33 - Enhanced Laboratory Services for Nephrology Patients (18 min)

Summary

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Podcast Summary:

Healthier World with Quest Diagnostics
Episode 33: Enhanced Laboratory Services for Nephrology Patients
Date: March 16, 2026 | Duration: 18 minutes
Host: Dr. Mason Lasko (Quest Diagnostics)
Guest: Inez Dawn (Diagnostics and Kidney Care Expert)

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Episode Overview

This episode focuses on how enhanced laboratory services, specifically through Quest Diagnostics' growing partnership with Fresenius, are impacting the care and continuity of treatment for nephrology patients—especially those progressing to dialysis or transplant needs. The conversation underscores the complexity and challenges in kidney care, the strategic operational changes in lab testing services, and the critical importance of comprehensive laboratory support for patients and their providers.

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Key Discussion Points & Insights

1. The Complexity of Nephrology and the Role of the Nephrologist

[02:18 – 05:37]

• Chronic kidney disease (CKD) is often advanced due to unmanaged hypertension or diabetes.

• Many patients are unaware of CKD until kidneys fail and require life-saving dialysis.

• Nephrologists serve across various settings: primary care, dialysis centers, and hospitals.

• The shortage of nephrologists and the multiplicity of care environments make the field uniquely challenging.

• Dialysis is a life-altering "part time job," demanding significant time and lifestyle changes from patients.

  “A typical patient treats three times a week for three and a half to four and a half hours in a clinic ... dialysis is a part time job.”
  — Inez Dawn [04:26]

2. The Quest-Fresenius Partnership: Scope and Impact

[06:17 – 09:10]

• Fresenius is a leading dialysis provider, caring for patients in ~3,000 U.S. facilities.

• Previously, testing was centralized in two labs; Quest now utilizes 18 labs nationwide, enabling:

  • Reduced logistical risks (e.g., weather events affect only local regions, not the whole system).
  • Improved courier service (Quest covers over 90% of dialysis clinics directly).
  • Faster, more reliable turnaround and broader access to advanced diagnostics.

  “If there is a weather event ... it doesn't affect a very large segment of the patient population, but rather only the geography ... it helps balance the services.”
  — Inez Dawn [07:33]

3. Enhancing Continuity of Care through Laboratory Services

[09:36 – 11:18]

• Kidneys regulate critical functions (fluid/toxin removal, metabolic balance, blood cell production).

• In dialysis, frequent chemistry and hematology testing is necessary.

• Quest delivers rapid turnaround—results from a patient’s current treatment available before their next scheduled session, supporting timely therapy adjustments.

  “If a patient is at treatment today, that blood gets drawn, we provide the results before the patient returns for their next treatment ...”
  — Inez Dawn [10:56]

4. Ensuring Water Quality in Dialysis Treatment

[12:02 – 13:36]

• Dialysis relies on ultra-purified water; contamination can compromise patient safety.

• Quest has invested in environmental water testing labs (notably in Clifton, NJ) to serve all 3,000+ facilities.

• Regular (monthly/quarterly) testing of both facility water supplies and dialysis machines is now a Quest specialty.

  “Validating that the water is completely free of contaminants is mission critical for a successful dialysis treatment.”
  — Inez Dawn [12:29]

5. Integrated Testing for Comorbid Conditions

[13:36 – 15:59]

• CKD rarely occurs alone—often accompanied by hypertension, diabetes, or autoimmune diseases.

• Quest supports comprehensive screening and monitoring, not just in nephrology but across primary care, endocrinology, and rheumatology practices.

• Goal: keep patients stable and delay progression to end-stage renal disease.

• The scale of CKD: 1 in 7 U.S. adults has some form of CKD; 9 out of 10 are unaware.

  “Chronic kidney disease is considered one of the new epidemics ... it’s about 35 million individuals in the United States.”
  — Inez Dawn [15:03]

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Notable Quotes & Memorable Moments

• On the demanding nature of dialysis:
  “Dialysis is a part time job … patients treat three times a week … three and a half to four and a half hours in a clinic.”
  — Inez Dawn [04:26]

• On distributed lab services:
  “We have invested in providing all of the different diagnostic tests that are necessary for dialysis patients, and we disseminate that testing.”
  — Inez Dawn [07:09]

• On patient awareness:
  “One in seven individuals is affected by some form of kidney disease ... 9 out of 10 do not know this.”
  — Inez Dawn [16:24]

• On prevention and public health:
  “The best cure is always prevention ... these are not complex tests ... stay as healthy as possible for as long as possible so that kidney dialysis or transplants never have to become part of the care plan.”
  — Inez Dawn [16:28]

