Published By MedPage Today
by Crystal A. Gadegbeku, MD, FASN

Forty million Americans are living with kidney diseases and 700,000 have kidney failure — a majority of whom depend on Medicare end-stage renal disease (ESRD) benefit for life-preserving medical care. While millions of lives are impacted by kidney-related illnesses, the United States, through unintended consequences of our healthcare system, has developed biomedical complacency that has resulted in a lack of therapeutic and technological advancement.

Because there is no cure available for ESRD, patients are presented with two treatment options to sustain life, kidney transplantation and dialysis therapies. The preferred option, kidney transplantation, is hindered by a national organ shortage that claims the lives of 13 Americans waiting for a kidney transplant every day and leaves another 100,000 waiting for a donor. For so many patients who are unable to secure a kidney transplant, the choice is limited to a dialysis modality.

Although dialysis and kidney transplantation were ground-breaking advancements in the past, little innovation has occurred in the last few decades, especially when compared with revolutionary high-tech advancements in other areas, and for other diseases such as cancer and diabetes.

Fortunately, after many stagnant years, there is finally hope on the horizon.

Since a report to Congress from the non-partisan Government Accountability Office highlighted that less than 1% of the cost of care is invested in kidney research, several research initiatives have gained important momentum – focusing on increased federal research funding and facilitating coordination among government agencies and research institutions. The result, we anticipate, will be an ecosystem that accelerates innovation toward the development of new therapies.

This exciting new wave of research programs is multidisciplinary, designed to unite the nation’s sharpest minds to address the challenges in creating kidney replacement systems that are patient-centered to developing targeted therapies that lead to cures.

The National Institutes of Health (NIH) All of Us Research Program is a groundbreaking scientific effort to gather data from at least a million Americans to develop precision medicine techniques — with far-reaching implications. A second, more kidney-focused project — the Kidney Precision Medicine Project — aims to secure and evaluate human kidney biopsies from participants with acute kidney injury or chronic kidney diseases, with the goal of developing a sound scientific understanding of the kidney and opportunities for novel therapies.

Moreover, action from Congress to appropriate a $3 billion increase in funding for NIH in fiscal year 2018 will likely help millions of Americans with kidney diseases. Promising action on behalf of kidney patients on Capitol Hill does not stop there. The broader kidney community is united in advocating for the Chronic Kidney Diseases Improvement in Research and Treatment Act (H.R. 2644), which if enacted will have a positive influence on research in our field. This Act would complement current kidney research efforts by requiring the U.S. Department of Health and Human Services (HHS) to study crucial issues facing kidney patients, such as factors influencing why minority populations are at greater risk for kidney diseases and what actions HHS could take to reduce barriers to transplantation.

Perhaps most excitingly, the federal government has also engaged with the private sector in unique partnerships to spur innovation and accelerate therapies for people with kidney diseases. HHS has partnered with the American Society of Nephrology (ASN) to establish KidneyX — a kidney innovation accelerator. Through a series of prize competitions, KidneyX will work to accelerate the development of drugs, devices, and other therapies across the spectrum of kidney care including diagnostics, prevention, and treatment. The result, we hope, will be therapies that could reduce or eliminate patients’ time on dialysis, slow or stop the progression of kidney diseases, improve patient outcomes, and provide a better quality of life.

KidneyX will focus on bringing new products into the hands of patients and serve as a catalyst for investment by the private market. With its 2018 launch, KidneyX will offer its first prize competition for commercialization of next-generation dialysis products.

I am inspired by these recent efforts to spur innovation in the field to bring new therapies to patients, and I share in the hope for the future for people living with kidney diseases. Now that these seeds have been planted, further cultivation with collaboration, creativity, and investment are needed to fully succeed in the fight against kidney diseases.

Crystal Gadegbeku, MD, FAHA, FACP, FASN, is section chief of nephrology, hypertension and kidney transplantation at Temple University Hospital, and chair of the Policy and Advocacy Committee of the American Society of Nephrology.

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