Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Kidney transplant recipient Charlie Cloninger and nephrologist Nauman Shahid discuss their article “How early care saved my life from silent kidney disease.” Charlie shares his personal story of being diagnosed with kidney disease while feeling healthy, making lifestyle changes with the help of his care coordinator, and ultimately receiving a transplant before dialysis. Nauman explains how early detection, coordinated care, and proactive treatment models are transforming nephrology and giving patients better outcomes. Together they highlight the importance of patient education, lifestyle support, and health care systems that reward prevention over crisis management. Listeners will take away both a patient’s perspective and a physician’s insights into how kidney disease care can save lives.

Our presenting sponsor is Microsoft Dragon Copilot.

Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click.

Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it’s backed by a proven track record and decades of clinical expertise, and it’s built on a foundation of trust.

It’s time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Charlie Cloninger and nephrologist Nauman Shahid. Together, they wrote the KevinMD article, “How early care saved my life from silent kidney disease.” Charlie and Nauman, welcome to the show.

Nauman Shahid: Thank you.

Charlie Cloninger: Thank you, Kevin.

Kevin Pho: Charlie, you shared your story on KevinMD. For those who didn’t get a chance to read it, just tell us a little bit about yourself and the story that you shared.

Charlie Cloninger: I’m Charlie Cloninger. I’m 77 years old. At 74, my doctor found some strange things going on with my blood and urine tests, so he referred me to Dr. Shahid to take a look and see what was going on with my kidneys. I went in to see Dr. Shahid. They evaluated me. Dr. Shahid came to me with a plan and said, “You do have kidney disease. Right now you’re in the treatment stage. You’re not in the transplant stage.”

He had a plan to keep me off of dialysis and carry me to a transplant. He put that plan into effect, and here I am today, happy, smiling, and ready to go.

Kevin Pho: Charlie, did you feel anything before you proceeded on that journey? You mentioned you had some urine tests that showed some abnormalities, but what exactly were you feeling around that time?

Charlie Cloninger: Actually, I wasn’t feeling anything that I didn’t blame on old age. I was just losing energy, had a little bit of memory loss, just the little mild odds and ends. But I just kept saying, “Well, hell, Charlie, you’re getting old.”

Kevin Pho: As far as you know, did you have any kidney issues before this journey?

Charlie Cloninger: I did not, but my mother actually died from kidney failure, kidney disease. I followed her through that and helped her with it but didn’t pay attention to what she was going through and didn’t realize that this was something that I could inherit and carry on and have.

Kevin Pho: Nauman, you’re Charlie’s nephrologist. Tell us how Charlie presented to you when you first met him.

Nauman Shahid: I remember three and four years ago, Charlie came to our office, much like any other patient who comes to our office and doesn’t know much about what’s going on. I can remember him being surprised, concerned, and uncertain about the future after our conversation. I remember that first and probably second meeting being rather stressful for him, with a lot of information and uncertainty. As Charlie said, he really didn’t have any symptoms out of the ordinary that he could put his finger on, which is very common for almost all of our patients that come and see us.

Interestingly, this is one of the bigger challenges that we in the nephrology community face, and also our colleagues in primary care: the patients are completely asymptomatic, even until very advanced stages of kidney disease. Helping them understand that that’s what’s going on is really very difficult for them to comprehend because they’re just feeling fine.

Kevin Pho: Nauman, when Charlie presented to you without a lot of symptoms, tell us the type of questions that he asked you and a little bit about that diagnostic journey, the tests that you recommended, and the path that it took to come to a diagnosis.

Nauman Shahid: The very first meeting, I and most colleagues generally spend time helping the patient understand what they have. That’s why this first meeting is so important because if you are unable to help your patient understand what’s going on, what the nature of their kidney disease is, and where everything is going to lead, you are going to lose a partner in the care. The very first meeting, we generally try to keep it very focused. We don’t talk a lot about specifics; we talk about general things: What are your kidneys? What are kidney functions? What is your kidney function? What is your risk of getting worse, and what are we going to do?

