This year world kidney day falls on Thursday March 12th 2020. World Kidney Day is celebrated annually to continue to raise awareness of chronic kidney disease and its increasing burden worldwide. The theme of the 2020 campaign is to highlight the importance of preventative measures to avert the onset and progression of kidney disease.
What is Chronic Kidney Disease (CKD)?
CKD is a non-communicable disease in which there is a progressive loss in kidney function over time. It includes any conditions that damage the kidneys, decreasing their ability to function.
Function of the kidneys: The kidneys perform multiple functions within the body including critical regulation of the body’s salt, potassium and acid content, removal of waste products and drugs from the body, release of hormones regulating blood pressure and production of red blood cells as well as producing the active form of vitamin D that is necessary for strong and healthy bones.
The main functional units within the kidneys are the nephrons. Each kidney contains around 1 million nephrons. Damage to these nephrons causes them to stop functioning. If just a few are damaged then the remaining healthy nephrons can compensate, however, if damage continues to occur then eventually there will be an insufficient number of healthy nephrons that can continue to properly filter blood. Beyond a certain point chronic kidney disease can develop into kidney failure, which affects the whole body and can be life threatening.
CKD affects 1 in 10 adults worldwide, that’s equivalent to around 850 million people. By 2040, CKD is projected to become the 5th most common cause of years of life lost with a very high economic burden for treatment of end stage disease- dialysis and transplantation in high income countries cost 2-3% of annual healthcare budget on under 0.03% of population. In low and middle income countries many people do not have access to such lifesaving treatments.
The two main causes of CKD are diabetes and high blood pressure, which are responsible for around 2/3 of cases. Less common conditions include inflammation or infections within the kidneys, long term blockage to the urinary tract (e.g. kidney stones or enlarged prostate) and inherited conditions such as polycystic kidney disease. The majority of individuals with early stage CKD do not have any obvious symptoms and may appear completely healthy, but CKD increases a person’s risk of premature death from associated cardiovascular disease i.e. heart attacks and strokes, regardless of whether individuals ever develop kidney failure. However, if CKD is detected early and managed appropriately, the deterioration in kidney function can be slowed or even stopped, and the risk of associated cardiovascular complications can be reduced. Thus the theme for World Kidney Day this year is to raise awareness and encourage people to check if they are at risk of developing kidney disease.
What are the current treatment options for CKD?
There is currently no cure for CKD. There are however many options to slow or halt the progression of the disease at the early stages, such as lifestyle modifications including proper diet, exercise, no smoking as well as medications that may help to maintain the critical balances in the body that the kidneys would normally control, for example blood pressure and cholesterol levels. For end stage renal disease ESRD, when the kidney stop functioning, long term dialysis (removal of waste and excess fluids by machine) or transplantation are the main treatment options.
Transplantation and overcoming immune rejection
Transplantation is considered the best treatment option as it has the potential to be a one time “cure”, however there are issue of availability of a suitable donor and the possibility of immune rejection of the new kidney by the host immune system. Work done by the ReSHAPE consortium, an EU funded project headed by Prof. Reinke from the Charité Universitätsmedizin Berlin (https://www.reshape-h2020.eu/home), could potentially solve the problem of graft rejection or the need to take immunosuppressive drugs for the rest of the patient’s lifetime. The ReSHAPE consortium are focused on developing regulatory T cell (Treg) therapy to overcome undesired autoimmunity, among other undesired Immune/Inflammatory reactions, to reshape the immune response and if successful allow future transplant patients to live a life free of a complex immunosuppressant treatment regimen.
A role for stem cell treatment for kidney disease?
Currently there are no stem cell therapies for kidney disease, however it is an active area of research. The kidneys are an incredibly complex organ and damage to the kidney can affect many different cell types. To find out more about the potential future role of stem cells in restoring kidney function please visit the website below.
Accelerating the development and increasing accessibility to life saving therapies
The aim of the RESTORE large-scale research initiative is to promote and support the development of Advanced Therapies such as Treg therapy or future stem cell therapies and to accelerate their path to the market whilst ensuring these treatments are accessible to all patients in need. To do this, RESTORE is striving to build a European ecosystem for Advanced Therapy development for the benefit of patients, society and the wider European economy.