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Martínez-Hernández SL, Muñoz-Ortega MH, Ávila-Blanco ME, Medina-Pizaño MY, Ventura-Juárez J. Novel Approaches in Chronic Renal Failure without Renal Replacement Therapy: A Review. Biomedicines 2023; 11:2828. [PMID: 37893201 PMCID: PMC10604533 DOI: 10.3390/biomedicines11102828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by renal parenchymal damage leading to a reduction in the glomerular filtration rate. The inflammatory response plays a pivotal role in the tissue damage contributing to renal failure. Current therapeutic options encompass dietary control, mineral salt regulation, and management of blood pressure, blood glucose, and fatty acid levels. However, they do not effectively halt the progression of renal damage. This review critically examines novel therapeutic avenues aimed at ameliorating inflammation, mitigating extracellular matrix accumulation, and fostering renal tissue regeneration in the context of CKD. Understanding the mechanisms sustaining a proinflammatory and profibrotic state may offer the potential for targeted pharmacological interventions. This, in turn, could pave the way for combination therapies capable of reversing renal damage in CKD. The non-replacement phase of CKD currently faces a dearth of efficacious therapeutic options. Future directions encompass exploring vaptans as diuretics to inhibit water absorption, investigating antifibrotic agents, antioxidants, and exploring regenerative treatment modalities, such as stem cell therapy and novel probiotics. Moreover, this review identifies pharmaceutical agents capable of mitigating renal parenchymal damage attributed to CKD, targeting molecular-level signaling pathways (TGF-β, Smad, and Nrf2) that predominate in the inflammatory processes of renal fibrogenic cells.
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Affiliation(s)
- Sandra Luz Martínez-Hernández
- Departamento de Microbiología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Martín Humberto Muñoz-Ortega
- Departamento de Química, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Manuel Enrique Ávila-Blanco
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Mariana Yazmin Medina-Pizaño
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Javier Ventura-Juárez
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
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Kataoka H, Shimada Y, Kimura T, Nishio S, Nakatani S, Mochizuki T, Tsuchiya K, Hoshino J, Hattanda F, Kawano H, Hanaoka K, Hidaka S, Ichikawa D, Ishikawa E, Uchiyama K, Hayashi H, Makabe S, Manabe S, Mitobe M, Sekine A, Suwabe T, Kai H, Kurashige M, Seta K, Shimazu K, Moriyama T, Sato M, Otsuka T, Katayama K, Shimabukuro W, Fujimaru T, Miura K, Nakanishi K, Horie S, Furuichi K, Okada H, Narita I, Muto S. Public support for patients with intractable diseases in Japan: impact on clinical indicators from nationwide registries in patients with autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2023; 27:809-818. [PMID: 37368094 DOI: 10.1007/s10157-023-02372-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend antihypertensive and tolvaptan therapies for patients with autosomal dominant polycystic kidney disease (ADPKD) in Japan. However, tolvaptan therapy may pose an economic burden. The Japanese Ministry of Health, Labour and Welfare supports patients with intractable diseases. This study aimed to confirm the impact of the intractable disease system in Japan on the clinical treatment of ADPKD. METHODS We analyzed the data of 3768 patients with ADPKD having a medical subsidy certificate from the Japanese Ministry of Health, Labour and Welfare in 2015-2016. The following quality indicators were use: the adherence rate to the 2014 clinical practice guideline for polycystic kidney disease (prescription rates of antihypertensive agents and tolvaptan in this cohort) and the number of Japanese patients with ADPKD nationwide started on renal replacement therapy in 2014 and 2020. RESULTS Compared with new applications from 2015 to 2016, the prescription rates of antihypertensives and tolvaptan for the indicated patients at the 2017 renewal application increased by 2.0% (odds ratio = 1.41, p = 0.008) and 47.4% (odds ratio = 10.1, p > 0.001), respectively. These quality indicators improved with antihypertensive treatment, especially in patients with chronic kidney disease stages 1-2 (odds ratio = 1.79, p = 0.013) and in those aged < 50 years (odds ratio = 1.70, p = 0.003). The number of patients with ADPKD who were started on renal replacement therapy in Japan decreased from 999 in 2014 to 884 in 2020 in the nationwide database (odds ratio = 0.83, p < 0.001). CONCLUSIONS The Japanese public intractable disease support system contributes to improvement of ADPKD treatment.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Shimada