After that initial conversation with Charlie, I told him, “Charlie, we’ve got to do three things for you. The first is try to stabilize and stretch your kidney function for as long as we can. Number two, by using that time, let’s help you get a kidney transplant even before you ever need dialysis. Number three, because most of our patients like Charlie not only suffer from kidney disease but the complications associated like heart disease, diabetes, and vascular disease, while we are trying to do number one and number two, let’s try to save your health from these complications like a heart attack and stroke.” I said, “Charlie, these are the three things. We’ll bring your family next time. Let me know what other information you need. Let’s meet again in a few months and then talk about the specifics of each one of those.”

Kevin Pho: Charlie, as you met Dr. Shahid for the first time and had subsequent interactions with the health care team, tell us what was going through your mind as they were telling you about your kidney disease and all the implications from that.

Charlie Cloninger: Of course, I was thinking back about my mother and how she died from kidney disease. I was thinking about how she absolutely refused any dialysis and why she refused dialysis. Then Dr. Shahid had said, “We’re going to try to keep you off of dialysis.” So, I was just trying to do what I could do to get the results that Dr. Shahid was looking for. That was the main thing on my mind.

Kevin Pho: Charlie, just in general, tell us about the interactions that you had with Dr. Shahid and the other members of the health care team. What about those interactions was most important to you as a patient?

Charlie Cloninger: The very first thing was my confidence level. Dr. Shahid and his assistant were very confident, so my confidence level went up. Actually, believe it or not, one of the first things they treated was my depression, before they even treated my kidneys, it seemed like. I appreciated him so much. The plan: he had a plan, and he was going to work the plan. I appreciated that.

Kevin Pho: Nauman, when Charlie asked you these questions, tell us in terms of next steps. He mentioned that he wanted to stay off of dialysis. Tell us about that decision point that you as a nephrologist confront the patient with, that fork in the road of dialysis or not. What are some of the questions that you asked yourself to guide the patient along the right path?

Nauman Shahid: It’s a very important question. I’m glad you asked. One of the biggest things that we have to help guide which direction we’re going to go is how far advanced the kidney disease is. That’s where an early referral to a kidney specialist is so important. I’m glad in Charlie’s case, when he came to see us, he did have moderate to advanced kidney disease, but we felt that there was enough opportunity there to intensely focus on helping him stay healthy and get a kidney transplant.

Unfortunately, that’s not the routine. We still see a lot of patients who come to us very far advanced in the stage of their kidney disease, and for us, unfortunately, the first thing we have to do is talk and prepare them for dialysis, and then talk about transplant. For all nephrologists, our wish is that we are able to see patients relatively early in the stage of their kidney disease, much like Charlie, where we have an opportunity to do things that can potentially change the outcomes, which is avoiding dialysis for their lifetime or getting them a transplant.

Kevin Pho: Nauman, what was the ultimate kidney diagnosis that necessitated the transplant? And just talk in general about clinical outcomes.

Nauman Shahid: Kidney disease is complex and chronic, which means that it’s years and years of damage, something that has been going on for a very long time. Type 2 diabetes, type 1 diabetes, high blood pressure, obesity, and family history are all common risk factors for kidney disease. For patients who have some or all of these risk factors, the chances and risk of kidney disease go up. Having these patients come in with these risk factors to their primary care physician, getting screened for kidney disease with simple basic tests, and being referred to a nephrologist in a timely fashion is the key for management here.

Once in a nephrology office, traditionally, nephrologists have really just been given an opportunity at the later stage to help prepare them for dialysis. But I think with more understanding and realization of how important early referrals are, we feel there’s an opportunity for us to improve the outcome of our patients.

Kevin Pho: Charlie, when you first heard that you needed a kidney transplant, what was your reaction?

Charlie Cloninger: Actually, it was relief because I knew I had been riding the borderline and didn’t qualify. So when I heard that I qualified, it was a mental relief to know that something was really getting ready to happen. That’s when InterWell Health got involved. I met Ms. Kathy, and Ms. Kathy took me to a whole different level.

She was the lady that took me out. She introduced me to the kidney surgeons. She introduced me to the social workers. She let me talk with the insurance people. She showed me dialysis; she took me on a tour and showed me what dialysis was if I had to go that far, and she prepped me for the transplant. That’s when I really felt good and excited because something was going to happen.

