The Doctor Who Gave Kidney Disease a Name

Andrew Levey addresses colleagues and friends at the Tufts Medical Center celebration in his honor in June 2022 (Photo: Caitlin Cunningham)

Andrew Levey addresses colleagues and friends at the Tufts Medical Center celebration in his honor in June 2022 (Photo: Caitlin Cunningham)

One of Tufts’ most influential scientists, Andrew S. Levey, revolutionized the field of nephrology and mentored other pioneering physicians and researchers before semi-retiring from clinical practice. A fundraising campaign to create a new professorship in his name is now under way.

Early in his career as a physician, Andrew Levey had an encounter with a patient that forever changed the way Levey thought about kidney disease—and eventually led to a revolution in the field.

“I was the director of the dialysis unit, and one of my jobs was to take on the care of every new patient in the unit,” Levey explained. “This patient was sitting in a dialysis chair, and I sat down on a stool across from him, so we were talking face to face. I asked him what caused his kidney disease. He reached into his wallet and pulled out a little scrap of paper, on which he’d written what he believed to be the answer to that question, given to him by another doctor. ‘Chronic renal insufficiency,’ he said, as he read off the paper. And that struck me. This poor patient: he really knew nothing about what had caused his disease or anything about the disease at all. He was only able to tell me words that didn’t mean anything to him.”

That’s when Levey knew that something had to change. “How can patients possibly do anything to understand their illness, be convinced that it’s important, or advocate for themselves if we can’t even tell them about the disease they have?” he said. “And how can you be told about a disease you have if there are no formal criteria for the disease and no name for it?”

That was the case with chronic kidney disease before Levey came along—there were no criteria to define it, and it went by many different names that ultimately held little meaning for patients, doctors, and researchers. Joseph Vassalotti, clinical professor at the Icahn School of Medicine at Mount Sinai and chief medical officer at the National Kidney Foundation, explained it this way: “Without Andy Levey, we would still be in a state of what I like to call chronic renal confusion.” 

Levey with a patient earlier in his career (Photo: Tufts University Digital Collections and Archives

Levey with a patient earlier in his career (Photo: Tufts University Digital Collections and Archives

In addition to naming the illness, Levey, chief emeritus of the Division of Nephrology at Tufts Medical Center and Dr. Gerald J. and Dorothy R. Friedman professor emeritus at Tufts University School of Medicine, transformed the field of nephrology in another critical way: he developed groundbreaking equations to estimate levels of kidney function from routinely measured laboratory tests. He then used those equations to create a paradigm that defines and outlines the stages of kidney disease, giving clinicians a way of identifying and classifying the disease—and giving patients a way of comprehending the severity of illness.

It’s difficult to overstate the ways in which his work altered the medical community’s approach to and understanding of kidney disease, according to Adeera Levin, professor of medicine and head of the Division of Nephrology at the University of British Columbia. “The whole idea of naming chronic kidney disease and getting the data to support a classification system really changed the accessibility of the concept to patients, care providers, and policymakers,” she said. “It also helped researchers begin to look at people with chronic kidney diseases in a different way, enabling them to test, imagine, and describe differences that were difficult to recognize before the classification system.”

The transformational effect was felt worldwide, Levin said. “Dr. Levey is incredibly collaborative and very inclusive in terms of the people around the world that he asks to help identify and clarify the important research questions. As a result, he’s really established the need for and importance of international collaborations on kidney disease.”

Vassalotti agreed but emphasized that it’s not just Levey’s approach to collaboration that has allowed him to have a global impact on nephrology; it’s also the trailblazing nature of the work. “When he published the groundbreaking U.S. clinical practice guidelines for chronic kidney disease in 2002, suddenly kidney disease became an issue all over the world, not just for kidney doctors or nephrologists but for clinicians of all types,” Vassalotti said. “The year after the guidelines were published in English, they were translated into other languages—his approach has had so much international influence.”

