Looking toward the next 30 years of treating kidney disease


Editor’s note: Nephrology News & Issues is celebrating 30 years of publishing this year. In this series, we are looking to the next 30 years. How will treating kidney disease change in the next three decades?

In 1965, at opposite ends of the country, the roles of nurse practitioners (NPs) and physician assistants (PAs) were created. Both professions came into being to augment medical care and to relieve overburdened physicians.

As they evolved independently, they assumed more training and expertise. They came into nephrology in increasing numbers partially due to the changing Medicare reimbursement structure in 2011 and partially due to the explosive increase in chronic kidney disease.

If the past 50+ years have been any indication, the future will show continued growth in the utilization and presence of advanced practice practitioners (APPs) in all fields and most certainly in nephrology. APPs are poised to fill many of the gaps left by the decreasing number of nephrology fellows and nephrologists.

In honor of this publication’s 30th anniversary, we surveyed APPs across the country and asked them what they thought the next three decades would bring to the field of nephrology.

Read also: Zen and the future of nephrology 

“APPs will be medical directors of dialysis units. In the hospitals, they will be directing nephrology services.”

“Reimbursement for APPs will be on par with that of physicians.”

“Those states that require collaborative practice for NPs will allow full practice authority and there will be some independent practices. PAs likewise will have more opportunity to practice independently.”

“Extended care and long term care facilities will have in-house dialysis.”

“Telemedicine will play a huge role and APs will no longer be logging miles and miles of travel.”

“In-center hemodialysis will no longer be the primary choice. Instead, home dialysis, either PD or home hemodialysis, will be first choice. More and more extended care facilities and rehab centers will have in- house dialysis.”

“APPs will be valued for and compensated for their contributions in educating patients and families. They will also function more in the home setting”

“Six to seven-day-a-week therapy will be standard.”

Many predicted the decline of traditional dialysis. “The wearable kidney and the proliferation of outpatient dialysis units will be things of the past. Instead, there will be an implantable kidney which will be grown in the lab. The vast majority of patients receiving traditional hemodialysis will be AKI patients.”

“We will all become computer programming experts as the bar of soap devices will need calibrations and adjustments but will provide continuous dialysis so that fluid and electrolytes will be easier to manage.”

“Dietary instructions will be replaced by complex technology teaching with iPhones, likely being able to download data on dialysis adequacy automatically.”

Others saw a less rosy picture. “The number of CKD patients will continue to increase and with improved treatments and technologies will live longer. Nephrology will be overwhelmed.”

We cannot help but be optimistic about the future of APPs in nephrology and all fields. However, it is up to us to create our future. We know the progress that has been made over the last 50+ years was not a gift. APPs have worked to obtain prescriptive authority and they have worked to expand their roles and responsibilities.

The future of nephrology is more than caring for patients in advanced stages of CKD. We must look to slowing disease progression in early stages. That will take educating both our primary care and specialty colleagues about kidney disease and their role in recognizing and treating/referring early.

The American Academy of Nephrology Physician Assistants, through their Kidney in a Box project, has demonstrated that implementing change in practice can have positive rewards.

The future is bright, but it is not guaranteed.

Many thanks to contributors Lillian Pryor, MSN; Terri Murray; Judi Dansizen, APN; Kim Diaz; Robin Bassett, APN, and Catherine Wells, DNP.