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Why Scalable Approaches Are Needed For Earlier Intervention Of Chronic Kidney Disease

Salvatore Viscomi MD, CEO and cofounder of Carna Health, is an entrepreneur with a passion for digital health.

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More than 850 million people in the world have chronic kidney disease (CKD), and up to 9 out of 10 are unaware they have it. Chronic kidney disease is widely recognized as one of the leading causes of death globally and is currently the 12th most common cause of death worldwide, yet the disease is often neglected. CKD increases in prevalence each year, and the staggering numbers only continue to get worse as risk factors such as diabetes, high blood pressure and obesity continue to climb. At this rate, CKD is projected to be the fifth leading cause of mortality in the world by 2040.

With these alarming statistics, we need to rethink our approach to identifying and managing CKD. What was once considered a hidden epidemic is no longer silent, and there is a global call for more proactive, early CKD diagnosis and management to address this health crisis. The need for accessible, scalable screening is greater than ever, especially in low- and lower middle-income countries that account for two-thirds of CKD diagnoses around the world.

Challenges With Current Solutions To Addressing Rising CKD

Well-functioning kidneys are vital to lead a healthy life. CKD was primarily known for affecting older patients, but now it is also occurring in younger populations for various reasons, including heat stress, which is on the rise globally and is now a known risk factor for kidney injury. Unfortunately, many people who are unaware that they have CKD will end up relying on a transplant or dialysis to save their lives.

Despite significant investments in healthcare, development of novel therapeutic options and building of new dialysis centers, more people are dying from kidney disease than ever before. Though the medical community has made great scientific and medical advances, even transplanting a genetically edited pig kidney into a living person for the first time, these are very expensive solutions that few people have access to.

A Global Call For Inexpensive Screening Methods

There is an urgent need for inexpensive screening methods that can help identify people who have CKD earlier to give them an opportunity to avoid needing a transplant or dialysis. If caught early enough, the disease could be manageable with diet and lifestyle changes alone, potentially eliminating the need for therapeutic interventions and improving patients' quality of life immensely.

When medical management of CKD is needed, modern medicine offers new therapeutics that are effective at slowing down the progression of the disease. The earlier the disease is identified, the more opportunity there is for successful therapeutic intervention.

Making testing more convenient by bringing it to the point of care, whether at the doctor's office or at home, and engaging patients through digital technologies, could also contribute to a higher CKD treatment adherence rates. By connecting innovative point-of-care testing (POCT) technologies that measure creatinine/eGFR, such as those developed by Nova Biomedical, to health platforms and user-friendly apps, we can provide accurate, reliable and highly valuable data to patients instantly, empowering them to take charge of their health before they develop irreversible disease.

Companies such as Healthy.Io are solving this challenge by providing albumin-to-creatinine ratio (ACR) tests, an important risk stratification tool, for patients to take in the comfort of their own homes. Results are available immediately using a smartphone and ready to share with care teams. Similarly, NeoDocs also provides an at-home testing kit that monitors kidney health by tracking parameters that could indicate kidney-related health problems.

Testing for CKD is not a one-and-done scenario. People with risk factors such as high blood pressure, diabetes and hypertension should continue to be tested over time with routine annual kidney testing. Changing genetic makeup and family history is not within one's control, but making people aware of these risk factors could be potentially lifesaving and important to track over time.

Technology Adoption Challenges

Despite the advantages of POCT, including convenience and ease of use, the adoption rate has been slow. The pandemic brought more awareness to POCT, but additional education is needed to overcome some of the hurdles to widespread use, including:

• Correctly using POCT tools and interpreting results. Quality assurance can be a challenge due to POCT mainly being formed by clinical staff versus laboratory staff who may be more familiar with quality control and assurance practices. Meeting accreditation requirements is vital to ensure accurate test results. Regulatory requirements include personnel training and strict adherence to the specific test procedure, which can be a barrier to adoption in remote or lower-income regions.

• Ensuring optimal test performance through easy-to-follow instructions to reduce the chance for human error. As more POCT tests are leaning toward "self-tests" for use by patients, it's important test directions are user-friendly and followed very carefully. Though they can be very effective if followed properly, they are not completely error-proof.

• Managing the data from POCT. Once the patient data is collected, it is important to ensure results are tracked and monitored through the patient's health record in a timely and secure manner. The information can be a powerful follow-up diagnosis tool for healthcare practitioners. Quicker result turnarounds are an advantage of POCT, but digital platforms that empower patients through apps and integration with EHRs are necessary to ensure that the testing results lead to the appropriate care pathways to ensure better health outcomes.

Overall, CKD is a growing global problem, and a large proportion of people living with CKD around the world lack access to kidney disease diagnosis, prevention or treatment. To change the trajectory of kidney disease becoming the fifth top mortality by 2040, we must take bold action to improve health outcomes by diagnosing and managing this chronic disease before it becomes deadly. Integrating point-of-care testing for quicker detection of CKD holds the potential for major benefits at both the individual and population level, emerging as a solution to help fill healthcare testing gaps. Leveraging innovative therapies and solutions can provide hope by offering a pathway forward for increasing patients' quality of life and decreasing the burden of CKD.

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Ozempic Cuts Risk Of Chronic Kidney Disease Complications, Study Finds

Semaglutide, the compound in the blockbuster drugs Ozempic and Wegovy, dramatically reduced the risk of kidney complications, heart issues and death in people with Type 2 diabetes and chronic kidney disease in a major clinical trial, the results of which were published on Friday. The findings could transform how doctors treat some of the sickest patients with chronic kidney disease, which affects more than one in seven adults in the United States but has no cure.

"Those of us who really care about kidney patients spent our whole careers wanting something better," said Dr. Katherine Tuttle, a professor of medicine at the University of Washington School of Medicine and an author of the study. "And this is as good as it gets." The research was presented at a European Renal Association meeting in Stockholm on Friday and simultaneously published in The New England Journal of Medicine.

The trial, funded by Ozempic maker Novo Nordisk, was so successful that the company stopped it early. Dr. Martin Holst Lange, Novo Nordisk's executive vice president of development, said that the company would ask the Food and Drug Administration to update Ozempic's label to say it can also be used to reduce the progression of chronic kidney disease or complications in people with Type 2 diabetes.

Diabetes is a leading cause of chronic kidney disease, which occurs when the kidneys don't function as well as they should. In advanced stages, the kidneys are so damaged that they cannot properly filter blood. This can cause fluid and waste to build up in the blood, which can exacerbate high blood pressure and raise the risk of heart disease and stroke, said Dr. Subramaniam Pennathur, the chief of the nephrology division at Michigan Medicine.

The study included 3,533 people with kidney disease and Type 2 diabetes, about half of whom took a weekly injection of semaglutide, and half of whom took a weekly placebo shot.

Researchers followed up with participants after a median period of around three and a half years and found that those who took semaglutide had a 24 percent lower likelihood of having a major kidney disease event, like losing at least half of their kidney function, or needing dialysis or a kidney transplant. There were 331 such events among the semaglutide group, compared with 410 in the placebo group.

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