40 years in nephrology: Reflecting on the past and looking to the future

U.S. Renal Care Senior Vice President and Chief Medical Officer Stan Lindenfeld, MD, retired last month after 40 years in the dialysis industry. The dialysis provider said it has not yet found a replacement. He spoke to me about his career, milestones in the field and where he thinks nephrology is heading. -by Rebecca Zumoff

NN&I: Tell us a little about your career in nephrology. Where have you worked?

Stan Lindenfeld, MD: I spent over 25 years in academic and private practice before transitioning into the dialysis industry as the founder of Total Renal Care, where I served as Chief Medical Officer from 1994 to 2002. During that time, the name was changed from Total Renal Care to DaVita. For the past eight years, I served as Chief Medical Officer for U.S. Renal Care.

NN&I: What attracted you to nephrology?

Lindenfeld: While I was in medical school, most of the department chairs were nephrologists, which had a tremendous impact on me. I grew to love the study of renal pathology and was fascinated by the groundbreaking research being conducted in the field renal physiology. It’s important to note that at that time, kidney disease was not thought of a chronic disease – there were no ESRD programs. As a third-year student, I had a mentor who truly inspired me and helped me solidify my choice of practice.

NN&I: How has the industry changed during your career?

Lindenfeld: The biggest change has been due to the consolidation of the industry from independent dialysis facility ownership to the current state where over two-thirds of the ESRD population is under the care of solely two organizations. There have been both positive and negative consequences from this but it has led to a more coordinated approach and centralized audience for CMS.

NN&I: What have been the biggest improvements in dialysis that you have witnessed?

Lindenfeld: One of most important improvements has been the recognition by the scientific community that the kidney is not just a filtering organ but an endocrine one. Another has been the ability of the biopharmaceutical industry to create the hormonal replacements for kidney function – notably the development of erythropoietin and active vitamin D. In addition, the improved monitoring systems for dialysis procedures have made dialysis significantly safer for the population.

NN&I: Where do you think the industry is headed?

Lindenfeld: Predicting the future is not always easy. That being said, I think a move towards recognizing the need to be more patient-centered has already begun. The outcome of the dialysis procedures and how patients feel about it is beginning to be viewed as just as important as the biochemical treatment.

Additionally, with the current research being done, it is my hope that within my lifetime there is a development of an implantable device or increasing the availably of donor kidneys for transplantation. That is truly my fervent hope.

NN&I: How do you think treating ESRD patients will change in the future?

Lindenfeld: The biggest focus must be a continued attempt in increasing the types of therapies that are available. This means specifically broadening the number of patients that are properly educated and treated with home care. We also must recognize that the senior population has a choice about their treatments. They need to be educated about the options for dialysis or choosing to forgo dialysis in the interest of quality of life. This must be a patient choice, and it is important to discuss with seniors and their families.

NN&I: What advice would you give a new nephrologist?

Lindenfeld: I’ve been involved in the treatment of patients for a long time, and my advice would be to recognize the gratification that comes from taking care of the dialysis population. Take the extra time to get to know your patients as people and not just patients going through the process. It’s not enough to just focus on the chemical outcomes, rather, talk to your patients and relate to their situation. It will make your service more rewarding. I would also be sure you are self-educating. By understanding all the treatment options available, including alternative therapies, you can provide a much better scope of care.

NN&I: What are your plans for retirement?

Lindenfeld: I will still be doing some part-time consulting with U.S. Renal Care. Beyond that, I plan to spend a lot of time reading, cycling and enjoying the beautiful outdoors in California.