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Glickman Urological & Kidney Institute C L E V E GLICKMAN UROLOGICAL L A N D C L I N I C & KIDNEY INSTITUTE | G L I C K 2019 Year in Review M The Cleveland Clinic Foundation A N 9500 Euclid Ave. / AC311 U R O Cleveland, OH 44195 L O G I C A L & K I D N E Y I N S T I T U T E | 2 0 1 9 Y E A R I N R E V I E W 19-URL-5068 22877_CCFBCH_19URL4030_19URL5068_ACG.indd 29-31 2/6/20 3:06 PM CONTENTS 3 Glickman Kidney & Urological Institute at a Glance 7 Message from the Chairman 9 Two Clinical Trials, One Ambitious Goal to Personalize Kidney Medicine 11 A New Paradigm for Advanced Prostate Cancer Clinical Trials 13 Another Landmark Year for Cleveland Clinic’s Kidney Transplant Program 15 Getting It Right: Nephrologists Are Working to Minimize the ‘White-Coat Effect’ for Patients with Hypertension 17 ‘A FitBit for the Bladder’: UroMonitor Takes Monitoring Out of the Clinic 19 Virtual Reality Tool to Offer New Way of Understanding Renal Physiology 21 First Kidney Transplant Performed Using Single-Port Robot 22 2019 Achievements 28 Resources for Physicians ON THE COVER Georges Nakhoul, MD, Director of the Center for Chronic Kidney Disease, launched a virtual reality program to enhance the renal physiology learning experience for trainees. 22877_CCFBCH_19URL4030_19URL5068_ACG.indd 32-34 2/6/20 3:06 PM CLEVELAND CLINIC GLICKMAN UROLOGICAL & KIDNEY INSTITUTE | 3 Glickman Urological AT A GLANCE & Kidney Institute The Glickman Urological BY THE NUMBERS & Kidney Institute’s (2019) activities encompass a unique combination of high- 132,663 volume and challenging OUTPATIENT VISITS clinical cases, extensive basic and translational scientific efforts, and 14,098 innovative laboratory SURGICAL CASES research conducted in an environment that nurtures the future leaders of its 21,255 DIALYSIS TREATMENTS specialties. 3,029 ADMISSIONS 12,116 PATIENT DAYS 4.0 AVG. LENGTH OF STAY (DAYS) 22877_CCFBCH_Text_Rev1_3-10.pdf 1 2/6/20 3:23 PM 4 | YEAR IN REVIEW 2019 VITAL STATISTICS & RANKINGS INSTITUTE VITAL STATISTICS 65 Urologists 28 Nephrologists 33 Advanced Practice Providers 30 Urology Residents 22 Urology Fellows 9 Nephrology Fellows 292 Caregivers SURGICAL CASES 532 Benign Prostatic Hypertrophy 1,157 Endourology and Stone Disease 1,555 Female Pelvic Medicine and Reconstructive Surgery 235 Male Fertility 642 Pediatric Urology 429 Genitourinary Reconstruction U.S. News & World Report has 204 Renal and Pancreas Transplant consistently ranked Cleveland 3,256 Urologic Oncology Clinic urology and nephrology among the country’s top programs for the past two decades. 22877_CCFBCH_Text_Rev1_3-10.pdf 2 2/6/20 3:23 PM CLEVELAND CLINIC GLICKMAN UROLOGICAL & KIDNEY INSTITUTE | 5 PATIENT ORIGINS 88 COUNTIES 50 U.S. STATES 70 COUNTRIES CENTERS DEPARTMENT OF NEPHROLOGY › Blood Pressure Disorders › Chronic Kidney Disease › Dialysis › Kidney Stones › Renal and Pancreas Transplant › Renal Diseases DEPARTMENT OF UROLOGY › Endourology and Stone Disease › Female Pelvic Medicine and Reconstructive Surgery › Genitourinary Reconstruction › Male Fertility › Men’s Health › Minority Men’s Health › Pediatric Urology › Renal and Pancreas Transplant › Robotic and Image-Guided Surgery › Urologic Oncology 22877_CCFBCH_Text_Rev1_3-10.pdf 3 2/6/20 3:23 PM 22877_CCFBCH_Text_Rev2_6-6.pdf 1 2/10/20 9:06 AM CLEVELAND CLINIC GLICKMAN UROLOGICAL & KIDNEY INSTITUTE | 7 MESSAGE FROM THE CHAIRMAN DEAR COLLEAGUES, I am humbled and honored once again to present In other clinical innovations, our nephrology and Cleveland Clinic Glickman Urological & Kidney hypertension team, which was again recognized Institute’s 2019 Year in Review. I hope you will view as a Comprehensive Hypertension Center — one this publication as a reflection of our commitment to of only eight in the nation — continues to expand advancing patient care, leading research discoveries its ambulatory blood pressure monitoring program. and training the next generation of physicians. The center provides 24-hour monitoring for a large cohort of patients to accurately diagnose and treat We are extraordinarily proud to have received the blood pressure disorders. distinction of best nephrology and urology programs, respectively, in Ohio in the 2019 U.S. News & In 2018, we launched the Center for Genitourinary World Report “Best Hospitals” survey. Our training Malignancies Research, a virtual center designed to programs also continue to attract rising stars within accelerate research findings to advance diagnostic the two fields. and therapeutic approaches for patients with cancers of the prostate, kidney and bladder. The Our nephrology fellowship programs (nephrology and generosity of patients has allowed us to establish hypertension, and kidney transplant) offer a unique, two endowed chairs for this program, which we will didactic training