- Intelligent Systems Laboratory, SECOM CO., LTD. Mitaka, Tokyo, Japan
- Department of Medical Eleactronic Intelligence Management, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomonori Kimura
- Reverse Translational Research Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Osaka, Japan
| | - Saori Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- PKD Nephrology Clinic, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumihiko Hattanda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Haruna Kawano
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, The Jikei University, Tokyo, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Daisuke Ichikawa
- Department of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Ishikawa
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital, Mie, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michihiro Mitobe
- Department of Nephrology, Takeda General Hospital, Fukushima, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Hirayasu Kai
- Pathophysiology of Renal Diseases, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mahiro Kurashige
- Nephrology and Hypertension, Department of Internal Medicine, The Jikei University, Tokyo, Japan
| | - Koichi Seta
- Department of Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Keiji Shimazu
- Department of Nephrology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuya Fujimaru
- Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shigeo Horie
- Department of Urology, Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan.
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Gansevoort RT, Hariri A, Minini P, Ahn C, Chapman AB, Horie S, Knebelmann B, Mrug M, Ong ACM, Pei YPC, Torres VE, Modur V, Antonshchuk I, Perrone RD. Venglustat, a Novel Glucosylceramide Synthase Inhibitor, in Patients at Risk of Rapidly Progressing ADPKD: Primary Results of a Double-Blind, Placebo-Controlled, Phase 2/3 Randomized Clinical Trial. Am J Kidney Dis 2022; 81:517-527.e1. [PMID: 36535535 DOI: 10.1053/j.ajkd.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
RATIONALE & OBJECTIVE Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the formation of multiple kidney cysts that leads to growth in total kidney volume (TKV) and progression to kidney failure. Venglustat is a glucosylceramide synthase inhibitor that has been shown to inhibit cyst growth and reduce kidney failure in preclinical models of ADPKD. STUDY DESIGN STAGED-PKD was a 2-stage, multicenter, double-blind, randomized, placebo-controlled phase 2/3 study in adults with ADPKD at risk of rapidly progressive disease, who were selected based on Mayo Clinic imaging classification of ADPKD class 1C, 1D, or 1E and an estimated glomerular filtration rate (eGFR) of 30-89.9mL/min/1.73m2. SETTING & PARTICIPANTS Enrollment included 236 and 242 patients in stages 1 and 2, respectively. INTERVENTIONS In trial stage 1, the patients were randomized 1:1:1 to venglustat, 8mg; venglustat, 15mg; or placebo. In stage 2, the patients were randomized 1:1 to venglustat, 15mg (highest dose identified as safe and well tolerated in stage 1), or placebo. OUTCOMES Primary end points were rate of change in TKV over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary end points were eGFR slope over 18 months (stage 1), rate of change in TKV (stage 2), and safety/tolerability, pain, and fatigue (stages 1 and 2). RESULTS A prespecified interim futility analysis showed that venglustat treatment had no effect on the annualized rate of change in TKV over 18 months (stage 1) and had a faster rate of decline in eGFR slope over 24 months (stage 2). Due to this lack of efficacy, the study was terminated early. LIMITATIONS The short follow-up period after the end of treatment and limited generalizability of the findings. CONCLUSIONS In patients with rapidly progressing ADPKD, treatment with venglustat at either 8mg or 15mg showed no change in the rate of change in TKV and a faster rate of eGFR decline in STAGED-PKD despite a dose-dependent decrease in plasma glucosylceramide levels. FUNDING This study was funded by Sanofi. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03523728.
