- One of the unique qualities of Wake Forest Baptist,
is the way in which we fully integrate research
and educational programs into our
daily patient care activities.
Ultimately, this is actually to the benefit
of our patients because we can quickly bring
discoveries from the laboratory through clinical trials
into improved patient care literally on a daily basis.
During this segment you'll learn a lot about how
research is integrated into patient care, for example,
the discovery of how a gene confers a higher risk
of kidney failure in African Americans,
and how our researchers are hoping to leverage
that discovery to actually lower the rate
of renal failure in a very vulnerable population.
In addition, we have a very large, academic based
dialysis program, in fact it's the largest such program
in America, we provide kidney dialysis services
at over 16 locations, that's a very important program,
bringing patients into our medical center,
then for transplantation, but also for many
clinical research studies, as well.
I think you'll be truly amazed by the accomplishments
of this great team of faculty, staff, and others
who contribute daily to the health
of patients with kidney disease.
Without question, one of our most preeminent
academic clinical programs is nephrology.
It's the combined excellence of research,
education, and patient care that typify this division
and make it a model division within the medical center.
With me today is the division chair, Dr. Barry Freedman,
who leads one of the country's leading
research programs in kidney disease, Barry,
how did Wake Forest get so preeminent in kidney disease?
- Couple of things should be stated at the outset,
we maintain the largest, academically owned and operated
dialysis program in the United States.
There's more than 1,550 patients
receiving end stage renal disease therapy
in 16 dialysis programs in the region.
We were one of the first sections to outreach
into the community and we have nephrologists
driving an hour in every direction to see patients
in their hometowns.
- Right.
- I have to tell you that the things that we develop
in the lab, the clinical research that we do,
has been brought to the fore to try and help
all the patients that we're able to treat
and interact with, I don't view a mission
as purely clinical, or purely research,
or purely educational, as you said, it's that
unique blend, and I think that blend is what
has brought us national attention.
We have absolutely superb clinical nephrologists
giving us such a high ranking, but every one of them
has a research program and clinical interests,
and we're able to bring that right to the dialysis units.
Our section maintains the largest DNA sample collection
for African Americans with end stage renal disease,
African Americans with type II diabetes,
as well as European Americans, we now have 17,000
DNA samples that have been recruited through
the section on nephrology for widespread studies
on kidney disease risk, heart disease risk,
brain disease, from high blood pressure
and diabetes and bone disease.
- So what does the future hold?
What's the next major research advance,
and how do you visualize the care
of kidney disease patients 20 years from now?
- Well I have to say, one of the most exciting parts
of our research program and highlights of my career
has been working with a couple of other teams
in Harvard and at the NIH to identify the APOL1
kidney failure gene, well identifying the gene
was a major breakthrough, it taught us what was really
causing kidney disease, not necessarily just
high blood pressure, but the goal now is to find a cure,
to be able to prevent kidney disease.
We know this gene doesn't act alone,
there are environmental triggers, viral infections
certainly interact with this gene, but we've just had
a major breakthrough, and I'm very optimistic
that soon we'll be able to vaccinate people
to prevent viral infections or prevent other environmental
exposures that can impact how these genes work.
I would like in the next 20 years for us
to put a stop to non-diabetic kidney failure
in the African American population, as well
as other forms of kidney disease in all people.
- That's a great vision, I bet you have
a reasonable chance of hitting that.
- [Dr. Freedman] Thanks Dr. McConnell.
- Congratulations to you and all your colleagues,
and I know it takes a team, but it's also very clear
to me who the orchestra director is,
thanks for everything you do.
- Thanks Dr. McConnell.
- Today I have Dr. Don Bowden, who's the director
of our diabetes research center.
Don and his colleagues have provided
amazing insight into the relationship
between diabetes and kidney disease.
But Don, not everyone with diabetes develops
kidney disease, could you give us some insight into that?
- That's correct, in fact, Barry Freedman and I
have been working together for over 20 years
trying to understand the relationship
of diabetes and kidney disease.
We really don't know at the most
fundamental level what the difference is.
It appears that long term exposure
to high levels of glucose in your blood,
which is really the definition of diabetes,
ultimately leads to problems in the organs,
in the vascular system, especially small vessel disease
which is where it ends up with kidneys,
and damaging the kidneys, everyone who has diabetes
will not develop kidney disease, and the goal
of our research has been to try to understand
the genetics of what the differences between people are,
so it's been a very powerful interdisciplinary team
of people with multiple expertises working together
to solve very complex problems, that's one thing
I'd like to emphasize is, having genes, and for these
clinical diagnosis, such as diabetic nephropathy,
doesn't mean there's a single gene that's likely
gonna be the change whether you're gonna be
diabetic or non-diabetic, we presume there's a combination
of genes that are contributing and they're interacting
with your lifestyle and your environment
to ultimately create risks, so,
it's a complicated problem,
but attacking it from multiple levels
gives us the best opportunity to solve the problem.
