Aja Best is a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant.

Crisis Point: Curbing the Chronic Kidney Disease Epidemic

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

CKD’s Emergence As A Public Health Crisis: Next Steps for Halting the Silent Spread

In recognition of National Kidney Month, this episode addresses the growing burden of 

 and its emergence as the biggest public health crisis of our time.

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. In many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited. While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Current estimates suggest 9 out of 10 people with kidney disease are unaware they have it, and 1 in 3 of those with severely reduced kidney function but who are not yet on dialysis are unaware they have kidney disease.

In addition to the need for better public awareness to facilitate early detection and treatment of CKD, patient-focused multidisciplinary care is also essential for improving outcomes. The burden of CKD cannot fall on nephrologists alone. Addressing this crisis requires a collaborative effort across the entire health care system but must be tailored in a way that ensures complete, equitable care for the patient.

Be sure to check out part 1 of this episode, which delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

In part 2, the conversation shifts to the importance of collaborative, multidisciplinary care that maintains a focus on patients’ wants and needs as well as the future of CKD care.

Brief descriptions of the speakers featured in this project are provided below:

, chief medical officer of the American Kidney Fund

, associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation

, chief executive officer of Carna Health

, a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

 to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

American Kidney Fund. Quick kidney disease facts and stats. Accessed March 5, 2025. 

https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

In part 2 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss strategies to address the CKD crisis.

Aja Best

Andrew J. Cutler, MD

 We can’t forget about insulin therapy. Insulin is a very effective tool. I talk about insulin as though it’s 1 thing, but there are many types of insulin being developed. One area that has seen a tremendous amount of evolution in recent years is the development of artificial pancreas systems. We have devices available that include both an insulin delivery component and a glucose sensor, or CGM [continuous glucose monitoring], component that are at least partially linked. The insulin delivery in at least some respect is directly affected by the ambient glucose level that the sensor detects.

We have a couple of devices that alter basal insulin delivery based on what the glucose level is, and that represents an exciting step forward. A true artificial pancreas—there are many such systems in development—would be completely hands-free or at least come very close. There are also a number of systems in development that include an algorithm or very sophisticated algorithms that alter insulin adjustment—not just for basal insulin delivery but for correction insulin or, to some extent, mealtime insulin in response to the individual’s activity and blood glucose level that will come a little closer. None of those hands-free systems are in development, but they’re getting closer.

We’ve seen published data, particularly in the pediatrics population, that look incredibly promising. Consistently, almost all the trials I’ve reviewed suggest that these kinds of systems reduce the risk of hypoglycemia compared with the traditionally available semi-integrated systems. The challenges we’ll see moving forward will be how these systems can be designed to account for meal intake, how to customize or appropriately deliver insulin in response to what the person is eating, and how the system reacts to hypoglycemia, should it occur.

Some of these systems are dual-hormonal systems that infuse not just insulin but also glucagon. Although none of these appear extremely close to becoming available, within the next 5 years, we’ll probably have multiple systems on the market that I hope will make life much easier for individuals who require these sophisticated insulin delivery systems. They’re not just for people with type 1 diabetes. These systems hold great potential for people with type 2 diabetes who need this intensive and complex treatment as well.

 Technology has certainly taken off. We have penny-size sensors for continuous glucose monitoring. We have subcutaneously implanted sensors. We get a lot of questions from patients who might not necessarily benefit from sensors. They may be cardiovascular patients or any patient with diabetes who says, “I’m on 2 medications. I’m on metformin, and my hemoglobin A1C [glycated hemoglobin] is 6.8%. Should I wear a sensor?” That’s probably not helpful. These are meant more for patients on complex insulin regimens or multiple daily injections, combined with insulin pumps and an algorithm used to semiautomate—at least for now—the basal rates.

