Chronic kidney disease affects veterans in greater proportions than in the general population. So it is a serious and expensive issue for the Veterans Health Administration. Kidney disease and treatment are also the object of extensive research at VA. For an update on a topic that influences all public health, the Federal Drive with Tom Temin spoke with a leading researcher and the nephrology specialist at the VA medical center in Albuquerque, New Mexico, Dr. Mark Unruh.
Tom Temin Doctor Mark Unruh, give us an overview of what is going on in the generalized area of dialysis of kidney disease outcome, because by some measures, it hasn’t advanced much since the 1940s.
Dr. Mark Unruh I think for me, I’m really excited for this moment in care of people with chronic kidney disease. You know, for those of us that take care of patients, the whole point of kind of working with veterans is to prevent people from going on to requiring hemodialysis or transplantation at this moment. There are a number of really exciting medications that have become broadly available for veterans. And, you know, it’s just a really exciting time as a nephrologist to care for veterans. You know, these medications are both related to the management of diabetes and diabetic kidney disease, with the SGLT-2 two medications, which are really kind of becoming more prominent and have like really remarkable effects on preventing and stage renal disease, as well as sort of specific mineralocorticoid antagonists that also seem to be of great benefit. So, I would say, like for general chronic kidney disease, I have not seen medications that have this degree of impact for the past 20 years since we kind of started with angiotensin receptor blockers and Ace inhibitors. And so, you know, this is like a time for veterans to make sure that they’re getting outstanding care in our system.
Tom Temin All right. And you have been concentrating on dialysis for a lot of people with kidney disease. That’s the one step removed from a death sentence is to go on dialysis. And what’s going on in your research? What’s the goal here to try to improve that? Pretty cumbersome, frequent, and tiresome process.
Dr. Mark Unruh For, I guess, time with someone that cares for a lot of veterans who are on dialysis. I have a little bit of a different take. I would say, like in the U.S., we’re actually very fortunate that we have access to dialysis. There are other countries that are under resourced where you don’t have that opportunity. I like to say hemodialysis in particular, as a part time job that doesn’t pay very well. And there are many veterans that can, like, do exceptional things while they’re undergoing dialysis. So, for me, I think it’s kind of a remarkable thing that we’re doing. I agree with you in that, you know, it’s been a while since there’s been market innovation in hemodialysis. You know, fortunately, the kind of VA is sponsoring a number of studies now to kind of push that field forward. You know, we are actually doing a study of less frequent dialysis for people that are starting dialysis. And, you know, this is a concept that we’re sort of taking from peritoneal dialysis, which is a type of analysis where you use the stomach as a way to exchange and pull toxins off, where you use an incremental approach as the patient has a residual renal function, or they make urine. You probably need to do dialysis, the SLAs. And so, in the hemodialysis sector, or like in patients who are receiving hemodialysis right now in the U.S., people just start at three times a week. And that’s just standard operating procedure. So, you know, we’ve been asking the question like what a more veteran centric, pragmatic approach be to start at twice a week and see how people do and then as they need more as their residual renal function or their kidney function or urine output goes down, why not like add another session? And if they still have…
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