Complexity a Calling for University Hospitals Ahuja Nephrologist
June 11, 2023
UH Clinical Update | June 2023
What do cars and kidneys have in common? Both are marvels of engineering, says nephrologist Andrew Lazar, MD, and he is drawn to the complexity in both.
Andrew Lazar, MDDr. Lazar, an independent physician who is Medical Director of Dialysis Services at UH Ahuja Medical Center, studied biomedical engineering as an undergraduate student at Boston University. He then spent the first five years of his career at General Motors, both in Michigan and in Canada, working in the powertrain division and writing software to enable fluid dynamics work. But he says he always somehow knew that he would ultimately become a physician.
“I kind of always knew that I would probably want to go back to medical school at some point,” he says. “But my expertise has always been writing software, which I still do – now medical applications. I really like bringing my old life and my new life together. Medicine has been so wonderful, and being an engineer, nephrology is a good fit.”
A Trusted Consultant
At UH Ahuja, Dr. Lazar has been a near-constant, caring presence ever since the hospital opened 11 years ago, says Chief Medical Officer Jessica Goldstein, MD.
“From day one, he made himself available for consults 24/7 and soon the nephrology service became synonymous with Dr. Lazar,” she says. “He routinely carries a consult census in the 20s-30s and takes pride in caring for our sickest patients. He takes the time to coordinate care with other consultants and keep families informed on the plan of care. He advocates for his patients to become more independent with peritoneal dialysis and home dialysis. In addition, patients trust him to guide them through end of life discussions and to advocate for them.”
These conversations are never easy, Dr. Lazar says, and it often takes more than one.
“In my field, we are often at that crossroads with people,” he says. “The easy thing for me to do is to not have this conversation put in a dialysis line and get dialysis going. The harder thing is to take the time and to and to share from my heart that I think that we would be prolonging suffering. I've come to prioritize and just do a little bit less of other things that I would like to do to make sure I have the time to devote to where it really matters, and it's these conversations.”
Dr. Lazar was recently recognized for this empathetic approach to care with a “Dinner with the Doc” honor from UH CEO Cliff A. Megerian, MD, FACS, Jane and Henry Meyer Chief Executive Officer Distinguished Chair.
Other Avenues for Impact
In addition to his work in patient care at UH Ahuja, Dr. Lazar is currently pursuing several projects that promise to improve the standard of care for all nephrology patients. He is working to further commercialize a dialysis safety device that he invented and patented. It’s an alarm that goes off when the venous needle on the dialysis machine becomes accidentally dislodged when a patient is sleeping – something that is available for the arterial needle, but not the venous one. These events – venous needle dislodgements (VNDs) -- can be deadly, Dr. Lazar says.
“Patients can literally exsanguinate,” he says. And it happens a lot more than you would think, maybe two deaths a week across the U.S.”
Dr. Lazar has also taken on a new role directing clinical trials for the Department of Nephrology, with the operation located near UH Ahuja to make patient participation more convenient. One key trial they’re enrolling for is a new drug called Inaxaplin, which targets the apolipoprotein 1 (APOL1) mutation known to be a specific risk factor for chronic kidney disease among African Americans.
“There's a very important racial disparity problem in medicine, and especially in chronic kidney disease,” he says. “About 35 percent of all patients who are on dialysis are African American, despite comprising only 13 percent of the population. Some of this is socioeconomic, but some we’re learning is genetic. I’m going to be a principal investigator in the Phase 3 study here, and we are trying to identify patients who have APOL1 kidney disease. Of all the trials I've ever been involved with, I’m more passionate about this and helping fix the racial disparity problem. I want the people in the community to know that we care.”
Building Confidence Among Patients
Dr. Lazar is also a tireless advocate for getting his patients to embrace home dialysis.
“Home dialysis is frankly grossly under-utilized,” he says. “We are still at approximately 10 to 12 percent of patients in the United States doing dialysis at home. That’s about 10 percent doing peritoneal and about 2 percent doing hemodialysis at home. We need to move that needle. We need to double that within the next decade.”
The key to achieving this lofty goal, he says, is empathy and effective patient communication.
“It's going to be hard to achieve,” he says. “The only way is for people to really trust you. When I talk to a patient and their family and I’m doing that education, I really explain to them, in the right words, at their level, the chances of having a good outcome. It's our obligation to give them every single option because dialysis just sucks. We have to make sure that we lighten the blow as much as possible. Home dialysis is not for everyone. But people can do more than they know. That's how you move that needle.”
Congratulations to Dr. Lazar for his “Dinner with the Doc” honor.