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Affiliation(s)
- Ronald T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ali Hariri
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Arlene B Chapman
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Bertrand Knebelmann
- Université Paris Cité, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - York P C Pei
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Vijay Modur
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Ronald D Perrone
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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Oberdhan D, Palsgrove AC, Cole JC, Harris T. Caregiver Burden of Autosomal Dominant Polycystic Kidney Disease: A Qualitative Study. Kidney Med 2022; 5:100587. [PMID: 36686593 PMCID: PMC9852954 DOI: 10.1016/j.xkme.2022.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale & Objective There is limited published research on how autosomal dominant polycystic kidney disease (ADPKD) impacts caregivers. This study explored how caregivers of individuals with ADPKD perceive the burdens placed on them by the disease. Study Design Qualitative study consisting of focus groups and interviews. Discussions were conducted by trained interviewers using semi-structured interview guides. Setting & Participants The research was conducted in 14 countries in North America, South America, Asia, Australia, and Europe. Eligible participants were greater than or equal to 18 years old and caring for a child or adult diagnosed with ADPKD. Analytical Approach The concepts reported were coded using qualitative research software. Data saturation was reached when subsequent discussions introduced no new key concepts. Results Focus groups and interviews were held with 139 participants (mean age, 44.9 years; 66.9% female), including 25 participants who had a diagnosis of ADPKD themselves. Caregivers reported significant impact on their emotional (74.1%) and social life (38.1%), lost work productivity (26.6%), and reduced sleep (25.2%). Caregivers also reported worry about their financial situation (23.7%). In general, similar frequencies of impact were reported among caregivers with ADPKD versus caregivers without ADPKD, with the exception of sleep (8.0% vs 28.9%, respectively), leisure activities (28.0% vs 40.4% respectively), and work/employment (12.0% vs 29.8%, respectively). Limitations The study was observational and designed to elicit concepts, and only descriptive analyses were conducted. Conclusions These findings highlight the unique burden on caregivers in ADPKD, which results in substantial emotional, social, and professional/financial impact.
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Affiliation(s)
- Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, Maryland,Address for Correspondence: Dorothee Oberdhan, Otsuka Pharmaceutical Development & Commercialization, Inc, 2440 Research Blvd, Rockville, MD 20850.
| | - Andrew C. Palsgrove
- Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, Maryland
| | | | - Tess Harris
- PKD International, London, UK,PKD Charity, London, UK
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5
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Perrone RD, Hariri A, Minini P, Ahn C, Chapman AB, Horie S, Knebelmann B, Mrug M, Ong AC, Pei YP, Torres VE, Modur V, Gansevoort RT. The STAGED-PKD 2-Stage Adaptive Study With a Patient Enrichment Strategy and Treatment Effect Modeling for Improved Study Design Efficiency in Patients With ADPKD. Kidney Med 2022; 4:100538. [PMID: 36204243 PMCID: PMC9529969 DOI: 10.1016/j.xkme.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rationale & Objective Venglustat, a glucosylceramide synthase inhibitor, inhibits cyst growth and reduces kidney failure in mouse models of autosomal dominant polycystic kidney disease (ADPKD). STAGED-PKD aims to determine the safety and efficacy of venglustat and was designed using patient enrichment for progression to end-stage kidney disease and modeling from prior ADPKD trials. Study Design STAGED-PKD is a 2-stage, international, double-blind, randomized, placebo-controlled trial in adults with ADPKD (Mayo Class 1C-1E) and estimated glomerular filtration rate (eGFR) 45-<90 mL/min/1.73 m2 at risk of rapidly progressive disease. Enrichment for rapidly progressing patients was identified based on retrospective analysis of total kidney volume (TKV) and eGFR slope from the combined Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease and HALT Progression of Polycystic Kidney Disease A studies. Setting & Participants Target enrollment in stages 1 and 2 was 240 and 320 patients, respectively. Interventions Stage 1 randomizes patients 1:1:1 to venglustat 8 mg or 15 mg once daily or placebo. Stage 2 randomizes patients 1:1 to placebo or venglustat, with the preferred dose based on stage 1 safety data. Outcomes Primary endpoints are TKV growth rate over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary endpoints include: annualized rate of change in eGFR from baseline to 18 months (stage 1); annualized rate of change in TKV based on magnetic resonance imaging from baseline to 18 months (stage 2); and safety, tolerability, pain, and fatigue (stages 1 and 2). Limitations If stage 1 is unsuccessful, patients enrolled in the trial may develop drug-related adverse events that can have long-lasting effects. Conclusions Modeling allows the design and powering of a 2-stage combined study to assess venglustat’s impact on TKV growth and eGFR slope. Stage 1 TKV assessment via a nested approach allows early evaluation of efficacy and increased efficiency of the trial design by reducing patient numbers and trial duration. Funding This study was funded by Sanofi. Trial registration STAGED-PKD has been registered at ClinicalTrials.gov with study number NCT03523728.
