narrower because of cost-saving techniques. Much of the care of ESRD patients is being relegated to hospitalists, and it is cardiologists performing renal denervation, not interventionists.  And why, Molatoris asked, do we limit nephrologists to late-stage chronic kidney disease? "We relegate care of CKD patients to physicians without optimal training."

So what are the solutions, and how to we improve what Molatoris called a specialty in need?  The ASN president offered the following four solutions:

1.     Enhance public awareness of CKD. The renal community, he said, have failed to convey to the public the severity of CKD. Everyone is at risk for CKD, and we need to make this message personal, he said.

2.     Innovate. Transformation, he said, requires innovation. "We need to challenge present kidney paradigms." Molatoris showed that the average National Institutes of Health spending on each cancer patient, by year, is $567, while only $28 is spent on each kidney patient.  Molatoris called for an increase in NIH spending on CKD research, and pointed to the ASN Foundation for Kidney Research as a step in the right direction.

3.     Create more partnerships. Not only should industry be working together, but the field needs more scientific diversity as well.

4.     Create more measurement tools. No medical specialty is able to move forward without proper scientific measurement of research goals, treatment goals, and outcomes.  

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