Bradley Warady, MD, Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City is an international leader in pediatric dialysis. In addition to being one of the principal investigators for CKiD, the largest study of pediatric chronic kidney disease ever conducted in North America, Dr. Warady is the lead editor of two authoritative textbooks: Pediatric Dialysis Case Studies and Pediatric Dialysis. He is also on the international committee developing new pediatric dialysis guidelines.
In this podcast, Dr. Warady discusses the state of pediatric dialysis today, where improvements can and are being made, and next steps for improving care.
Pediatric Dialysis: What’s Next?
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Learn more about Brad Warady, MD
Brad Warady, MD
Dr. Warady is Director of the Division of Nephrology at Children’s Mercy and Director of Dialysis and Transplantation. In spring 2015, Dr. Warady was presented with the Henry L. Barnett Award for outstanding teaching and clinical care for children with kidney disease by the American Academy of Pediatrics Section on Nephrology. Dr.Warady’s previous awards include the National Kidney Foundation’s 2013 J. Michael Lazarus Award for enhancing the clinical care of patients on dialysis or with chronic kidney disease (CKD) and the Patrick and Virginia Clune Award of Excellence by the National Kidney Foundation of Kansas and Western Missouri. Dr.Warady is Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. His major areas of research are chronic kidney disease and end-stage renal disease (ESRD) management of children. He is the senior editor of two leading books in the field, “Pediatric Dialysis” and “Pediatric Dialysis Case Studies.” He is also Co-Principal Investigator of the NIH funded “Chronic Kidney Disease in Children (CKiD) Study”, the largest study of CKD in children ever conducted in North America.Learn more about Brad Warady, MD
Transcription:
Pediatric Dialysis: What’s Next?
Dr. Michael Smith (Host): So, our topic today, is Pediatric Dialysis, what we’ve learned and where we are heading. My guest is Dr. Brad Warady. Dr. Warady is Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City and Director of Dialysis and Transplantation. Dr. Warady is a lead author of two authoritative textbooks; Pediatric Dialysis Case Studies and Pediatric Dialysis and he is one of the principle investigators for the largest pediatric kidney disease study ever conducted in North America. Dr. Warady, welcome to the show.
Dr. Brad Warady, MD (Guest): Thanks. Good morning.
Dr. Smith: So, let’s just start with this, what is the current state of pediatric dialysis?
Dr. Warady: Well, I think that what is probably not recognized by a lot of folks is that there are children that area actually born with kidney disease or children that acquire kidney disease as they grow and in some situations, these kids need dialysis as a bridge to transplant and one of the things that we have done here at Children’s Mercy over the years, is care for some of the sickest children and some of the smallest children who require dialysis and we are able to provide them with the pretty excellent care in terms of dialysis to get them ready ultimately for a kidney transplant.
Dr. Smith: What do you see as the biggest challenges that we face to making improvements to pediatric dialysis?
Dr. Warady: Well, I think the technical issues have been addressed I think fairly well over the past several decades and we have done a lot of that work here at Children’s Mercy, so that we can provide true optimal dialysis to children of all ages and all sizes. I think more and more we are recognizing some of the psychosocial issues that we have to address. The fact that children that are on dialysis, don’t attend school as often as their peers, have to take medications that their peers don’t have to take and so, I think more and more as we hope to improve the care of these children, we have to address those psychosocial issues on the part of the children and the families themselves.
Dr. Smith: You know when you look, Dr. Warady in the past say like ten years, you look back a little bit, what do you think were some of the best improvements that actually happened that have brought us to a better place today, some of the research, the approach and the early diagnosis of kidney problems? What is it or what are some of those big things that you think really has made a big impact in how we take care of these kids?
Dr. Warady: Yeah, that’s a good question. And I have been doing this for 35 years and, so I have seen a lot of improvements. Back when I started it was very uncommon to provide dialysis to the smallest children, so I think one of the major improvements has been in the technology so that we have the equipment to provide optimal dialysis to even the very, very youngest child. But I think one of the other things that we have done is recognize that working together, multiple different sites around the US and even internationally, working together, we can come up with answers to questions in a much more rapid manner and so I coordinate an international registry of children on dialysis and that registry has allowed us to again, gain information, gain education in a more rapid manner so that we can implement changes to children much more rapidly and improve their care. And I think one of the things that we have seen in these collaborations, is the important role of parents and families in the care of their children and so twenty years ago, we really didn’t sit at the table with the parents to develop a strategy for their child’s care, but now that happens every day, and at Children’s Mercy, I think we are at the forefront of having these regular interactions with families where there is no agenda when we sit down together. The agenda is how can we improve the dialysis care for your child? And we work together with the families to design the best possible strategy and individualize it for that child and family.