If you look at the requirements from the FDA for diabetes medications, they’re very stringent on outcome trials. For durable medical equipment, we’ve never had an outcome trial, other than looking at time in euglycemia or hemoglobin A1C. We don’t know well whether using a pump vs multiple daily injections would reduce microvascular or macrovascular complications. I alway s thought that would be a very interesting area to explore. But much of this has to do with quality of life in addition to quality of care. More time spent in euglycemia, safer insulin use, shut-off algorithms—basal insulin in the middle of the night—etc. These are the main advantages of pumps and continuous glucose monitoring. It’s available with phone data, so it becomes much more user friendly. If you look at pictures of how the first pump, the backpack pump, was developed to now automated algorithms, it’s really taken off. Diabetes care will become much easier, much safer, and outcomes will become much better in the future.

Some of the most encouraging data for us endocrinologists and cardiologists have been from a large Swedish cohort that looked at mortality data in patients with diabetes, emphasizing the comprehensive care model. I keep citing the Steno-2 trial in every presentation because it sends the message of comprehensive care, where if patients are treated with their hemoglobin A1C and albuminuria protected, and smoking, LDL cholesterol, and blood pressure all under control—all 5 of those factors were under control in this large Swedish cohort—there was no significant excess mortality across every age group. This is really encouraging. We have all the tools available to do that. The challenge will be to bring this to the wider population and to fill a lot of the gaps that we’re dealing with.

 I completely agree. I briefly mentioned the GRADE study. We have just a few moments left, but some of the information that trial will ultimately provide will be a bit of insight into personal phenotypes and drug choices that may be particularly effective and tolerable for individual patients. I’m interested to hear more from that study about personal phenotypes, individual predictors of accomplishment of good glycemic control, and even benefits from a microvascular or macrovascular perspective within the various classes of drugs that were studied in that trial.

Thank you, Dr Bruemmer. I’d like to thank everyone for watching this 

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Expert clinicians discuss insulin therapy for treating type 2 diabetes and comment on what to look forward to in the future of diabetes care.

Insulin Therapy and the Future of Type 2 Diabetes Care

Dennis Bruemmer, MD, PhD

Panelists discuss how key nonpharmacological interventions include vaccinations to prevent infections, pulmonary rehabilitation to improve function, and lung cancer screening for high-risk patients to enable early detection.

Vaccination and Pulmonary Rehabilitation in COPD

Video content above is prompted by the following:

What nonpharmacological interventions should one consider for their patients, including vaccination, pulmonary rehabilitation, and lung cancer screening?

Emily Wan, MD MPH

emerging treatment options for gout and share tips for monitoring and managing gout in patients with comorbid conditions.

Emerging Agents in the Treatment of Gout

14:00 Mechanisms to improve uric acid excretion

15:40 Options for treatment resistant gout

25:50 Challenges in monitoring patients with gout

29:50 Management of gout in patients with comorbid conditions

In this discussion, experts focus on emerging treatment options for gout and share tips for monitoring and managing gout in patients with comorbid conditions.

Emerging Agents in The Treatment of Gout

Gordan Lam, MD

Grace Lee, MD, MPH, serves as a professor of pediatrics at Stanford University School of Medicine.

American Thoracic Society (ATS) International Conference

 in San Francisco, a presentation titled ‘Vaccines in the Crosshairs: Facing Contemporary Challenges in Immunization Science’ was given to attendees at the pulmonology conference.

One presenter, Grace Lee, MD, MPH—known for her work as a professor of pediatrics at Stanford University School of Medicine—addressed contemporary challenges in immunization science on the policy side. Her portion of the talk was titled ‘Vaccine Policy in Flux: Balancing Science, Policy, and Public Health.’

Vaccine Policies and Public Health Concerns in Immunization Science, with Grace Lee, MD, MPH

“From a scientific perspective, there's a huge opportunity in the world of vaccines in terms of advancing the scientific thinking about future innovations,” Lee said. “There was a great talk in our session by Kevin Harrod, who spoke about really precise vaccine design and what might be possible to actually tailor vaccines to be very focused on how we develop an immune response.”

Lee highlighted a variety of elements from her and her co-panelists’ presentations related to vaccinations. She also spoke to the policy perspective of public health concerns surrounding immunization science.