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Affiliation(s)
- Ronald D. Perrone
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ali Hariri
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | | | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Bertrand Knebelmann
- Université de Paris, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama and Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Albert C.M. Ong
- Academic Nephrology Unit, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - York P.C. Pei
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Vicente E. Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Vijay Modur
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | - Ronald T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, The Netherlands
- Address for Correspondence: Ronald T. Gansevoort, MD, PhD, Department of Nephrology, University Medical Center Groningen, The Netherlands.
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6
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Raina R, Houry A, Rath P, Mangat G, Pandher D, Islam M, Khattab AG, Kalout JK, Bagga S. Clinical Utility and Tolerability of Tolvaptan in the Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD). Drug Healthc Patient Saf 2022; 14:147-159. [PMID: 36105663 PMCID: PMC9467294 DOI: 10.2147/dhps.s338050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- Department of Nephrology, Akron Children’s Hospital, Akron, OH, USA
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Correspondence: Rupesh Raina, Consultant Nephrologist, Adult-Pediatric Kidney Disease/Hypertension, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA, Tel +1 330-543-8950, Fax +1 330-543-3980, Email ;
| | - Ahmad Houry
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Pratik Rath
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Guneive Mangat
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Davinder Pandher
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- Mount Sinai South Nassau, Oceanside, NY, 11570, USA
| | - Muhammad Islam
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Joseph K Kalout
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Sumedha Bagga
- Questrom School of Business, Boston University, Boston, MA, USA
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Chen S, Huang L, Zhou S, Zhang Q, Ruan M, Fu L, Yang B, Xu D, Mei C, Mao Z. NS398 as a potential drug for autosomal-dominant polycystic kidney disease: Analysis using bioinformatics, and zebrafish and mouse models. J Cell Mol Med 2021; 25:9597-9608. [PMID: 34551202 PMCID: PMC8505825 DOI: 10.1111/jcmm.16903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022] Open
Abstract
Autosomal‐dominant polycystic kidney disease (ADPKD) is characterized by uncontrolled renal cyst formation, and few treatment options are available. There are many parallels between ADPKD and clear‐cell renal cell carcinoma (ccRCC); however, few studies have addressed the mechanisms linking them. In this study, we aimed to investigate their convergences and divergences based on bioinformatics and explore the potential of compounds commonly used in cancer research to be repurposed for ADPKD. We analysed gene expression datasets of ADPKD and ccRCC to identify the common and disease‐specific differentially expressed genes (DEGs). We then mapped them to the Connectivity Map database to identify small molecular compounds with therapeutic potential. A total of 117 significant DEGs were identified, and enrichment analyses results revealed that they are mainly enriched in arachidonic acid metabolism, p53 signalling pathway and metabolic pathways. In addition, 127 ccRCC‐specific up‐regulated genes were identified as related to the survival of patients with cancer. We focused on the compound NS398 as it targeted DEGs and found that it inhibited the proliferation of Pkd1−/− and 786‐0 cells. Furthermore, its administration curbed cystogenesis in Pkd2 zebrafish and early‐onset Pkd1‐deficient mouse models. In conclusion, NS398 is a potential therapeutic agent for ADPKD.
