After earning his medical degree at Emory University, Tom Watson, MD continued his training in Internal Medicine and Nephrology at New York-Presbyterian Hospital of Cornell University. In 2008, he joined Nephrology Associates in Birmingham.

What is the state of kidney disease today?

Approximately eight to ten percent of people in the world have some level of kidney disease. It’s a bigger number than most people would think. It’s so prevalent that there is at least one dialysis clinic in almost every county in Alabama. In many cases it’s a mild problem, but in some, it can be very significant. And even in younger people, the main problem we see is that some percentage of that large number of people will get worse with time and develop kidney failure. There are approximately 600,000 to 700,000 people in the United States suffering with kidney failure, and that requires a transplant or dialysis.

What are the main causes of kidney disease?

The major cause is diabetes. About 30 percent of people with type 2 diabetes will develop kidney disease. Number two would be high blood pressure, and then we get into some combination of autoimmune diseases like lupus.

There are also some genetic diseases. The most common is an inherited form of polycystic kidney disease where the kidneys are replaced by cysts, just bags of fluid. One other genetic cause that has been recently discovered is a mutation of the Apolipoprotein A1 gene, which is seen mostly in people of West African descent. And that confers as a much as a tenfold higher risk of kidney failure compared to the general population. It’s just terrible. And we’re hoping for some treatments to come down the path.

What are the treatment options for kidney disease?

Most people are treated at dialysis centers. They have to go 13 times a month, and they may have other doctor appointments, as well. When someone has to give up half a day, three days a week for the treatments, that person usually can’t work. And then their children or family members have to take a day off work to get them to an appointment. So it’s extremely burdensome.

10 to 15 percent of patients will choose home dialysis. In this case, a nephrologist will help educate and support them, and train them to provide their own care. There’s a learning process, but it’s not so hard that a patient can’t be trained to do it on his or her own, and that provides them with much more freedom and they feel better.

What is the current state of kidney transplants?

There’s a major waiting list for kidney transplants. In Alabama, the wait can be three to five years,  depending on your blood type and other things. Another way is to find someone who is willing to donate one of his kidneys to you. This could be a family member, but it doesn’t have to be. For example, I had a patient who was willing to ask anybody. A man came to his house to fix his washing machine, and the washing machine repairman ended up giving him a kidney.

The donor, of course, will go through the stress of surgery and miss a month or more of work. Now there’s discussion in Washington about supporting donors during that time so it wouldn’t be a financial hurdle.

There are also donor chains. An example would be a husband who wants to donate a kidney to his wife, but he has type B blood, and wife has type A, so he can’t donate. But out there, there’s another somebody with type A. So there’s a donor registry, several different ones throughout the nation and statewide that transplant centers use to match donors with recipients.

Some of the more exciting things recently are the pig transplants, xenotransplantation. It’s showing the promise of what it could look like to have an almost unlimited supply of organs to be able to transplant. Now that’s well down the road. But they’ve made some significant strides in proving that a pig kidney that’s been genetically engineered to be transplanted into a human could survive the first two or three days at least. So it’s a start.

Have there been any new medicines for kidney disease?

In the 1990s, ACE inhibitors and angiotensin receptor blockers became standard therapy for patients with kidney disease. And in the last five to 10 years, they’ve developed some new medications, especially for diabetics, but also for anybody with kidney disease, especially those who have any protein in their urine. These are SGLT2 inhibitors. Farziga and Jardiance are the two most commonly used ones. They’ve shown incredible improvements in the prevention or worsening of kidney disease, but also preventing heart related complications as well as hospitalizations and death.

I understand there are new payment models?

Yes. So kidney disease patients are some of the most expensive to the medical system because in addition to the cost of dialysis, these patients have higher hospitalization rates, an increased rate of heart disease, along with higher rates of cancer and need for chemotherapy. So Medicare and private insurers are motivated to improve matters for these patients in ways that will also result in lower costs to the healthcare system. The result is what some call “value-based care.” We prefer to call it “physician-driven patient-centered care.”

So our practice has partnered with Evergreen Nephrology to help patients with better healthcare education, disease prevention, care coordination, dietary education, and general support in an effort to prevent kidney disease from worsening, to prevent hospitalizations, to increase planning and uptake of kidney transplants, and when dialysis is necessary, to focus on home therapies that are often better for quality of life.