Overview of our Mission Glickman Urology & Kidney Institute June 22, 2018 Ziad S. Zaky, MD Transplant Nephrology staff, Glickman Institute Assistant Professor of Medicine Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Clinic, Cleveland, OH, USA

Financial disclaimer I have no financial relationships to disclose within the past 12 months relevant to my presentation. My presentation does not include discussion of off-label or investigational use. I do not intend to reference unlabeled/unapproved uses of drugs or products in my presentation.

Outline: 1- Nephrology & Hypertension Overview & recent advances Opportunities for potential growth 2- Dialysis Overview 3- Kidney Transplant

Our Care Providers Diverse background Clinical and Research expertise

Glickman Nephrology Team

Glickman Transplant Team

Glickman Urology and Kidney Institute

Outline: 1- Nephrology & Hypertension Overview & recent advances Opportunities for potential growth 2- Dialysis Overview 3- Kidney Transplant

Nephrology and Hypertension An overview Acute and Chronic kidney diseases Renal Stones Autoimmune & Cystic diseases Hypertension Lab Inpatient Dialysis Infusion Center

Latest Technology in Patient Care

Remote Patient Monitoring Patient-Generated Health Readings

App Download and Device Set Up To begin the process, patients will be directed to the Apple® App Store SM or Google Play TM store to download their device specific app

Data Integration into Epic Current available Epic Orders: CONNECTED HOME BLOOD PRESSURE MONITORING CONNECTED HOME GLUCOSE MONITORING CONNECTED HOME PULSE OXIMETER (SpO2) MONITORING CONNECTED HOME TEMPERATURE MONITORING CONNECTED HOME WEIGHT MONITORING CONNECTED HOME ACTIVITY MONITORING

In-basket Messages After the initial set up, the care team* will receive inbasket message notifications for abnormal readings as well as weekly readings. All data is able to be displayed graphically. *Care Team needs to be identified in the order as either individual names or a specific pool

Nephrology & Hypertension(International patients) Opportunities for potential growth Expanding virtual visit technology for initial consultations and follow up for overseas Medical concierge Medical plan, care providers & ancillary services

Outline: 1- Nephrology & Hypertension Overview & recent advances Opportunities for potential growth 2- Dialysis Overview 3- Kidney Transplant

Dialysis (international patients) An overview

Dialysis (international patients) (Stephanie Tubbs Jones Health Center) 1791 dialysis sessions 1781 dialysis sessions 1529 dialysis sessions

Out patient Dialysis (International patients in USA ) Fresenius medical care (~70%) Davita (~30%) (courtesy of market intelligence research of FMC-NA)

Embassy Sponsored International Dialysis Patients 2015   Referral Sources Total number of patients Cleveland Billing (Michigan) Lake side Billing (Florida) 2 Mesa Billing (JH - Baltimore) Peachtree Billing (Cleveland Clinic) 27 Tayler Billing (Texas) 3 Indianapolis Billing (Arizona & CA) 2016 23 55 1 2017 13 39 6 Courtesy of Tesfa Seyoum, MBA Sr. Manager, Domestic & International Travel Program, Fresenius Medical Care-North America

Embassy Sponsored International Dialysis Patients in USA FMC dialysis 2017 Data Courtesy of Tesfa Seyoum, MBA Sr. Manager, Domestic & International Travel Program, Fresenius Medical Care-North America

Dialysis (international patients) Opportunities for potential growth Streamline the process of dialysis start State-of-the-Art dedicated dialysis unit Self sponsored patients

Outline: 1- Nephrology & Hypertension Overview & recent advances Opportunities for potential growth 2- Dialysis Overview 3- Kidney Transplant

Kidney Transplant (International patients)

Overview Number of adult international kidney transplant evaluations in Cleveland Clinic (Cleveland) 2001-2013=36 average ~3/y 2014-2016=30 average ~10/y

Latest Innovation Kidney swap programs

US centers enrolled in NKR (National Kidney Registry)

Kidney swap program In 2016 a Kuwaiti husband wanted to donate a kidney to his wife who has been on dialysis for 2 years, but he is not a match. They have been married for 10 years, have 4 kids, all potential donors have been declined due to (non compatibility) In November 2016 they were enrolled in the kidney swap program in Cleveland Clinic

Kidney swap program

Kidney swap program Donor’s center Recipient’s center Brigham & Women’s, MA Cleveland Clinic WalterReed, MD Colorado, CO Hershey, PA Penn State, PA Madison, WI Legacy, OR Georgetown, DC Date of surgery 12/1/16 12/6/16 12/14/16 12/15/16

On December 1st 2016, his wife received a kidney transplant from a donor from Boulder, Colorado On December 6th 2016, he donated to a recipient from Hershey, Pennsylvania Mojeb from Kuwait donated to his wife Wasmeyah in December 2016 via NKR

Our latest success story

Kidney transplant (International patients) Opportunities for potential growth Expanding the kidney swap program to international patients Streamlining and remote screening of potential donors & recipients

Cleveland Clinic transplant numbers in one snap shot Organ Start year Number of transplants Kidney 1963 5005 Liver 1984 2601 Heart 1914 Pancreas 1985 418 Lung 1990 1772 Intestines 2008 108 Total organs 11818