Bryan Becker, MD, on 60 Years of the National Kidney Foundation

Benton, Emilia

doi: 10.1097/01.NEP.0000393758.66579.1a
The Clinical Interview

The National Kidney Foundation (NKF) celebrated its 60th anniversary on November 15. Bryan Becker, MD, Immediate Past President of the NKF, spoke with Nephrology Times to reflect on the organization's past accomplishments, present projects, and goals for the future.

How has the field of nephrology changed over the lifetime of the National Kidney Foundation?

Dr. Becker: We have transitioned from viewing kidney failure as a death sentence to being able to detect kidney disease early in its course and put preventive therapeutics and treatments into place. New technologies have flourished, expanding our ability to deliver dialysis and provide arteriovenous access. At the same time, novel pharmaceutical-informed transplantation has improved graft and patient survival. Over time, the field has spurred new trials for what are now common medications in proteinuria, certain forms of kidney disease, and anemia and bone disease management. Today, we are expanding our practice earlier in the disease with population-based screening, working to fortify patient health when this disease state is recognized.

What are some of the most significant changes the NKF has undergone over the past 60 years?

Dr. Becker: The NKF has transformed from a formative group of concerned individuals intent on developing research funding for kidney disease into a multifaceted, internationally recognized organization. With a patient focus still at its core, the NKF has developed policy expertise and comparative effectiveness assessment with guideline development, and advanced the idea of kidney disease as both a personal and population-level health concern. We have moved from an affiliate-based to a division-based model, which has allowed us to support specific programs across the United States. We have expanded our core membership base into the tens of thousands, covering patients and families and every aspect of the kidney health care environment while never losing sight of our mission. Even as it has remained patient- centered, the NKF has been more of an advocate for quality in care delivery, for improvements in policy, and for the ability to be a catalyst for a community.

What are some of the future directions for the National Kidney Foundation?

Dr. Becker: The NKF is looking to further hone and expand screening and detection programs for chronic kidney disease, and not just in the United States, but across the globe. Additionally, the NKF has been very engaged in the transplant community. Our “End the Wait” campaign has a broad agenda, but at its core, it's involving more collaboration among all the parts of our transplant system in the United States, and the NKF is uniquely positioned to make that a reality. Lastly, I think as we move into a different era of dialysis reimbursement, the National Kidney Foundation really is positioned to be an advocate for quality of care for patients and even to improve efficiency in the face of a different economic climate.

What do you think the field of nephrology will look like in another 60 years?

Dr. Becker: I hope we will have figured out how to prevent progression of kidney disease so that when we detect risk factors early and even a slight decrease in kidney function, different therapeutics and different management will have successfully slowed that down. In a more pragmatic circumstance, we may not have achieved that goal, but we will have developed new technologies for delivery of treatment for kidney failure in the context of dialysis that leave patients more mobile and allow them to be treated more effectively throughout more time frames with less infringement on their personal time. I hope we will have developed smaller, more biocompatible devices to give patients the chance to lead healthier lives without taking as much time away from them as dialysis units or other at-home treatments. I do think if we still have kidney failure, transplantation will continue to be the better choice, if we can provide one, to restore people to more activity, but I hope we will have developed different therapeutics and different genomic tissue management to reduce the side effect profile and complications of transplantation and make it a simpler treatment for people to keep for a much longer period of time.

What do you think the NKF will be doing in another 60 years?

Dr. Becker: Like most organizations, it will continue to try to raise money and look to crystallize its voice over the next 60 years. Sixty years from now, we'll probably focus on bringing therapeutics and management profiles to individuals across all aspects of our socioeconomic spectrum, serving as a voice for equity in delivery of treatment and delivery of the best treatment to all. Second, the NKF will need to be a pragmatic voice, advocating for patients if they have to access high-end technologies among health care entities that might want to view them in different lights, whether it be from financial perspectives or risk-benefit perspectives, while remaining a voice on patients’ behalf, giving them access to those treatments. This will change how we view our partnerships both with industry and government, because we need to be positioned between them to successfully advocate for the people who are constituents. Lastly, I think the NKF in 60 years will have a different mission in identifying how to continue to collect the appropriate information for patients with kidney disease. We're going to have to look at the environment and make certain that we know how to best partner with data resources and management and analytic tools and partners so that we can know that quality of care and best population-based assessments are being done for people with kidney disease to further enhance their care.

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NKF Rooted in One Family's Mission

By Emilia Benton

The National Kidney Foundation was originally launched as the National Nephrosis Foundation in 1950, one year after founder Ada DeBold's son, Robert, was diagnosed with the disease at age 18 months.

Ms. DeBold founded the organization with her first husband, Harry, to get doctors to collaborate with one another and to meet with other families who were affected by nephrosis. She was also concerned with getting monetary assistance for the families, as many were not in a financial position to get the necessary help for their children.

Ms. DeBold's sons Robert and Paul were active in the foundation as small children, when the office was run out of their New York home.

“We didn't have copy machines and Xeroxes, so my brother and I would hand-crank the ditto master machines and make the copies, lick the envelopes and stamps for the solicitation letters, and so forth,” said Paul DeBold, a retired officer of the Ft. Lauderdale Police Department and the US Coast Guard, who is the only living person to have attended the NKF's initial meeting. Ms. DeBold passed away in 2003.

“It's really amazing how much the NKF has grown when you think about the fact that it all started because of one sick kid whose parents decided something had to be done, even if it meant doing it right out of their living room,” Mr. DeBold said.

© 2010 Lippincott Williams & Wilkins, Inc.