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Affiliation(s)
- Sixiu Chen
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Linxi Huang
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China.,Graduate School of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Shoulian Zhou
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China.,Graduate School of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Qingzhou Zhang
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Mengna Ruan
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lili Fu
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Internal Medicine Ⅲ (Nephrology and Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai, China
| | - Dechao Xu
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of People's Liberation Army (PLA), Changzheng Hospital, Second Military Medical University, Shanghai, China
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8
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Sanon Aigbogun M, Oberdhan D, Doane MJ, Rooney J, Inyart BC, Pao CS, Denny AH. Disconnect in Assessments of Autosomal Dominant Polycystic Kidney Disease Burden Between Patients and Physicians: A Survey Study. Int J Nephrol Renovasc Dis 2021; 14:105-115. [PMID: 33880055 PMCID: PMC8053527 DOI: 10.2147/ijnrd.s297491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is a rare inherited kidney disorder with considerable symptom burden and negative effects even in early-stage disease. Patients' reporting of ADPKD symptom burden may differ from physicians' impressions. In this quantitative, cross-section survey study, we evaluated patient and physician assessments of symptom burden at early- and late-stage ADPKD. Methods In the United States, 300 patients with ADPKD and 155 physicians treating patients with ADPKD completed online surveys administered by Kantar. Disease stage was categorized as early (chronic kidney disease [CKD] stages 1-3) or late (stages 4-5). Patients completed the Work Productivity and Activity Impairment Questionnaire and reported current disease symptoms. Patients and physicians assessed impacts of ADPKD on daily life and burden of specific symptoms. Statistical analyses compared patient versus physician responses stratified by early- versus late-stage ADPKD. Results We found that impairment in work productivity was statistically greater in late- versus early-stage CKD. Compared with physicians' impressions, patients were more likely at early stages and less likely at later stages to report a moderate/strong impact of ADPKD on daily life. Among patients, 74% with early- and 88% with late-stage disease reported that ADPKD caused them to modify their daily lives. In early-stage disease, patients reported a statistically greater burden from feeling exhausted and less burden from dull kidney pain, cardiovascular problems, high blood pressure, and liver cysts than physicians assumed. At later stages, patients reported feeling exhausted and skeletal/joint pain as more burdensome, and frequent urination, high blood pressure, liver cysts, and hematuria as less burdensome, compared with physicians' impressions. Conclusion The results of this survey study demonstrate a disconnect between patients' experiences and physicians' awareness of the burden of ADPKD and highlight the need for more patient/physician discussion of symptoms and disease management.
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Affiliation(s)
- Myrlene Sanon Aigbogun
- Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Dorothee Oberdhan
- Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | | | | | - Christina S Pao
- Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Alexis H Denny
- Government Affairs, Polycystic Kidney Disease (PKD) Foundation, Kansas City, MO, USA
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Hajirezaei F, Ghaderian SMH, Hasanzad M, Nafar M, Ghadiani MH, Biglari S, Sohrabifar N, Jafari H. Methylation of the PKD1 Promoter Inversely Correlates with its Expression in Autosomal Dominant Polycystic Kidney Disease. Rep Biochem Mol Biol 2020; 9:193-198. [PMID: 33178869 DOI: 10.29252/rbmb.9.2.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD), a multisystem disorder, is the most prevalent type of hereditary kidney disease. Here, we aimed to evaluate methylation of the PKD1 gene (PKD1) promoter and its correlation with PKD1 expression in peripheral blood. Methods In this case-control study methylation of the PKD1 promoter was evaluated using methylation-sensitive high-resolution melt (MS-HRM) analysis. PKD1 expression was assessed by quantitative real-time PCR. The correlation was evaluated using the Pearson correlation test. Results Twenty subjects from both the patient and control groups (n= 40 for each) were methylated at the PKD1 promoter to various levels (18.9% in patients and 62.5% in controls). This difference was statistically significant (p< 0.0001). PKD1 expression in blood samples was significantly greater in ADPKD patients than in controls (p= 0.0081). Significant correlation was seen between PKD1 expression and its promoter methylation status in peripheral blood (r case= -0.5300, p= 0.0162, and r control = -0.6265, p= 0.0031). Conclusion Methylation of the PKD1 promoter in ADPKD patients was inversely correlated with PKD1 expression.
