2023 American Society of Nephrology (ASN) Kidney Week takeaways

A great conference has the power to leave you energized and inspired, and that’s precisely how I felt after recently returning from the 2023 American Society of Nephrology (ASN) Kidney Week in Philadelphia, Penn. earlier this month. Each year, ASN Kidney Week draws kidney care experts from around the world and is an opportunity to learn about recent advances in kidney care, research, and technology.

Here’s what stood out for me from the sessions I attended:

Hemodiafiltration is a potential game-changer. This innovation in dialysis technology not only rids the body of toxins through conventional diffusion but also removes significant toxin-laden water volumes through convection, followed by replacement with ultrapure water and electrolytes. The recent CONVINCE trial in Europe showed that patients using hemodiafiltration had a remarkable 23% lower risk of death compared to those using conventional dialysis methods. While it’s already widely used in Europe, it has yet to be approved by the FDA for use in the U.S. We still need more research to figure out how to tailor this to different patient profiles and integrate it into our existing dialysis infrastructure in the U.S. – but hemodiafiltration holds incredible promise for our patients.

Incremental hemodialysis was another hot topic. With this approach, new dialysis patients who have residual kidney function would start twice-weekly in-center hemodialysis, vs. the typical three-times-per-week schedule. The dialysis frequency can increase over time, as a patient’s kidney function decreases. This echoes our current home dialysis practices, and several studies suggest it could reduce hospitalizations and substantially improve patients’ health-related quality of life, with no change in mortality. There was a lot of discussion about this at Kidney Week, and it was great to see speakers advocating for dialysis prescriptions that center around patients’ quality of life. There are a number of policy changes, logistical challenges, and clinical questions (about frequency of residual urine volume monitoring, for example) that would need to be addressed before dialysis centers could implement this as a default strategy for patients.

Results from two late-breaking/high-impact clinical trials were surprising. This is always one of my favorite sessions at the conference each year, and it always offers intriguing insights – especially when the study findings are unexpected. Here are two that I thought were particularly interesting:

• The ALCHEMIST trial looked at whether spironolactone, which is used in combination with other medications to treat conditions like heart failure, liver disease and high blood pressure, could benefit chronic hemodialysis patients with cardiovascular complications. While it sounded promising, the study found the medicine had little impact on patient outcomes.
• The EnAKT LKD Cluster Randomized Clinical Trial in Ontario, Canada, tested various tactics to increase access to kidney transplants, including enhanced transplant educational resources and a peer transplant ambassador program. Surprisingly, despite these combined efforts, there was no significant increase in referrals to transplant centers or completed transplants. Although patients appreciated the peer program, it didn’t yield substantial results. The bottom line: As dialysis providers, we know it’s incredibly important to increase access to transplants – but we still need more research to determine what steps will be most effective and allow us to scale our efforts.

Challenges remain in how to grow home dialysis and transplant in the U.S.I attended a fascinating session focused on home dialysis and transplant policy. The speakers reviewed a recent pilot program from Medicare in which one-third of all dialysis clinics in the country were assigned to an incentive-based payment scheme. For those clinics, Medicare awarded bonus payments based on how many patients are treated with dialysis at home or who receive kidney transplants.

Early results have not shown a big impact of the program, despite a lot of time and effort invested.  One sobering takeaway from this session is that there is still so much we don’t know about how to promote treatments such as home dialysis and kidney transplant for patient with kidney failure, treatments that have been shown to improve quality of life and other outcomes.

I came away from ASN Kidney Week impressed by the amount and quality of research and innovation presented and inspired about the future of kidney care here in the U.S. and around the world.  There are many new treatments coming that have the potential to improve outcomes and quality of life significantly for patients living with kidney diseases, and so many innovative scientists that are dedicated to this cause. Perhaps most of all, the conference reinforced for me the critical importance of work we’re doing every day at Northwest Kidney Centers – focusing on patient-centered care, advocating for healthcare policy changes, collaborating with kidney researchers, and striving to expand access to kidney transplants.