Kevin Pho: Charlie, again, how important was that coordination of care? It’s not just one doctor; you have a whole health care team behind you. It sounds like in this case, this team was well-integrated, from the nephrologist like Dr. Shahid to the surgeon who did the operation. It sounded like there was a unified team behind you. How important was that for you?

Charlie Cloninger: It’s amazing. I mean, it is just totally amazing. I brag about my transplant team. I love the way that system works. Kathy was my direct contact, and InterWell Health directed me through it, introduced me to these people, and moved me where I needed to be when I needed to be there. In fact, she’s here today. I felt so confident. When I called them, they gave me an answer, and that’s all I needed. My confidence level was so great.

Kevin Pho: Charlie, how is your health today?

Charlie Cloninger: My health today is fantastic. I’m back to shag dancing and DJing. I didn’t coach football this year, but I’ve been coaching youth football up until this year. I took this year off because I don’t quite have the endurance that I want yet. I’m working on building back my endurance, but my health and feeling good, I’m feeling great.

Kevin Pho: Nauman, it sounds like in this case, early detection really led to a great outcome for Charlie. I’m a primary care physician; I do internal medicine. You said that screening and looking out for early symptoms are things that we in primary care should do. Specifically, what kind of tests, what kind of things should we be doing in the primary care setting that would potentially point to early kidney disease?

Nauman Shahid: I think in our modern-day evaluation, we are fortunate that measuring kidney function and measuring the signs of damage to the kidney in urine, such as protein leak, can be done fairly quickly and inexpensively. Identifying the high-risk patient population, which we just talked about, and making sure that those patients get their risk factors managed while getting stratification for the risk of kidney disease by these tests is key.

The other thing I’ll mention is that you said a magic word, which is coordination, the backbone of success to help patients with complex medical problems, particularly kidney disease patients like Charlie. It starts with early detection and education. The third final piece is coordination. It makes perfect sense in our office and sounds great, but unfortunately, it’s something that has not been done very successfully in our health care system. The reason is that the backbone of our health care system, the most prevalent form, is still fee-for-service, where margins are very narrow. It’s a volume-driven initiative that does not leave physicians and practices with enough resources to focus on all these three things. That’s where the transition away from fee-for-service to value-based care, to be able to help practices generate some additional resources that can then be utilized to provide education and care coordination, is so very important.

Kevin Pho: We’re talking to Charlie Cloninger and Nauman Shahid. Charlie is a kidney transplant recipient; Nauman is a nephrologist. We’re talking about the KevinMD article, “How Early Care Saved My Life From Silent Kidney Disease.” I’m going to end by asking each of you just to share some take-home messages with the KevinMD audience. Nauman, why don’t you go first?

Nauman Shahid: I would say to my primary care physicians and colleagues, thank you for screening your patients. Thank you for looking for kidney disease and early signs, and we are grateful for your timely referrals. This is key in our ability to help our patients do well.

My second message is to my patients and their families, much like Charlie. I know it is scary. I know there’s uncertainty. Educational knowledge is your friend. When you are in your physician’s office, look for opportunities for education. If they schedule you for an education visit, this is very important; go ahead and do that.

My third message is to my colleagues in nephrology. All of us have been talking for years that whatever we are doing does not seem to be enough. Our patients are just not doing well. I think there is an opportunity for us to change the paradigm, move away from fee-for-service to value-based care, and use these additional opportunities of care coordination, providing more resources to our patients, and helping our patients, their families, and communities in general.

Kevin Pho: Charlie, we’ll end with you. Share your take-home messages with the audience.

Charlie Cloninger: Don’t be afraid to talk to your doctors. Don’t be afraid to talk to your nurses and your PAs. If you’ve got something bothering you, talk about it because not knowing doesn’t mean you don’t have it. A lot of people think that, “Well, if he doesn’t say I got it, I don’t got it.” But the truth is, kidney disease is there. If you’re having problems, any kind of problems, don’t blame it on old age. Find out what it is. Get the knowledge.

Kevin Pho: Well, thank you everyone for sharing your story, time, and insight. Thanks again for coming on the show.

Nauman Shahid: Thank you.