“What I would say is, from a policy perspective, we did speak a lot about what are the policy levers that can really impact innovation, and what the policy levers are that can affect hesitancy, as well as the levers that will actually help us think about how to continue to gain trust,” Lee said. “Trust in institutions, trust in providers, trust in data, and in the science. I think that continues to be a huge challenge for all of us.”

Lee noted her former membership on the Advisory Committee on Immunization Practices, highlighting 1 of the key components of that committee being its service to the public as a federal advisory committee, providing advice and guidance on the use of vaccines for the US civilian population.

“As part of the Federal Advisory Committee Act, one of the things that's really important to us is making sure that all decision making is done in public view,” Lee said. “So all meetings are announced in advance and are available for public both for public comment, written and oral, as well as for public to view what the public to view the decision-making process. I think that's really important, because decision-making behind closed doors doesn't engender trust. People may disagree with the decision, but at least everyone will have a look at the data that are out there, what we know and what we don't know.”

Lee later commented that she was impressed that the ATS put together a workshop looking at long-term complications of pulmonary infection, noting that this may in the future provide the chance to articulate the value of vaccines and the impact they can have on chronic conditions.

“One of the key takeaways is that the ATS has really put together a really forward-thinking workshop on how to better understand the impact of pulmonary infections on long-term outcomes in both children and adults,” Lee explained. “My hope is that with that framing, we'll be able to understand in a deeper way the impact long-term impact in one year or five years out of pulmonary infections on the health of our populations. [Hopefully we’ll be] able to articulate that vaccines not only prevent the acute infection, but also can promote long-term well-being and health.”

For additional information on this topic, view the full video above. To learn more about talks and new data presented at ATS 2025, view our 

The quotes used in this summary were edited for the purposes of clarity.

This interview at ATS 2025 highlights the talk given by Grace Lee, MD, MPH, regarding the policy side of public health concerns over widespread immunization.

Grace Lee, MD, MPH

Joseph Anderson, MD, is an associate professor of medicine at Geisel School of Medicine at Dartmouth.

Colonoscopy’s Role in CRC Screening, The Importance of Adequate Bowel Preparation

 is the second leading cause of cancer-related death in the United States, a stark reality that underscores the need for effective screening and prevention.

Each March, Colorectal Cancer Awareness Month serves as a reminder of the importance of early detection to reduce colorectal cancer’s significant impact. Colonoscopy remains the gold-standard screening tool, but its effectiveness relies heavily on adequate bowel preparation. Inadequate preparation can lead to missed lesions, prolonged procedures, and the need for repeat exams, diminishing its preventive power.

New guidance from the US Multi-Society Task Force on Colorectal Cancer (USMSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, provides clinical recommendations to address challenges related to bowel preparation for colonoscopy, focusing specifically on outpatients at low risk for inadequate bowel preparation.

In the first segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, discuss their work as co-authors on the recent USMSTF consensus statements and explain why adequate bowel preparation is so important in the context of colonoscopy.

Anderson begins by emphasizing the continued importance of colonoscopy as a cornerstone of colorectal cancer screening and prevention, particularly in the context of evolving noninvasive screening modalities. He highlights the comprehensive nature of colonoscopy, noting its dual role in both detecting and preventing colorectal cancer through polypectomy. While acknowledging the utility of noninvasive tests, both experts agree that colonoscopy remains the gold standard, acknowledging that even with noninvasive testing, a colonoscopy will still be required following a positive result.

The conversation then shifts to the critical role of bowel preparation in ensuring effective and complete exams. Anderson notes that inadequate preparation can result in missed lesions, increased healthcare costs, and the need for repeat procedures, undermining the value of the screening itself. He emphasizes that proper bowel preparation safeguards the efficacy of colonoscopy and protects patients from potential morbidity associated with incomplete exams.

: Brian Jacobson, MD, MPH, an associate professor of medicine at Harvard Medical School and director of program development for gastroenterology at Massachusetts General Hospital

: Joseph Anderson, MD, a professor of medicine at Geisel School of Medicine at Dartmouth and a gastroenterologist at White River Junction VAMC

Editors’ note: Jacobson has relevant disclosures with Curis and Guardant Health. Anderson has no relevant disclosures.

Jacobson BC, Anderson JC, Burke CA, et al. Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer. 