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Affiliation(s)
| | - Sayyed Mohammad Hossein Ghaderian
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Nafar
- Chronic kidney disease research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sajjad Biglari
- Department of Laboratory Sciences, Jondishapour University of Medical Sciences, Faculty of Paramedical Sciences, Ahvaz, Iran
| | - Nasim Sohrabifar
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Jafari
- Department of Laboratory Sciences, Jondishapour University of Medical Sciences, Faculty of Paramedical Sciences, Ahvaz, Iran
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10
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Lai S, Mangiulli M, Perrotta AM, Gigante A, Napoleoni L, Cipolloni E, Mitterhofer AP, Gasperini ML, Muscaritoli M, Cianci R, Giovannetti A, Falco F, Mastroluca D, Mazzaferro S. Cardiovascular Risk and Quality of Life in Autosomal Dominant Polycystic Kidney Disease Patients on Therapy With Tolvaptan: A Pilot Study. Curr Vasc Pharmacol 2020; 19:556-564. [PMID: 32957887 DOI: 10.2174/1570161118999200918094809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cardiovascular (CV) complications are the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients. In 2017, the Italian Medicines Agency authorised tolvaptan, a vasopressin V2 receptor antagonist, for the treatment of ADPKD, based on the Tolvaptan Phase 3 Efficacy and Safety Study in ADPKD (TEMPO 3: 4), TEMPO 4: 4 and Replicating Evidence of Preserved Renal Function: An Investigation of Tolvaptan Safety and Efficacy (REPRISE) studies. AIM OF THE STUDY The aim of the study was to assess the impact of tolvaptan on CV risk and quality of life, evaluated by nutritional, inflammatory, metabolic, instrumental parameters and psychocognitive tests on ADPKD patients. METHODS AND MATERIALS We evaluated 36 patients with ADPKD; 10 patients (7 males, mean age 42.5±7.0 years) treated with tolvaptan and 26 controls (11 males, mean age 36.7±9.1 years). They underwent, at T0, monthly, and at T1 (1 year) clinical, laboratory and instrumental evaluation, in addition to psychocognitive tests. RESULTS In ADPKD patients treated with tolvaptan, we found at T1, a decrease in carotid intima-- media thickness (p=0.048), epicardial adipose tissue thickness (p=0.002), C-reactive protein (p=0.026), sympathovagal balance during night (p=0.045) and increased flow-mediated dilation (p=0.023) with a reduction in depression (Hamilton and Beck tests, p=0.008 and p=0.002, respectively) compared with controls. CONCLUSION These preliminary results suggest that treatment with tolvaptan could improve early atherosclerosis and endothelial dysfunction markers and improve mood in ADPKD patients (probably by acting on endothelial cell and adipocyte V2 receptors).
