Innovation or Problem? KidneyX's Sustainability Prize

Jennifer Kang posed a question to our team, "What comes first, an innovation or a problem?" I've been wrestling with this question throughout my career, so my sticky note answer didn't help and probably killed the chicken-or-egg analogy when I said "both".

One of the hardest decisions for any innovator is choosing a "concept" that commits resources to demonstrate "proof-of-concept". A single problem is rarely solved by a single innovative technology, often for reasons beyond the scope of well-intentioned tech development. On the flip side, focusing on a single problem (particularly during the early stages) could limit the potential impact of an innovative technology. The line of compromise between innovation flexibility and problem-solving focus is everchanging, with a world full of examples where a solution being developed to address "X" was re-focused to address "Y". Pfizer's Viagra is an often-cited example because it was originally developed to treat hypertension until a side-effect became its new problem statement.

Focusing innovators on "Y" by defining a solvable problem

The ASN and HHS KidneyX teams just wrapped up our latest competition, focused on reducing the impact of dialysis treatment on our climate. The problem statement was summarized in ASN's Statement on Climate Change by an ASN task force led by Zach Kribs in 2022. The authors highlighted statistics, such as, "Hemodialysis, in particular, is an extremely water and power-hungry therapy, consuming approximately 156 billion liters of water and 1.62 billion kW/h of power in the treatment of around 2 million people per year." This Statement concluded with a call for technological and process innovations that reduce the impact of dialysis care on our planet.

It's not just the impact on the climate, this reliance also threatens access to a life-sustaining treatment that needs to be administered multiple times in a single week. All healthcare facilities are vulnerable to natural disasters and resource outages that also disrupt patient transport and communications. But, the extraordinary dependency on water and energy resources for dialysis treatment flags a significant vulnerability in providing this type of care.

As ASN's statement describes, dialysis facilities are heavily reliant on continuously supplied municipal drinking water. Each facility also requires a reliable source of power for operations and purifying water through reverse osmosis. This energy-intensive purification process results in only a fraction of water making it to a dialysis machine, with a majority of water (50-70%) discharged as sewage. A generator won't be helpful if there is also a water outage and it probably wouldn't be able to keep up with the energy demand for water purification.

And here we have a complex problem that could be solvable by multiple shots on goal.

Understanding how innovations can solve problem statements

The KidneyX Steering Committee, chaired by John R. Sedor, MD, FASN, reviewed the ASN Statement and assessed the diversity of technological and scientific approaches that could be redirected to ASN's call-to-action. No other groups were supporting these types of innovators toward this problem statement and the urgency was palpable, leading to a Steering Committee recommendation on the KidneyX Sustainability Prize.

In partnership with colleagues at HHS, Suzanne Watnick organized a roundtable that convened patients with management, nurses, and technicians from various dialysis facilities. I was shocked to learn that many kidney patients requiring dialysis treatment relocated their families to cities that are less prone to natural disasters because of concerns about uninterrupted access to care. One example was the Gulf Coast versus the Northeast, but even those analogies aren't steadfast as we've seen with recent hurricanes and wildfires.

Dr. Watnick also hosted a site visit to the water treatment room of a local dialysis facility. This blog describes an ideal set-up, but the room we visited was chaotic and crammed with signs of past leaks, corrosion, and enough chemicals in the air to make my eyes water. I left wondering why yesterday's methods couldn't be replaced with the latest water purification approaches seen in other sectors. Just when we thought the problem statement was on water and power demands, the site visit showed that the complexity of water purification adds tasks to the operational readiness for any dialysis facility, including maintaining pipes and multiple pieces of equipment in a corrosive environment while ensuring sufficient supplies of water-softening salt.

Problem <> Innovation: are we done?

Now that the competition has concluded, we know there is a diversity of innovators who could address the Call-to-Action in ASN's Statement, beyond those whom we could award. $7.25 million distributed to seven technology innovations seems like a lot of support but pales in comparison to what is needed to develop, evaluate, and scale any of these technology solutions for one or multiple dialysis facilities (or networks).

We are far from "mission accomplished" and exploring partnerships that can further these and other innovations to simplify the logistics, reduce resource demands and vulnerabilities, and ensure reliable access to dialysis treatment.

Do you know someone who wants to partner with us?