Renal Remission and Hypertension Consultants is a 100% referral-based full-service nephrology practice. We have three areas of special expertise:
Chronic kidney disease, especially diabetic nephropathy, is traditionally viewed by medical professionals as a relentlessly progressive disease. In current guidelines and in generally accepted standards of care, effort is primarily directed toward slowing the progression of the disease and preparing the patient for dialysis or kidney transplant.
Recently developed multimodal intensive treatment protocols of several antihypertensive and lipid lowering medications make it possible to not only delay the progression of renal failure, but in up to 70% of cases to stop progression altogether (renal remission). In a small proportion of patients with previously progressive renal disease treated with these protocols, we see not only stabilization, but an improvement in renal function (renal failure regression). Medical professionals can access the History of Renal Remission presentation in the Presentations section of this website for more information.
The basis for our Renal Remission Clinic's protocols was developed by Drs. Piero Ruggenenti and Giuseppe Remuzzi in Mario Negri Institute in Bergamo, Italy, with contribution from Dr. Barry Brenner in Harvard, MA, USA. We use our version of their protocols, modified to better serve our older, predominantly Type 2 diabetic population. Our protocols also reflect the contemporary specifics of medical practice in the United States. The latest version of our protocols is available to medical professionals in Presentations section of this website.
Our experience with using these protocols in Type 2 diabetics is the largest reported in the medical literature or on the Internet. Medical professionals can access these results in the Presentations section of this website.
Individualized Hypertension Management
The Difficult to Control Hypertension Clinic was first developed to serve the needs of our Renal Remission Clinic patients, who as a group have notoriously resistant hypertension. Insights and experience gained in the process led to the development of a rational pathophysiologic-based approach to the evaluation and management of individual patients. Using our proprietary protocols, validated by our colleagues around the country, we achieve substantial improvement in blood pressure control, often with fewer medications. Medical professionals can access our protocols in the Presentations section of the website.
The experience of the Difficult to Control Hypertension Clinic was used in the development of the patented ACD/DC® tool for the management of uncomplicated hypertension. Using simple demographic and clinical data (Laragh's concept), a rotational approach to the administration of antihypertensive medications (modified Cambridge AB/CD tool), and aggressive discontinuation of ineffective or marginally effective medication (DC-tool®), we select the best, simplest, and most effective individual medication or combination of medications for each individual patient. This is a somewhat more involved and labor intensive process compared to the traditional “add (yet) another drug” approach, but we believe that this initial investment quickly pays for itself by accumulating over a lifetime the benefits of a simpler, less expensive medication regimen with less side effects. Medical professionals can learn more about the ACD/DC® tool in Presentations section of this website.
How Nephrologists Came to Atherosclerosis
Long term follow up of our Renal Remission Clinic patients revealed that concentrating on only one area of vascular medicine and only one set of methods, e.g. using antihypertensive medications to achieve a decrease in proteinuria and stabilization of renal function, does not afford significant cardiovascular protection by itself. Our patients, while in renal remission, continued to suffer and die from heart attacks, strokes, et cetera while receiving what was generally thought to be acceptable therapy—well within the established standard of care. We saw no other choice than to expand our prevention concept to the whole cardiovascular system and all cardiovascular events. Thus started our quest for the elimination of cardiovascular and renal morbidity and mortality in our patients.
We launched a pilot project of atherosclerosis regression in patients with bilateral or single functional kidney renal artery stenosis (who were not candidates for or who failed interventional treatments) in November of 2006. We started with existing protocols (see below) and modified them to our high risk population. We documented the regression of atherosclerosis by serial carotid intima to media thickness (CIMT) in a majority of patients. Remarkably, stabilization and improvement in renal function were also seen in patients able to achieve CIMT regression. This is the first experience of this kind, not yet described in any medical literature. From that point on the atherosclerosis regression project was expanded and offered to the rest of our Renal Remission Clinic patients.
After years of consultations with leaders in the field, such as Ross Tanner DO of Anchorage, AK, Brad Bale MD of Lubbock, TX, and Amy Doneen ARNP of Spokane, WA, with attendance by Drew Garcia PA-C of the Bale-Doneen Method preceptorship in Lubbock, TX we launched our own Atherosclerosis Regression Clinic. It can work in coordination with our other clinics for more complicated patients in our practice, or it can be offered as a standalone clinic for either primary or secondary prevention.
Our seemingly diverse expertise, spreading over at least four subspecialty areas, is in reality all about comprehensive management of systemic vascular disease. The disease can manifest itself as proteinuria and renal damage (nephropathy), coronary thrombosis and ischemia (atherosclerosis), or ischemic or hemorrhagic stroke (hypertension, atherosclerosis). Through intimate knowledge of pathophysiology, vascular biology, and the role of individual components in each patient, we are able to design individualized treatment plans and achieve our goal of adding quality years to our patients' lives.
We use a combination of “hard” endpoints (atherosclerosis regression by CIMT) and a number of “soft” endpoints (lipids, microalbuminuria, inflammatory markers, blood pressure, etc.) to determine the success of therapy and the need for more aggressive care. We aim at normalization of all soft endpoints and CIMT regression.
Speaking and Consulting Services
Dmitri Vasin M.D. is providing speaking and consulting services on topics related to hypertension, renal disease, renal remission, and high cardiovascular risk management.
Dr. Vasin can be contacted to schedule continuing medical education presentations to physicians, pharmacists, and mid-level providers, as well as pharmaceutical company-sponsored promotional presentations of various formats. Contact Dr. Vasin at firstname.lastname@example.org.