Innovations in Kidney Disease: Chirag R. Parikh, MD, PhD Faculty Spotlight

“India has a wealth of engineers, programmers, and analysts, making it an ideal place to build healthcare infrastructure. By combining expertise from Johns Hopkins with the needs in India, I believe we can expect immense progress in improving care and expanding access.”

Dr. Chirag R. Parikh, Director of the Division of Nephrology and Professor of Medicine, was drawn to nephrology by the interplay of chemistry and mathematics. His curiosity was sparked by the question of how such a small organ could have such a profound impact maintaining body homeostasis.

This question led him to a career as a physician scientist, where his work as a nephrologist focuses on the care of patients with inpatient and outpatient kidney diseases, as well as kidney disease in the community.

“Kidney disease disproportionately affects certain populations, so improving access to care and decreasing disparities is a major challenge that we have to work very hard to address.”

Dr. Parikh’s interest in nephrology was further fueled by the opportunity to integrate groundbreaking ideas in treatment and devices. The wealth of laboratory data available to nephrologists, according to Dr. Parikh, makes the field particularly well-suited for the use of artificial intelligence and machine learning in disease management and treatment.

“Kidney disease allows a lot of room for innovation. An example is with the dialysis machine, there’s a lot of room for device innovation when working with engineers and other chemists,” Dr. Parikh explained. “You can always make the machines smaller and more efficient, and someday we’ll have an artificial machine inside the body or that can be carried as a backpack.”

With his training in translational research and clinical investigation, he and his team have discovered several biomarkers found in blood and urine tests that can either help with the screening of kidney disease and risk assessments, or help with therapeutic treatment strategies. However, there have also been challenges.

“Dialysis has been around for 40 or 50 years, but I don’t think we’ve made meaningful progress in the machines. In this time period, devices such as radio, tape recorders and video recorders have vanished. We have seen a smartphone revolution, but somehow dialysis machines are still where they were,” he explained. “Part of it, I think, is because it’s an extremely regulated industry and the financial reimbursement systems do not promote innovations.  We need to break some barriers with help from engineers and AI experts to make this happen faster.”

“I also lead the Precision Medicine Center for kidney disease, and we do a lot of regression models and data science methods where we predict the future events and we roll it back to physicians so that they can offer this to the patients,” he said. “The goal is to do similar innovations in India on a larger scale.”

Bridging the Gap with India

Dr. Parikh, who was born and raised in India and attended medical school at Seth GS Medical College and KEM Hospital, has a unique insight into how Johns Hopkins can work together with India when it comes to AI and nephrology.

“I think a huge opportunity lies here. India is about 10 years behind the U.S. in terms of electronic medical records and data integration, but they have the advantage of skipping the mistakes we made. They can leapfrog inefficient processes and advance much faster,” he explained. “India also has a wealth of engineers, programmers, and analysts, making it an ideal place to build healthcare infrastructure. By combining expertise from Johns Hopkins with the needs in India, I believe we can see immense progress in improving care and expanding access.”

He notes that there are many important facets that need to be addressed in research coming out of this partnership, from patterns of care (and how it’s being delivered), whether there are there any gender or socioeconomic disparities, and analyzing the evidence of how medicine is practiced in India.

“It can be handled very quickly once we see what the data tells us,” Dr. Parikh said. “We also need to develop benchmarks and report cards around dialysis units that would help people reach the goals of usage. You have to prescribe a certain amount of dialysis so that the patients maintain quality of life, but all this is yet to be standardized in India.”

“India is also shifting focus from communicable diseases to non-communicable diseases like kidney disease,” he explained. “It’s estimated that 20 percent of Indians have kidney disease, but less than 10 percent know it. Addressing this will be a major opportunity for improving health care.”

To work toward this goal, he’s collaborated with many different groups in India. He has been a consultant and on the Scientific Board for the Apex Kidney Foundation, which is a nonprofit dialysis group of nephrologists in India, and is working with the president of the International Society of Nephrology from India.

In addition to his research, Dr. Parikh plays a role in training the next generation of nephrologists. He participates in a three-day annual board review course with the Apex Foundation. They’ve since started a program where the top students get to visit Johns Hopkins and review the health system currently in place.

“We have several junior faculty in the division who are interested in working with the Indian teams and offer their expertise to harness data and knowledge,” he said. “It’s an exciting opportunity to bridge the gap between training in India and current standard of care.”