That influence has been felt both on the ground, changing the ways in which physicians prescribe medicine, pharmacists consider drug safety, and clinical laboratories report numbers related to kidney function, and in clinical research circles. “The term ‘chronic kidney disease’ was nonexistent in the medical literature before 2002,” Vassalotti said. Now, the definition and classification are routinely cited in journals like The Lancet. Or, as Vassalotti puts it, “In 2021, there were almost ten thousand papers on the topic published in peer-reviewed journals.”

Fundraising for a Named Professorship

For all of these reasons, Mark Sarnak, who took over as chief of the Division of Nephrology at Tufts Medical Center when Levey stepped down in 2017 and is a professor at the School of Medicine, spearheaded an effort to recognize Levey’s contributions to the field of nephrology—and to Tufts—by establishing a professorship in his name. “It was time to honor him,” Sarnak said. “He’s made some of the biggest advances in kidney disease over the last two decades.”

Sarnak’s effort has resulted in a fundraising campaign meant to celebrate Levey’s legacy and support a faculty member at a critical junction in their career. Upon its establishment, the professorship will be awarded to early career clinical nephrologists, in order to support the physicians who will continue to study kidney disease in the future.

Brian Pereira, president and CEO of the biotechnology company Visterra, who trained as a nephrologist under Levey, was the first to contribute to the campaign, along with his wife, Sunita.

“I was his first research fellow when he was a young assistant professor, and it was a wonderful experience,” Pereira explained. “He set my career up on a trajectory that I never imagined. That was his style: he mentored people until they were ready to fly on their own. He was always available if needed, but he never felt he had to control. In a lot of science environments, brilliant people struggle to grow in the shadow of their mentors. Andy always had the confidence to let others take control of their career and destiny. My fellowship with him opened doors to amazing opportunities for me, and so my wife and I raised our hands to kick off the campaign. We are delighted to do so—it’s the right cause.”

The others echoed Pereira’s words, acknowledging that it’s not only Levey’s work that has made him a giant in the field—it’s also his style of leadership, mentorship, and collegiality. As Sarnak put it, “He leads a group in a very cohesive way to reach consensus. Physicians have strong opinions, but he’s able to bring people with differing opinions together so that the field moves forward.”

“He’s mentored people around the world in productive collaborations, and he’s always been inclusive of multiple perspectives,” said Levin. “His inclusivity has allowed us to grow the community, grow the questions, and grow the researchers.”

“He uses humor in a brilliant way,” Vassalotti observed. “He has a light, relaxed way of interacting with people and uses humor to help convene a group and move things forward. That’s one of the outstanding things about him.”

Levey also uses humor to deflect attention from himself and put the spotlight on his colleagues and mentees. “It’s easy to be a good mentor if you have good mentees,” Levey joked. “And it’s easy to give research questions and ideas away to junior people who are training with you if you have too much to do yourself.” 

Levey with colleagues at the June 2022 celebration

Levey with colleagues at the June 2022 celebration

All joking aside, Levey, who still teaches and participates in research at the School of Medicine and Tufts Medical Center, deeply values the opportunities he’s had to work with mentees. “I was lucky that we had an oversized group of extraordinarily talented young people who came through our institution, each of whom has contributed in huge ways to the field,” he said. “Many have allowed me to continue to be involved with them and their work, and that is gratifying.”

“But more than anything,” he added, “it meant a lot to my collaborators that I was a physician. I’ve been fortunate to work with the world’s smartest epidemiologists and smartest biostatisticians, but my contribution really has been as a doctor. All the important research questions came from listening to patients and learning what is needed in patient care.”

There’s one other contribution Levey has made as well: A dedicated advocate for kidney donation, in 2009, Levey demonstrated that dedication in a significant way when he donated one of his own kidneys as part of a three-way exchange at Tufts Medical Center. One of the recipients in that exchange was his wife, oncologist Roberta Falke, whose family is affected by a genetic illness that causes kidney failure.

Supporting the Campaign

To make a gift to the campaign to establish a professorship in honor of Levey’s impact on the field on nephrology and in appreciation of the legacy he has created at Tufts, visit http://go.tufts.edu/levey