• On transplant donations:
  “It takes only one kidney to have a perfectly healthy life ... I always encourage individuals to learn about kidney transplants and transplant donations because they can be a wonderful bridge to provide an amazing quality of life for a very deserving patient.”
  — Inez Dawn [16:51]

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Timestamps for Key Segments

| Timestamp | Topic Summary | |----------------|-----------------------------------------------------------------------------------------| | 02:18–05:37 | Complexity of nephrology, patient journey, role of nephrologists, scope of dialysis | | 06:17–09:10 | Quest-Fresenius partnership, lab logistics and courier innovations | | 09:36–11:18 | Impact on continuity of care, speed and importance of lab results | | 12:02–13:36 | Water testing: critical lab process for dialysis | | 13:36–15:59 | Testing for comorbidities, CKD awareness, Quest’s reach into primary/specialty care | | 16:22–17:12 | Final thoughts on prevention, testing access, and kidney donation awareness |

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Episode Takeaways

• Partnerships matter: The Quest Diagnostics–Fresenius collaboration enhances logistical efficiency, business continuity, and access to advanced diagnostics for the massive and growing CKD/dialysis patient population.
• Lab testing is central to care: Timely and reliable chemistry, hematology, and environmental (water) testing underpin the safety and effectiveness of dialysis treatment.
• CKD often goes undetected: Most CKD patients are unaware until disease is advanced; routine and comprehensive lab testing can enable earlier detection and intervention.
• Prevention and education are key: Widespread public and provider education, along with accessible testing, can dramatically improve kidney health outcomes and potentially reduce the need for end-stage interventions.
• Transplant awareness: Kidney donation and transplant initiatives can transform lives, leveraging the resilience of the human body.

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For more resources and clinical education, visit the Quest Diagnostics Clinical Education Center.

Transcript

[A]

Welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from Insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine and wellness medicine. Chronic kidney disease, or ckd, is a major healthcare crisis. And here on Healthier World, we often speak about how to identify and prevent ckd. But what about the other side of disease progression? What happens to patients who need critical and end stage disease management? I'm Dr. Mason Lasko and today I'm joined by Inez dawn to discuss how Quest Diagnostics is serving nephrology and how this has a profound opportunity to positively impact continuity of care for patients transitioning between primary care, nephrology, dialysis and even transplant care. Welcome, Inez. So happy to have you on today.

[B]

Hello, Mason. Thank you for having me.

[A]

Absolutely. I'm looking forward to the discussion. So, before we jump in today, I would love it if you could tell me a little bit about yourself and your experience in the space.

[B]

Yeah, certainly. I'd be happy to. Well, you can probably tell by the few sentences I've already said that I'm originally from Germany, but I've spent the majority of my life and career in the United States dedicated to working in healthcare. My experience spans from healthcare technology to test portfolio management and also diagnostics overall and operations. In the past 25 years, I've spent my career between healthcare, information technology, diagnostics and kidney care. In this time, I've spent about 10 years focused on technology solutions, removing friction in healthcare, about 10 years in diagnostics and testing, including Quest Diagnostics, Garden Health and Spectra Laboratories. And I've also spent an overlapping eight years focused on kidney care and dialysis. It's a privilege to serve in this industry of very complex healthcare challenges with very deserving patients and care providers.

[A]

Thanks for that background, Inez. And given your experience in the world of kidney care and dialysis, can you speak a little bit about the role of a nephrologist here and who they're serving and specifically the role that dialysis plays in a patient population seen in nephrology?

[B]

Yeah, certainly. I have a tremendous amount of respect for nephrologists because they manage incredibly complex patient presentations in many cases. Kidney disease, chronic kidney disease does not start as just kidney disease alone and it is advanced by hypertension that's not managed, and also diabetes. So when a patient first finds out that they have chronic kidney disease and they start seeing a nephrologist, a nephrologist looks at the patient very holistically to Understand all the other conditions and how well they are managed to preserve the patient's kidney function as long as possible. Unfortunately, many patients do not know that they have chronic kidney disease until the point that their kidneys fail completely and they have to transition to dialysis as their only means to stay alive. As you can imagine, if your kidneys don't work, we cannot thrive as humans. So essentially, in the United States, there's about a half a million patients today on dialysis. And when kidneys fail, the only two options for management of the condition are dialysis or kidney transplants. You may have heard that there are a lot of initiatives around improving transplant rates, having access to transplantation and available organs. And of course, we still have a long road ahead. But all in all, the majority of patients really have to go and rely on dialysis services. I always say dialysis is a part time job because a typical patient treats three times a week for three and a half to four and a half hours in a clinic. Since these patients are not healthy, a nephrologist will actually come see them in the treatment center. In that dialysis clinic, a nephrologist really has to work between their own nephrologist practice to see patients with chronic kidney disease. Then they have to go visit their patients in a dialysis center. And lastly, they also spend a significant amount of time in hospitals because still about 50% of patients crash into dialysis, meaning they did not know they were in advanced stages of kidney disease. They find themselves without kidney function overnight and they need a nephrologist. So, so because of that, the nephrologist also has to spend time meeting these new patients that now need nephrologist care in a hospital. So I have a tremendous amount of respect for these physicians because they cover a very complex set of health conditions and comorbidities, and they have to do it across multiple physical locations. So it can be tremendously challenging. And as with many other spaces, of course, there's no abundance of nephrologists available.