The American Journal of Gastroenterology.

Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. 

In the opening segment of this 6-part RX Review, experts discuss new USMSTF guidance on bowel preparation for colonoscopy.

Joseph Anderson, MD

To watch the video series component of this episode, click here.

1:35 Importance of early diagnosis of Alzheimer’s disease

05:48 The pathophysiology of Alzheimer’s disease

09:32 Screening for Alzheimer’s disease

21:37 Utility and practicality of PET scans

In this episode of MEDcast, expert geriatric psychiatrists explore the urgent need for effective diagnostic methods that can detect Alzheimer’s disease at an early stage. We will discuss blood-based biomarkers and other advancements that can help screen Alzheimer’s disease non-invasively and early in the disease course.

Screening for Alzheimer’s Disease: Facilitating an Early Diagnosis for Prompt Intervention

Marc Agronin, MD

Olivia L. Lee, MD, is a corneal disease and uveitis specialist at UCI Health.

Age Predicts Pterygium Progression in Phase 2 Analysis, With Olivia L. Lee, MD

A post hoc analysis from a Phase 2 trial of CBT-001, a topical multikinase inhibitor, suggests that younger age and recurrent disease are key risk factors for 

American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

, found that among 48 patients evaluated, those younger than 52 years and those with a history of recurrence were more likely to show disease progression over six months.

"We want to inform ophthalmologists who see patients with pterygia what the risk factors for pterygium progression are," Olivia L. Lee, MD, a corneal diseases and uveitis specialist at UCI Health, told 

. "There was a finding that the younger patients, less than 52 years of age, had a higher risk of progression, and the patients who had recurrent pterygia were at higher risk for progression."

Pterygium affects up to 15 million people in the US, but only 2.5 million have been diagnosed, and there is little evidence on the clinical characteristics correlated with pterygium progression. This post-hoc analysis measured data from a Phase 2 randomized clinical trial on the safety and efficacy of a topical multikinase inhibitor.

Lee and colleagues evaluated the link between disease characteristics at baseline from 48 patients (study arm, n = 25; placebo arm, n = 23) and through 6 months (placebo arm, n = 23). The team assessed baseline characteristics, including age, sex, pterygium type, duration of disease, symptoms, vascularity, and hyperemia using Spearman correlation coefficients (CC) for continuous variables and t-tests for dichotomous variables.

Upon analysis, pterygium length was associated with vascularity (CC, 0.64; 

 <0.001) and conjunctival hyperemia (CC, 0.473; 

 =0.001), but investigators found these factors did not predict pterygium progression (

 =0.160, respectively). Further progression occurred in patients younger than the median age (CC, –0.508; 

 =0.013) and those with recurrent pterygium (

Lee noted that patients with more hyperemia and more vascularity in the pterygia itself were associated with longer length, emphasizing the importance of monitoring these clinical features during assessment. Surgical intervention remains the primary treatment for pterygium, but managing recurrences remains a challenge.

"Those recurrent pterygia that, despite good surgical outcomes initially, tend to be more challenging to treat," Lee told HCPLive. "We're hoping that this drug, once it's approved, can be used for helping with these recurrent pterygia."

Lee indicated the Phase 3 trial of CBT-001 is underway, with one-year follow-up ongoing.

"The patients just finished enrolling, but we're still following those patients for one year," Lee told 

. "We’re very hopeful that we'll get good results from the Phase 3, and we can, at future meetings, tell you the progress towards FDA approval."

Hacopian A, Brunson PB. Patient Reported Outcomes and Visual Acuity after Bilateral Implantation of a Next Generation Presbyopia Correcting Intraocular Lens. Poster presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

Younger age and recurrent disease significantly increase the risk of pterygium progression, highlighting critical factors for ophthalmologists.

Olivia L. Lee, MD

In this MEDcast episode,Raj Chovatiya, MD, PhD, and George Han, MD, PhD interview Vivian Shi, MD, FAAD, to discuss the latest clinical evidence on the management of atopic dermatitis (AD) in different age groups and patient factors to consider when selecting a treatment for AD.

Authors