A Mentoring Relationship Develops into One of Collaboration

Dr. Manjula Kurella Tamura is Professor of Medicine in Nephrology at the Stanford School of Medicine and has been Director of the VA Palo Alto Geriatrics Research and Education Clinical Center (GRECC) since 2017. Her mentor-mentee relationship began years earlier during her nephrology fellowship at UCSF, where Dr. Kristine Yaffe is a Professor of Psychiatry, Neurology, and Epidemiology.

During her fellowship, Dr. Kurella Tamura recognized an important knowledge gap: there was limited prognostic data to inform and support dialysis treatment decisions for older adults with multimorbidity or frailty. Little was known about whether dialysis could improve symptoms such as cognitive dysfunction or physical limitations. When mentors introduced her to Dr. Yaffe, the idea of using the tools of geriatric assessment to measure patient-centered outcomes such as cognitive function in kidney disease began to crystallize.

Dr. Yaffe, whose work at UCSF focuses on the investigation to identify which patients are at greatest risk of cognitive aging and Alzheimer disease and related disorders and how we can modify that risk, was interested in more in-depth cognitive testing of patients with chronic kidney disease (CKD) not requiring dialysis. Although the relationship between early CKD and cognition is now better understood, at the time, there was little known about cognitive function in early CKD. The mentor-mentee relationship grew during their work on an NIH grant awarded to Dr. Yaffe to assess cognitive function in the Chronic Renal Insufficiency Cohort (CRIC), and over time, evolved to more of a peer and collegial role. In fact, when the NIH grant was renewed, both Drs. Yaffe and Tamura served as co-principal investigators.

Dr. Kurella Tamura says, “Forming a mentoring relationship outside of one’s clinical specialty has several advantages. These mentoring opportunities enable you to look at questions in your specialty from a completely different perspective and to form a niche as someone who can bridge interdisciplinary lines.” During Dr. Kurella Tamura’s fellowship, Dr. Yaffe served as mentor in several different roles. She guided Dr. Kurella Tamura’s acquisition of research skills, ensuring she was well prepared scientifically to execute her research program. In addition, Dr. Kurella Tamura says, “Dr. Yaffe gave me career advice, including how to go about building a career in academic medicine, building research partnerships, and building research teams. She is an amazing clinician investigator and role model, and I relied on her advice often.”

When asked to share her viewpoint, Dr. Yaffe added, “I was interested in vascular and metabolic issues when the question about CKD came up. People with kidney failure on dialysis had cognitive impairment but little was known about this in early kidney disease, and evaluating geriatric outcomes in CKD required additional high-level expertise in nephrology. I thought that there could be a great deal of synergy between our two specialties, making the research exponentially better. Dr. Kurella Tamura was the ideal partner and I learned so much from her.”

It was also through Dr. Yaffe and other mentors in geriatrics that Dr. Kurella Tamura became aware of the Clin-STAR initiative, for which Dr. Yaffe is chair of the Mentoring and Career Development Core and Dr. Kurella Tamura is a member of the Clin-STAR External Advisory Committee.

The story of Drs. Tamura and Yaffe demonstrates how successful mentoring and career development can be accomplished across disciplines and institutions, serving as a model for Clin-STAR’s overall mission and objectives. In other words, this is exactly the way that Clin-STAR is intended to work. Clin-STAR’s community of scholars, who may be facing similar questions but in different specialties, provides an avenue for researchers to come together across disciplines, leveraging expertise in geriatrics and clinical specialties.

Drs. Kurella Tamura and Yaffe have continued to maintain their collaborative relationship. What began as a mentor-mentee relationship during the early years of Dr. Kurella Tamura’s nephrology fellowship evolved into these two researchers becoming respected colleagues and collaborators, with Dr. Kurella Tamura developing into her current leadership position. Per Dr. Yaffe, “Dr. Tamura has become the premiere clinical investigator in CKD in the geriatric world. By the time Dr. Kurella Tamura left UCSF to continue her career at Stanford, I knew her quite well and felt I could advise her from afar, but her career was already skyrocketing.” “It wasn’t until I became a mentor that I fully appreciated how much my mentors had put into the mentoring relationship,” says Dr. Kurella Tamura. “So much is done behind the scenes to promote mentees and get them on the track to success. I’m very grateful for the energy Dr. Yaffe put into my career and our mentoring relationship.”