[A]

Yeah, and that's such an important point. Nephrology really is a challenging field for clinicians and an incredibly demanding journey for patients. Many individuals do receive dialysis in the centers for three and a half to four and a half hours at a time, three days a week. And it truly does become part of their routine. That's one of the reasons why supporting nephrologists in dialysis centers matters so much. And I know at Quest Diagnostics we've been serving nephrology for a long Time. But recently there's been a strategic partnership between Fresenius and Quest Diagnostics. Can you speak a little bit about the rationale behind this partnership and what it means for patients?

[B]

Yes, certainly. To your point, Quest Diagnostics already serves the nephrologist community both in their practice settings and in many cases, of course, also in the hospital setting. Nephrologists also visit their same patients in dialysis centers. Fresenius is a leading dialysis provider in the United States and worldwide, and they see and take care of patients in about 3,000 facilities. These facilities are spread across the United States, including Puerto Rico and Hawaii, and their laboratory testing up until recently was performed by two laboratories, one in the middle of the US and one on the East Coast. As you can imagine, the logistics of managing 200,000 patients dialysis laboratory testing needs across two laboratories brings its own logistical challenges. And it also brings challenges around convenience in the clinics and some risk around business continuity. In our Quest model, we actually have 18 different laboratories across the United States where we have invested in providing all of the different diagnostic tests that are necessary for dialysis patients, and we disseminate that testing. So if there is a weather event or similar in a geography, it doesn't affect a very large segment of the patient population, but rather only the geography where likely the patients at that point in time also do not get their labs drawn. So it helps balance the services. Secondly, I would say because of the two facilities that were in play in the past, it wasn't very easy to manage a courier network. So FedEx and UPS were really the companies that were moving the samples. As we have a wonderful network of couriers, they actually visit over 90% of the dialysis clinics and collect the samples there and then transport them to the closest laboratory. So the proximity of the laboratory to the patient is certainly advantageous. So we can get our hands on testing the sample as quickly as possible, removing the risk of disruptions by operators like FedEx or UPS if in any one of their hubs there are weather related issues. And we avoid that by using our couriers. And the clinics love the friendly smile of the courier they see every day. So, in terms of convenience, business continuity, of course, our laboratories are experts in diagnostic testing, so we can bring operational efficiency and focus to this testing. And we can provide access to a large set of advanced diagnostic testing that had to be referred out to other laboratories in the past.

[A]

Great. So it sounds like the partnership helped from a logistical lens, right? Increasing the number of labs, running testing from 2 to 18 and improving the courier system as well, all of which bring a level of efficiency and business continuity. Now, given the huge role of laboratory testing in a nephrology clinic, can you expand on how this partnership contributes to the continuity of care for patients as well?

[B]

Yes, thank you for the question. I would definitely encourage the audience to learn more about all the amazing things that a kidney manages in the human body. So we probably all know it removes fluids from the body and toxins, but it also helps regulate aspects of metabolism, for instance, for minerals like phosphorus, calcium, potassium, and so forth. So with the absence of kidneys, those types of balancing mechanisms need to be compensated with medication. So what would be considered fairly straightforward standard chemistry tests. Physicians can decide whether the patient is having the right amount of potassium or calcium, you know, removed from the body. Because it can be very dangerous from the patient. Patients typically have to get tested for a battery of chemistry testing once a month and then multiple times a month for hematology, because another important kidney function is to help stimulate the creation of red blood cells that keep us from having anemia. So because of this very high frequency of testing, we have to be prepared to provide the service to the patient at a quick turnaround time at all times. So not only are we working with very high volumes for 200,000 patients in monthly and weekly tests, but also, of course, we're committed to providing the results very quickly. So if a patient is at treatment today, that blood gets drawn, we provide the results before the patient returns for their next treatment, which would be two days from now, essentially.