- We are very appreciative of your leadership,
and thanks to both you and your team for everything you do.
- Thank you.
- As we all know, education and research
is firmly embedded in our single mission to improve health.
Our overall kidney disease program here is a great example
of how research is embedded in daily patient care
to improve outcomes and to prevent disease.
I have with me today Dr. Amret Hawfield,
who's one of our leading young investigators,
could you tell us a little bit about your research programs?
- My main research activity is being involved
in the Sprint Study, which as you probably know
is an NIH funded, multi-center randomized control trial.
About 10,000 people are expected to be enrolled
nationwide, to date at Wake Forest, we have 290
participants enrolled, we have three clinical sites,
together with Michael Rocco, I run the nephrology
clinical site where we have 87 patients,
and what we do is we randomize patients
to two different blood pressure targets.
The patients all have hypertension, and they
are either treated to a treatment target
of a systolic blood pressure of less than 120,
or less than 140, which is standard care,
and we're trying to reduce cardiovascular events
by using more intensive blood pressure control.
So it's a great benefit to the patients.
They are enrolled for four to six years,
they receive free medications for the study,
which is wonderful for our community here,
and what we learn from the study will be helpful
for future generations of doctors,
and writing blood pressure guidelines,
and how to manage these patients.
Although I know as a young assistant professor
in nephrology, it's very exciting
to participate in research, but you also have patient care
obligations, how do you balance that?
- Right, we have a very good system here at Wake Forest
which allows me to participate in in-patient care
about half of the year, and the other half of the year
that I'm not participating in in-patient care,
I have days assigned where I work in the Sprint clinic
and I meet with the study coordinators once a week
and other days where I have my own
out-patient continuity clinic.
- Well I wish you a really amazing career here
at Wake Forest, I know you're destined
to do great things, thank you.
- Thank you.
- Wake Forest is very fortunate to have one of the country's
leading kidney transplant programs, not just in terms
of the tremendous volumes of patients they transplant,
but also in terms of the quality of their outcomes,
with me is Dr. Robert Stratta, Professor of Surgery,
who's the director of the transplant program.
Tell us a little bit about the nature of the program,
and of our patients that are transplanted
on a yearly basis, et cetera.
- Currently there's about 500,000 people on dialysis
in the United States, and of those 500,000, about 100,000
are on waiting lists for kidney transplantation.
In any given year in the United States, we perform
about 17,000 kidney transplants, so only about one in five
or one in six of the waiting list actually gets
transplanted in a given year, so clearly it's a numbers game
and one of our biggest challenges is improving
access to the waiting list for all of those
dialysis patients and then trying too get them
transplanted in a timely fashion
once they are on the waiting list,
and we currently are performing about 180 to 200
transplants per year, which makes us the largest program
in the state of North Carolina, and arguably
the largest program in the southeastern United States.
Like many of our marquee programs, I know
your transplant center's heavily involved in research,
can you tell us a little bit more
about that aspect of your program?
- Do a lot of clinical research on, not only,
of transplanting high risk patients, for instance,
the elderly patients, we've transplanted more
than 100 patients over age 70 with excellent outcomes,
but also with expanding our limits for acceptable donors.
What we've been able to show with our research
is that we have excellent outcomes.
- Dr. Stratta, you and your team make
amazing contributions here at the medical center,
and we're very grateful for the great accomplishments
of your team, and for the great care
you provide our patients, thank you very much.
It should be obvious to you what a great team
of individuals we have working at our Wake Forest Baptist
kidney disease program, all the way from
very basic research, clinical trials, education,
the integration of those functions into
enhanced patient care, our physicians and staff
on a daily basis are working on ways to improve
the outcomes of dialysis, developing new ways
to actually treat and prevent kidney disease,
and to optimize the outcomes of kidney transplantation,
but I would say one of the most interesting things
that you heard in the last few minutes
is the repeated use of the word team.
Probably no finer example of how a team of individuals,
united around a single goal, in this case,
to improve the outcome of patients with kidney disease,
allows us to accelerate change and to be one of the
leading institutions in America
in this important area, thank you.