Bringing a Wider Lens to Our Medical View

BRINGING A WIDER LENS TO OUR MEDICAL VIEW  | FRESENIUS MEDICAL CARE

Dragonflies can see everything, all the time, all around. They have so many lenses on their head that nothing gets by them. When they see a predator approach, they can react in a fraction of a second. I wish I had the eyes of a dragonfly.

Seven years ago, my life required saving and I didn’t even know it. 

At that time, I was only 52 years old, a doctor for 27 years and a respected voice in my field. Considered healthy by all accounts, I was lying on an exam table watching my heart on a monitor during a routine evaluation that millions of Americans get every year. 

Because of my experience, I knew that the obstructed blood vessel on the monitor would require a serious procedure. Soon after, I underwent heart surgery. 

As a practicing kidney doctor, I have seen thousands of patients. I have explained the risks of “silent” kidney disease that could lead to a life of dialysis to many. But how often had I missed the signs of silent cardiac disease like my own? 

It made me think of my own medical vision – or lack thereof. I was somehow unable to look beyond what was right there in front of me. But what if I could see my entire health view like a dragonfly. What if our medical system as a whole could see the big picture?  

The body is much greater than the sum of its parts. Yet health professionals often look at things in terms of independent organs or disease processes.

Systemic diseases do not play by those rules. Comorbid conditions, the presence of more than one disease, can appear in as much as 25 percent of the population, according to a 2010 study by the Centers for Disease Control and Prevention. 

As medical professionals, we need to improve our ability to view patients’ complete health – otherwise we risk missing a host of interacting disorders.

A prime example is kidney and cardiac disease. A number of studies have shown that cardiac disease is the biggest killer among patients on dialysis, accounting for 20 to 30 percent of deaths. 

In our medical office, we are finding new ways to predict comorbidities through data, identifying patients at risk and ensuring our full view of their care is accurate. We are even looking at ways to predict complications and potential hospitalizations by allowing computers to read a nurse’s notes.  

Meanwhile, new genomic and proteomic tests hold the promise to help us better predict disease, and find the targeted treatments needed for improving outcomes. Can we help our patients with kidney failure avoid further complications from certain medications by better understanding their genomic profile? We must try and unlock the unique nature of each individual and respond with thoughtful therapies. 

When new simple predictive tests come along that are proven effective, we need to adopt them. A study by Johns Hopkins University showed that a simple blood and urine test used to identify people with kidney issues can also accurately predict an increased risk for heart and vascular disease. The U.S. Preventive Services Task Force should recommend aggressive screening with these simple tests for all adults.

Finally, we need to train physicians to spot the links between kidney, heart disease and related chronic conditions, as well as complete further research into these links. 

We should not let heart disease sneak up on our patients like it did to me. We need more active surveillance to link systemic conditions. It’s time to take what we learn from the dragonfly and apply it to medicine. A 360-degree view can save lives.

Franklin W. Maddux, MD, FACP
Chief Medical Officer
EVP of Clinical and Scientific Affairs

As we recognize American Heart Month in February, it’s important to understand the tight relationship between the kidneys and the heart. A growing body of research has documented the way kidney disease can trigger or worsen heart disease and how heart disease can destroy the kidneys. Learn more about the relationship in “A Cardiorenal Approach.”