[A]

That's great to hear how much effort Quest Diagnostics put into laboratory efficiency for nephrology, especially because, as you mentioned, a lab like potassium, it's not just operational. Right. It's vital to the patient's health. Honing in now on dialysis, specifically, the dialysis machine for these patients is essentially functioning as an external kidney, filtering a patient's blood several times a week. And to do that, it relies on highly purified water. So water testing has become another key component and a critical laboratory measure that needs to be monitored closely. Can you speak to water testing and what Quest Diagnostics has done to ensure high quality in this area as well?

[B]

Yes, certainly. So this is a new area of expertise in which Quest Diagnostics has invested significantly. Water testing, sometimes it's also referred to as healthcare water testing or environmental testing, validates that the water used in the dialysis process and also certain solutions, chemical solutions, that are used in the dialysis process are pure and free of contaminants and as you can imagine in a dialysis process, a lot of water flows through the patient's body, and the water that is used for the treatments is typically managed through reverse osmosis systems and additional purification processes. So validating that the water is completely free of contaminants is mission critical for a successful dialysis treatment. In addition, water that runs through the dialysis machine needs to be tested to ensure that there is no bacterial contamination that needs to be addressed. So as a result, clinics typically test waters monthly in the facility. Certain tests are done in a quarterly or semiannual fashion, but of course, the dialysis machines are also tested very regularly. So we have invested in and an entire environmental water healthcare water lab in our Clifton, New Jersey facility, and we are proud to serve over 3,000 facilities with our water testing today.

[A]

Thank you. That was a wonderful overview. So I want to pivot here. I know nephrologists are often seeing patients in the disease management stage, especially because CKD often goes undetected, right? In fact, 9 in 10 patients in the primary care setting with CKD don't know they have it. So by the time they reach a nephrology office, they're likely dealing with other comorbid cardiometabolic conditions such as hypertension, fatty liver, cardiovascular disease, and even diabetes. Can you speak about how the laboratory testing at Quest Diagnostics can greatly support nephrologists who are dealing with patients who have these other cardiometabolic conditions as well?

[B]

Yes. So kidney disease is seldom just started on its own. It's usually brought on by certain conditions. You already mentioned many of the metabolic conditions. They can also be autoimmune conditions, like lupus, for instance. Providing our extended menu of testing services, not just to the nephrologist, but in primary care, to endocrinology practices. Two rheumatology practices allows the physicians to monitor patients comprehensively so that the patient can stay out of dialysis or renal failure and on their current level of acuity as long as possible. You did mention that only 1 in 10 patients is aware that they have chronic kidney disease. In addition to that, one in seven people in the United States actually has a form of chronic kidney disease. So if you think about, you know, the numbers of individuals that are affected here is quite substantial. It's about 35 million individuals in the United States. Chronic kidney disease is considered one of the new epidemics. And as much as the physicians can work with our patients, test proactively, but also patients getting involved, understanding this better and taking better measures to prevent Kidney failure is incredibly important, and Quest Diagnostics offers many different opportunities for testing, obviously in supporting physician practices, but also consumer testing.

[A]

That's great. Thank you so much for detailing the wide reach of Quest Diagnostics testing, specifically the cardio IQ testing that centers around cardiometabolic, endocrine, endocrine and wellness testing that can help support physicians in that patient journey. Inez, it's been so wonderful to speak with you today and learn from you. And before we round out, do you have any final thoughts for our audience?

[B]

Well, if there's one thing I have learned, the best cure is always prevention. One in seven individuals is affected by some form of kidney disease in the United States today. 9 out of 10 do not know this. Um, so my first plea is always to go and check the numbers. These are not complex tests. They can be done quickly, go and speak to their physician and take the right steps to stay as healthy as possible as long as possible so that kidney dialysis or transplants never have to become part of the care plan for a patient. On the other hand, I also mention always that it takes only one kidney to have a perfectly healthy life. There are a lot of initiatives in the United States around share your spare, sharing your kidney, the extra kidney, because humans can absolutely function very well with one kidney. So I always encourage individuals to learn about kidney transplants and transplant donations because they can be a wonderful bridge to provide an amazing quality of life for a very deserving patient.

[A]

Well, that was beautiful. Thank you so much for joining me, Inez, and sharing your wisdom with us.

[B]

Thank you, Mason. It's my privilege.

[A]

That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.