2. 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

3. 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.

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

5. Our Care Providers
Diverse background
Clinical and Research expertise

6. Glickman Nephrology Team

7. Glickman Transplant Team

8. Glickman Urology and Kidney Institute

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

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

12. Latest Technology in Patient Care

13. Remote Patient Monitoring
Patient-Generated Health Readings

15. 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

16. 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

17. 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

18. 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

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

20. Dialysis (international patients) An overview

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

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

23. 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

24. 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

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

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

27. Kidney Transplant (International patients)

28. Overview
Number of adult international kidney transplant evaluations in Cleveland Clinic (Cleveland)
=36 average ~3/y
=30 average ~10/y

29. Latest Innovation Kidney swap programs

30. US centers enrolled in NKR (National Kidney Registry)

31. 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

32. Kidney swap program

33. 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

34. 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

35. Our latest success story

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

37. 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