Nov 13, 2019

Faces of U of T Medicine: David Cherney

Nephrology, Research
Cherney, David

Claire Wiles

Cherney, DavidDr. David Cherney is an Associate Professor and Clinician-Scientist in the Division of Nephrology at University of Toronto. He is also a physician at the University Health Network and Mount Sinai Hospitals, where he is the director of the Renal Physiology Laboratory. With a specific interest in the relationship between diabetes and kidney and heart disease, Dr. Cherney’s research focuses on the physiological factors that lead to kidney disease in patients with diabetes. He had led a number of large clinical trials that look at the different causes of kidney disease, particularly diabetes.

Dr. Cherney also works at the Toronto General Multi-Care Kidney Clinic, an integrated clinic for patients with chronic kidney disease and leads the “CArdio-Renal-Endocrine” or CaRE Clinic at TGH. The interdisciplinary clinic is specially set up so patients who have multiple conditions that are affected by their kidney disease don’t have to see multiple specialists at different times and different locations.

“These areas are so intimately linked, so it doesn’t make sense to artificially piece them apart to different clinics, which is hard for patients,” explains Dr. Cherney. “It makes much more sense to try as much as possible to tie everything together so that we can provide better care for patients.”

Dr. Cherney spoke with writer Claire Wiles about his research focus and motivations for becoming a Clinician-Scientist.

Can you explain your area of research?

I’m a nephrologist, so a kidney specialist, trained in human physiology with a focus on the kidney and cardiovascular system. My area has been looking at mechanisms of kidney and heart injury in people with diabetes, especially around the physiology that’s involved. During my training I began to examine various pathways and mechanisms linked with developing kidney disease later in life, especially in people with type 1 diabetes. I was interested in the factors that could potentially be identified in early life which then predisposed to developing kidney problems later in life.

A lot of people associate diabetes with the field of endocrinology. What might people not know about diabetes’s relationship to kidney disease or heart disease?

What’s really important to know about diabetes is that it’s the most common cause of developing kidney disease. About 40% of those on dialysis with end-stage kidney disease have had diabetes as a cause of their kidney damage. What’s being recognized more and more is that diabetes also accounts for a very significant proportion of people who end up in the hospital with heart failure. More and more we’re not thinking about just diabetes, or just endocrinology, or just kidney disease or heart failure - we’re thinking about it in a more integrated way. A lot of pharmaceutical companies that make therapies for diabetes are getting input and expertise from advisors, physicians and patient advisory groups who are interested in all three of these areas, to ensure that the medicines they develop target the heart, kidney and endocrine system.

What motivated you to become a Clinician-Scientist?

I’ve always really liked clinical medicine, but I also wanted to understand why I was doing what I was doing. Being a Clinician-Scientist is so compelling and interesting because I’m constantly taking what is being learned in the research field and applying it to patients, and vice versa. For example, in the CaRE Clinic we do a lot of recruitment for clinical trials to look at therapies for cardiac conditions, kidney conditions and diabetes. We have the ability to bring patients from the clinic into the clinical trials unit in order to answer important questions that are relevant to them and to other people with diabetes, then go back and implement them in the clinic. The back and forth “bench-to-bedside” approach is really one of my favourite parts of my job.

What was the most challenging obstacle during your path to becoming a Clinician-Scientist?

There are a couple of challenges, the first being the training duration. It’s a long time and you have to balance that with the other things that people tend to want to do during that time, like settling down and having a family. Another challenge is funding. A challenge that all of us have right from the beginning is supporting a lab with nurses and graduate students. Finding funding to support that lab is an area of pressure and challenge that needs to be addressed on an ongoing basis. Finally, being a clinician scientist and a physician is wonderful but also has its own challenges because although they are integrated, they really are two independent jobs. We have to find time to do both and still have a life outside of work.

What advice do you have for people who want to become a Clinician-Scientist?

The first piece of advice is to make sure you’re doing something you love. I think that is critical because this will get you past the challenges around funding, the long days and the many rejection letters that researchers receive from journals and granting agencies. I would also recommend as much as possible to align your research discipline with your clinical discipline. For example, my clinical practice is in diabetes and its complications, and my research area of focus is in diabetes and complications. That way I have an alignment of the two areas so the bench to bedside jump isn’t that far to make. Everything is always integrated. I’ve found this to be very helpful in order to make the research and clinical focuses fit as optimally as possible.

This is part of a series of profiles that feature trainees and graduates of the Department of Medicine’s Eliot Phillipson Clinician Scientist Training Program. Established in 1994, this competitive program enables MD specialists to pursue research as a major component of their career in academic medicine and become leading innovators in research.