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Affiliation(s)
- Silvia Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Marco Mangiulli
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Adolfo M Perrotta
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ludovica Napoleoni
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Cipolloni
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Anna P Mitterhofer
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Maria L Gasperini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Antonello Giovannetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabiana Falco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniela Mastroluca
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
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11
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Joly D, Quinn J, Mokiou S, O'Reilly K, Sánchez-Covisa J, Wang-Silvanto J, Doll H. Rationale and study protocol of ACQUIRE, a prospective, observational study measuring quality of life, treatment preference and treatment satisfaction of autosomal dominant polycystic kidney disease (ADPKD) patients in Europe. BMC Nephrol 2020; 21:298. [PMID: 32709218 PMCID: PMC7379359 DOI: 10.1186/s12882-020-01927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/05/2020] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is considered the most common inherited renal disease. Patient-Reported Outcomes (PROs) and patient experience in ADPKD are difficult to quantify and have not been well studied, particularly in the early stages of the disease. There is evidence to suggest that early-stage ADPKD patients have a lower Health-Related Quality of Life (HRQoL) than the general population due to the signs and symptoms of early-stage ADPKD. However, no research has been carried out on the HRQoL of early-stage ADPKD patients using validated ADPKD-specific PRO measures. Additionally, a new disease progression delaying treatment option has recently emerged for ADPKD. Patient preference for this treatment and unmet treatment needs have not yet been investigated. METHODS The ACQUIRE study is a prospective, observational study investigating the influence of early-stage ADPKD-related symptoms and treatments on PROs. It aims to collect real-world data on patient demographics, treatment patterns, clinical outcomes, and PROs such as HRQoL, treatment satisfaction and treatment preference in early-stage ADPKD. Adult ADPKD patients in stages 1-3 of chronic kidney disease (CKD) with evidence of rapidly progressing disease are being recruited from seven European countries. At baseline and every 3 months, for a follow-up period of 18 months, general and disease-specific questionnaires are completed remotely to capture patients' own assessment of their overall and ADPKD-related HRQoL. A Discrete Choice Experiment (DCE) is also used to investigate the value patients place on different attributes of hypothetical treatment options (e.g. treatment outcomes, side effects) and the role each attribute plays in determining overall patient treatment preference. DISCUSSION The results of this study will highlight the real-world effects of ADPKD-related challenges on PROs including HRQoL, treatment experience and satisfaction; and help physicians gain greater insight into likely disease outcomes based on early-stage patient symptoms and patients' experience with treatment. Data captured by the DCE may inform ADPKD treatment decision-making from a patient perspective. The DCE will also provide insights into which patients are more likely to perceive benefit from treatments based on the value and trade-offs they place on specific treatment attributes. TRIAL REGISTRATION NCT02848521 . Protocol Number/Version: 156-303-00096/Final.
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Affiliation(s)
- Dominique Joly
- Nephrology Department, Necker Hospital, 149 Rue de Sèvres, 75015, Paris, France.
| | | | | | | | | | | | - Helen Doll
- Clinical Outcomes Solutions, Folkestone, UK
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12
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Cho Y, Rangan G, Logeman C, Ryu H, Sautenet B, Perrone RD, Nadeau-Fredette AC, Mustafa RA, Htay H, Chonchol M, Harris T, Gutman T, Craig JC, Ong ACM, Chapman A, Ahn C, Coolican H, Kao JTW, Gansevoort RT, Torres V, Pei Y, Johnson DW, Viecelli AK, Teixeira-Pinto A, Howell M, Ju A, Manera KE, Tong A. Core Outcome Domains for Trials in Autosomal Dominant Polycystic Kidney Disease: An International Delphi Survey. Am J Kidney Dis 2020; 76:361-373. [PMID: 32359822 DOI: 10.1053/j.ajkd.2020.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE Outcomes reported in trials involving patients with autosomal dominant polycystic kidney disease (ADPKD) are heterogeneous and rarely include patient-reported outcomes. We aimed to identify critically important consensus-based core outcome domains to be reported in trials in ADPKD. STUDY DESIGN An international 2-round online Delphi survey was conducted in English, French, and Korean languages. SETTING & PARTICIPANTS Patients/caregivers and health professionals completed a 9-point Likert scale (7-9 indicating critical importance) and a Best-Worst Scale. ANALYTICAL APPROACH The absolute and relative importance of outcomes were assessed. Comments were analyzed thematically. RESULTS 1,014 participants (603 [60%] patients/caregivers, 411 [40%] health professionals) from 56 countries completed round 1, and 713 (70%) completed round 2. The prioritized outcomes were kidney function (importance score, 8.6), end-stage kidney disease (8.6), death (7.9), blood pressure (7.9), kidney cyst size/growth (7.8), and cerebral aneurysm (7.7). Kidney cyst-related pain was the highest rated patient-reported outcome by both stakeholder groups. Seven themes explained the prioritization of outcomes: protecting life and health, directly encountering life-threatening and debilitating consequences, specificity to ADPKD, optimizing and extending quality of life, hidden suffering, destroying self-confidence, and lost opportunities. LIMITATIONS Study design precluded involvement from those without access to internet or limited computer literacy. CONCLUSIONS Kidney function, end-stage kidney disease, and death were the most important outcomes to patients, caregivers, and health professionals. Kidney cyst-related pain was the highest rated patient-reported outcome. Consistent reporting of these top prioritized outcomes may strengthen the value of trials in ADPKD for decision making.