experience. As you will read, we use to recruit new faculty to expand this work. recently announced a virtual-reality program through the Oculus Quest® platform to enhance the learning These achievements, above all, illustrate our experience and knowledge base for our nephrology commitment to delivering the best possible care fellows. We are also proud to share that our to patients. As Teddy Roosevelt once observed, urology residency program once again earned a top “Nobody cares how much you know, until they know ranking in the Doximity Residency Navigator for the how much you care.” Everything we do is in the 2019/2020 academic year. service of caring for patients. Our team continues to demonstrate innovation in Thank you for your interest in our program. I hope robotic and image-guided surgery. This year we were you enjoy reading about the Glickman Urological & the first in the world to perform a kidney transplant Kidney Institute. using the daVinci SP® Surgical System. Our kidney Sincerely, and pancreas transplant program, a collaborative effort between Nephrology and Urology, had another record-breaking year in transplant volume and outcomes. We are also pleased to be at the helm of clinical innovation in our female pelvic medicine program. Eric A. Klein, MD Our team recently launched a clinical trial using the Chairman, Glickman Urological & Kidney Institute UroMonitor, a wireless device that is designed to Professor, Cleveland Clinic Lerner College of Medicine monitor bladder function in real time. LEFT — ERIC A. KLEIN, MD 22877_CCFBCH_Text_Rev1_3-10.pdf 5 2/6/20 3:23 PM 8 | YEAR IN REVIEW 2019 2019 HIGHLIGHT TWO CLINICAL TRIALS, ONE AMBITIOUS GOAL TO PERSONALIZE KIDNEY MEDICINE Cleveland Clinic began enrolling its first patients in two multicenter, NIH-sponsored studies this year. Both trials aim to develop personalized strategies to prevent, treat and manage kidney disease. John Sedor, MD; Emilio Poggio, MD; and John chronic and progressive kidney disease,” says Dr. O’Toole, MD, nephrologists in the Glickman Poggio. “We are examining the implications of the Urological & Kidney Institute, lead the Cleveland mutations on kidney transplant recipient outcomes.” Clinic arm of the Kidney Precision Medicine Project (KPMP) as one of six recruitment sites — and 14 This work complements the ongoing basic institutions overall — involved in the study. investigations in Cleveland Clinic Lerner Research Institute to identify the mechanisms by which The primary goal of the KPMP is to understand and APOL1 causes progressive kidney diseases, in differentiate kidney disease phenotypes at a genetic the laboratories of Drs. Sedor, O’Toole and Leslie and molecular level. The leaders of this initiative Bruggeman, PhD, another staff member working in hope this information, taken together with clinical this area. They are all consultants on this project. data, will lead to personalized approaches to treat diabetes, hypertension, and acute and chronic Patient and community-centered involvement kidney diseases. Further, Dr. Poggio notes that both the KPMP and “This is where we must improve. Therapeutic APOLLO studies foster patient and community- development for kidney disease has lagged behind centered involvement, something he has seldom over the last decade or so,” says Dr. Sedor. “There observed in studies at this scale. There is a council is no one-size-fits-all approach to treating patients of patients and community members who work with kidney disease. We need more targeted alongside the team to develop study protocols, therapies.” including consent documents. “They come to every meeting. They participate in every phone call,” he The strategy is to build a robust repository of patient says. “It is very helpful for them to be involved in the samples and leverage new research technologies entire process — from the question to the answer.” to investigate kidney disease in a patient — or a particular set of patients — in the context of For KPMP, patients are chiefly concerned with environment, lifestyle and genetics. shaping safety protocols, which is important as biopsy does have some inherent risk. APOL1 Dr. Poggio is also an investigator on the APOL1 disproportionately affects patients in the African Long-term Kidney Transplantation Outcomes American community, so having these patients Network (APOLLO) study. It also just enrolled its involved in the conversation about protocol first patient this year. Cleveland Clinic is one of 13 development for the trial has been very helpful and clinical centers in the U.S. that will prospectively important, notes Dr. Poggio. enroll living kidney donors and recipients of kidney transplants from donors of African descent. These Dr. O’Toole remarks that both research initiatives transplants have an increased risk
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