Dr. Smith: So, what do you think is the next big opportunity on the horizon in improving pediatric dialysis?
Dr. Warady: Well, one of the things that we are looking at now is enhancement of the capacity of remote information, so that when a child is on dialysis at home, and many of these children receive dialysis at home; we can actually download data from that dialysis session every single morning in our dialysis unit so that we can see exactly what’s going on and be able to come up with any issues that may have to be addressed in a much more rapid manner. We are working with industry at Children’s Mercy which is one of the few sites around the country who is gathering this kind of data so that we can see with this remote monitoring, how can we better serve the children and better serve the families and I think that that partnership between the family and the healthcare providers will clearly be enhanced by utilizing this remote monitoring and I think the outcomes will improve as well.
Dr. Smith: Yeah and that seems to also address the issue of like the socioeconomic issues you brought up before, you know the more information we have, the better you are going to be able to take care of the patient, the family, not just even during dialysis, right, throughout the life of that child. What about research specifically? What are you interested in? Where would you like – what would you like to study in the near future?
Dr. Warady: Well, I think one of the things that we are doing at Children’s Mercy, is we lead one of the – well actually the largest study ever in North America of children with chronic kidney disease, called the See Kid’s Study and that study which involves 54 sites around the country is a study that is intending to look at factors that lead to worsening of kidney disease in children. And the goal of that study is to ultimately figure out interventions that might halt the progression or slow the progression or worsening of kidney disease, so that fewer kids actually have to go dialysis. That’s a very, very important research project that has been funded by the National Institutes of Health for almost 15 years and we hope again, in the subsequent five years that we can find some therapeutic points of the therapeutic intervention that may benefit the kids. And then the other side, we want to look at transplant and we always want to improve transplant and outcome for these children and at Children’s Mercy, we are proud of the fact that we have 100% survival of the kidney transplants over the past several years and so we are doing a great job in providing these kids transplant and we want to do whatever we can with research to enhance the longevity of those kidney transplants in these kids so they can have a more normal life despite the need for this support of kidney transplant.
Dr. Smith: So, Dr. Warady in conclusion, what would you like people to know about pediatric dialysis?
Dr. Warady: Well, I think people should recognize that like adults, children can have kidney failure, but despite the fact that they have kidney failure, thankfully we have dialysis, we have the expertise to provide these kids with very, very good care while they are on dialysis; care that allows them to grow, develop, go to school, receive their education, but that at the same time, dialysis is a bridge to transplantation and so what we do at Children’s Mercy is really care for the whole spectrum of kidney disease from the chronic kidney disease before dialysis, provide them with optimal dialysis and get them ready for a successful transplant. And so, again, even being born with kidney disease, you can still have a very bright future.
Dr. Smith: Dr. Warady, I want to thank you for the work that you are doing at Children’s Mercy Kansas City and I also want to thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to www.childrensmercy.org , that’s www.childrensmercy.org . I’m Dr. Mike Smith, thanks for listening.
Pediatric Dialysis: What’s Next?
Dr. Michael Smith (Host): So, our topic today, is Pediatric Dialysis, what we’ve learned and where we are heading. My guest is Dr. Brad Warady. Dr. Warady is Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City and Director of Dialysis and Transplantation. Dr. Warady is a lead author of two authoritative textbooks; Pediatric Dialysis Case Studies and Pediatric Dialysis and he is one of the principle investigators for the largest pediatric kidney disease study ever conducted in North America. Dr. Warady, welcome to the show.
Dr. Brad Warady, MD (Guest): Thanks. Good morning.
Dr. Smith: So, let’s just start with this, what is the current state of pediatric dialysis?
Dr. Warady: Well, I think that what is probably not recognized by a lot of folks is that there are children that area actually born with kidney disease or children that acquire kidney disease as they grow and in some situations, these kids need dialysis as a bridge to transplant and one of the things that we have done here at Children’s Mercy over the years, is care for some of the sickest children and some of the smallest children who require dialysis and we are able to provide them with the pretty excellent care in terms of dialysis to get them ready ultimately for a kidney transplant.
Dr. Smith: What do you see as the biggest challenges that we face to making improvements to pediatric dialysis?
