The field of kidney replacement technology has evolved greatly over the last two decades, with improvements in nanotechnology, cell growth techniques, and bioreactors. Two of the most recent technological advancements in this field are the implantable bioartificial kidney (BAK) and kidney regeneration technology,” informs Dr Shrey Srivastav, consultant, Sharda Hospital.
He further adds that immune tolerance or immunosuppression-free protocol, allows your body to accept the donor organ as its own.
Chronic kidney disease (CKD) continues to be a major challenge for health care systems globally. The KDIGO defined CKD as abnormalities of kidney structure or function, present for >3 months, with implications for health,” and requires one of two criteria documented or inferred for >3 months: either GFR <60 ml/min/1.73 m2 or markers of kidney damage, including albuminuria. In India, the prevalence of CKD has increased to epidemic proportions and population-based studies have reported a 4%–20% prevalence of CKD.
Risk factors are systemic hypertension, Nephrotoxins (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], intravenous contrast media), decreased perfusion (eg, from severe dehydration or episodes of shock), Proteinuria (in addition to being a marker of CKD), Hyperlipidemia, Hyperphosphatemia with calcium phosphate deposition, Smoking and uncontrolled diabetes
Imaging modalities are critical in diagnosing CKD, giving vital information on renal anatomy and function. Computed tomography (CT) scan, X-ray, magnetic resonance imaging (MRI), and ultrasonography (USG). Some Lab Parameters also helps in diagnosis like S. PTH level, Anemia, UACR levels (protein in urine), KFT etc.
“There are now new preclinical models to improve target validation and understand disease development like 3D bioprinting which involves printing-like techniques, where fugitive ‘ink’ is printed onto a gelatin/fibrogen matrix to pattern open vascular and tubular channels. Organs-on-Chips Technology- these micro-engineered systems model the in vivo micro-environment, and represent a new paradigm for cell-based models. It allows to model the glomerulus – the kidney’s filtration barrier – which breaks down in CKD,” Dr. Srivastav explains.
FDA has approved diabetes drug for chronic kidney disease for the CKD management and to treat the cause. Drug empagliflozin, received approval from the US Food and Drug Administration (FDA) for adults with chronic kidney disease (CKD) in January 2023. Steroids could treat IgA nephropathy, according to a new study. A study that investigated the effect of oral steroids on patients with IgA nephropathy in 2022, has garnered attention as it could prove to be a potential treatment for the disease.
Hemodialysis performed 6 times per week significantly increased the risk of vascular access complications compared with a conventional 3-day regimen in one study. Next generation therapeutics for CKD include Cell therapy. Expanding knowledge on the cells involved in CKD is allowing greater precision in identifying and reaching relevant therapeutic targets. Antisense oligonucleotides- APOL-1 – a gene with variants that is related to an increased risk of early onset kidney disease and rapid progression.
Dr. Srivastav informs that the annual average cost of CKD treatment is Rs. 25,836 for patients solely on medication and Rs. 2,13,144 for patients undergoing haemodialysis in addition to medications. Financial assistance is provided under Rashtriya Arogya Nidhi (RAN) and Health Minister’s Discretionary Grant (HMDG) Schemes to patients living Below Poverty Line (BPL) who are suffering from CKD or ESRD. Under “Susrusha” scheme, an amount of Rs. 1.00 lakh is given as financial assistance to people who have undergone kidney transplantation.
Barriers to optimal care in late-stage CKD is delayed referral to nephrologists. In late-stage CKD, most patients see their nephrologist every 1 to 3 months. This may not be sufficient as there are many adverse events that can occur between nephrologist appointments. Patients with late-stage CKD often have complex medical issues and other concomitant chronic diseases that require attention from several specialists, along with a primary care physician.
Patient education is required and patients with CKD should be educated about the importance of avoiding factors leading to increased progression, natural disease progression, prescribed medications (highlighting their potential benefits and adverse effects), avoidance of nephrotoxins, diet, renal replacement modalities, including peritoneal dialysis, haemodialysis, and transplantation and timely placement of vascular access for haemodialysis.
