Leonid Pravoverov, MD

Nephrology, KP Oakland

Optimal Renal Replacement Therapy

“Having the capability to change people’s lives is what drives me and my colleagues. We observe in a very real way how our coordinated efforts help people avoid complications and have a higher quality of life.”

Of all the contributions Dr. Pravoverov has made since joining The Permanente Medical Group in 2004, perhaps none is as impressive as his success in helping transform the lives of patients with end-stage renal disease (ESRD).

Just 1% of Medicare patients in the United States have ESRD, yet the care they require consumes 7% of Medicare pending. This is because their care is often complicated by blood stream infections, chronic inflammation, and stenosis of major blood vessels that result from the use of central venous catheters.

Dr. Pravoverov and his nephrology colleagues designed and implemented Optimal ESRD Starts, a remarkable dialysis program that reduces the use of these temporary catheters by getting patients started as early as possible on renal replacement therapy (RRT) via hemodialysis, peritoneal dialysis, or a preemptive kidney transplant.

Transitioning a patient from chronic kidney disease to early initiation of RRT involves tight coordination of a multidisciplinary team of nephrologists, vascular surgeons, general surgeons, social workers, and case managers. It also involves getting patients engaged early in the course of their disease by ensuring they understand what they’re facing and what their choices are.

Dr. Pravoverov’s drive to improve the quality of care for these patients, combined with his collaborative nature and creative approach to problem solving, enabled him to design a systematic and streamlined process that circumvents delays in care.

In 2010, just 2 years after the initiation of the program, 39% of patients began renal replacement therapy using an Optimal Starts method. In 2012, that number grew to 50%. Today 71% of patients with ESRD in Kaiser Permanente Northern California are starting RRT optimally, compared to 32% nationally.

“Dr. Pravoverov’s keen ability to work with multiple stakeholders and understand diverse viewpoints was key to his success in moving such an enormous effort forward,” says Stephen Parodi, MD, TPMG associate executive director. “He’s an outstanding clinician, physician leader, and innovator who led the TPMG dialysis program to achieve unparalleled success.”