Dr. Warady: Well, I think the technical issues have been addressed I think fairly well over the past several decades and we have done a lot of that work here at Children’s Mercy, so that we can provide true optimal dialysis to children of all ages and all sizes. I think more and more we are recognizing some of the psychosocial issues that we have to address. The fact that children that are on dialysis, don’t attend school as often as their peers, have to take medications that their peers don’t have to take and so, I think more and more as we hope to improve the care of these children, we have to address those psychosocial issues on the part of the children and the families themselves.
Dr. Smith: You know when you look, Dr. Warady in the past say like ten years, you look back a little bit, what do you think were some of the best improvements that actually happened that have brought us to a better place today, some of the research, the approach and the early diagnosis of kidney problems? What is it or what are some of those big things that you think really has made a big impact in how we take care of these kids?
Dr. Warady: Yeah, that’s a good question. And I have been doing this for 35 years and, so I have seen a lot of improvements. Back when I started it was very uncommon to provide dialysis to the smallest children, so I think one of the major improvements has been in the technology so that we have the equipment to provide optimal dialysis to even the very, very youngest child. But I think one of the other things that we have done is recognize that working together, multiple different sites around the US and even internationally, working together, we can come up with answers to questions in a much more rapid manner and so I coordinate an international registry of children on dialysis and that registry has allowed us to again, gain information, gain education in a more rapid manner so that we can implement changes to children much more rapidly and improve their care. And I think one of the things that we have seen in these collaborations, is the important role of parents and families in the care of their children and so twenty years ago, we really didn’t sit at the table with the parents to develop a strategy for their child’s care, but now that happens every day, and at Children’s Mercy, I think we are at the forefront of having these regular interactions with families where there is no agenda when we sit down together. The agenda is how can we improve the dialysis care for your child? And we work together with the families to design the best possible strategy and individualize it for that child and family.
Dr. Smith: So, what do you think is the next big opportunity on the horizon in improving pediatric dialysis?
Dr. Warady: Well, one of the things that we are looking at now is enhancement of the capacity of remote information, so that when a child is on dialysis at home, and many of these children receive dialysis at home; we can actually download data from that dialysis session every single morning in our dialysis unit so that we can see exactly what’s going on and be able to come up with any issues that may have to be addressed in a much more rapid manner. We are working with industry at Children’s Mercy which is one of the few sites around the country who is gathering this kind of data so that we can see with this remote monitoring, how can we better serve the children and better serve the families and I think that that partnership between the family and the healthcare providers will clearly be enhanced by utilizing this remote monitoring and I think the outcomes will improve as well.
Dr. Smith: Yeah and that seems to also address the issue of like the socioeconomic issues you brought up before, you know the more information we have, the better you are going to be able to take care of the patient, the family, not just even during dialysis, right, throughout the life of that child. What about research specifically? What are you interested in? Where would you like – what would you like to study in the near future?
Dr. Warady: Well, I think one of the things that we are doing at Children’s Mercy, is we lead one of the – well actually the largest study ever in North America of children with chronic kidney disease, called the See Kid’s Study and that study which involves 54 sites around the country is a study that is intending to look at factors that lead to worsening of kidney disease in children. And the goal of that study is to ultimately figure out interventions that might halt the progression or slow the progression or worsening of kidney disease, so that fewer kids actually have to go dialysis. That’s a very, very important research project that has been funded by the National Institutes of Health for almost 15 years and we hope again, in the subsequent five years that we can find some therapeutic points of the therapeutic intervention that may benefit the kids. And then the other side, we want to look at transplant and we always want to improve transplant and outcome for these children and at Children’s Mercy, we are proud of the fact that we have 100% survival of the kidney transplants over the past several years and so we are doing a great job in providing these kids transplant and we want to do whatever we can with research to enhance the longevity of those kidney transplants in these kids so they can have a more normal life despite the need for this support of kidney transplant.
Dr. Smith: So, Dr. Warady in conclusion, what would you like people to know about pediatric dialysis?
Dr. Warady: Well, I think people should recognize that like adults, children can have kidney failure, but despite the fact that they have kidney failure, thankfully we have dialysis, we have the expertise to provide these kids with very, very good care while they are on dialysis; care that allows them to grow, develop, go to school, receive their education, but that at the same time, dialysis is a bridge to transplantation and so what we do at Children’s Mercy is really care for the whole spectrum of kidney disease from the chronic kidney disease before dialysis, provide them with optimal dialysis and get them ready for a successful transplant. And so, again, even being born with kidney disease, you can still have a very bright future.
Dr. Smith: Dr. Warady, I want to thank you for the work that you are doing at Children’s Mercy Kansas City and I also want to thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to www.childrensmercy.org , that’s www.childrensmercy.org . I’m Dr. Mike Smith, thanks for listening.