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Affiliation(s)
- Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - Gopala Rangan
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Charlotte Logeman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Benedicte Sautenet
- Department of Nephrology Hypertension, Dialysis, Kidney Transplantation, Tours Hospital, SPHERE - INSERM 1246, University of Tours and Nantes, Tours, France
| | - Ronald D Perrone
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | | | - Reem A Mustafa
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Bukit Merah, Singapore
| | - Michel Chonchol
- Department of Nephrology, University of Colorado, Denver, CO
| | - Tess Harris
- Polycystic Kidney Disease International, London, United Kingdom
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Arlene Chapman
- Department of Medicine, The University of Chicago, Chicago, IL
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Helen Coolican
- Polycystic Kidney Disease Foundation of Australia, Roseville, NSW, Australia
| | - Juliana Tze-Wah Kao
- School of Medicine, Fu Jen Catholic University and Fu Jen Catholic University Hospital, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Ron T Gansevoort
- Faculty of Medical Sciences, University Medical Center Gronigen, Groningen, the Netherlands
| | - Vicente Torres
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - York Pei
- Division of Nephrology and Division of Genomic Medicine, University of Toronto, Toronto, Canada
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Department of Nephrology, Mater Hospital, Brisbane, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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13
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Cloutier M, Manceur AM, Guerin A, Aigbogun MS, Oberdhan D, Gauthier-Loiselle M. The societal economic burden of autosomal dominant polycystic kidney disease in the United States. BMC Health Serv Res 2020; 20:126. [PMID: 32070341 PMCID: PMC7029467 DOI: 10.1186/s12913-020-4974-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases characterized by progressive development of renal cysts and numerous extra-renal manifestations, eventually leading to kidney failure. Given its chronic and progressive nature, ADPKD is expected to carry a substantial economic burden over the course of the disease. However, there is a paucity of evidence on the impact of ADPKD from a societal perspective. This study aimed to estimate the direct and indirect costs associated with ADPKD in the United States (US). METHODS A prevalence-based approach using data from scientific literature, and governmental and non-governmental organizations was employed to estimate direct healthcare costs (i.e., medical services, prescription drugs), direct non-healthcare costs (i.e., research and advocacy, donors/recipients matching for kidney transplants, transportation to/from dialysis centers), and indirect costs (i.e., patient productivity loss from unemployment, reduced work productivity, and premature mortality, caregivers' productivity loss and healthcare costs). The incremental costs associated with ADPKD were calculated as the difference between costs incurred over a one-year period by individuals with ADPKD and the US population. Sensitivity analyses using different sources and assumptions were performed to assess robustness of estimates and account for variability in published estimates. RESULTS The estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with ADPKD. In the base scenario, direct healthcare costs accounted for $5.7 billion (78.6%) of the total $7.3 billion costs, mostly driven by patients requiring renal replacement therapy ($3.2 billion; 43.3%). Indirect costs accounted for $1.4 billion (19.7%), mostly driven by productivity loss due to unemployment ($784 million; 10.7%) and reduced productivity at work ($390 million; 5.3%). Total excess direct non-healthcare costs were estimated at $125 million (1.7%). CONCLUSIONS ADPKD carries a considerable economic burden, predominantly attributed to direct healthcare costs, the majority of which are incurred by public and private healthcare payers. Effective and timely interventions to slow down the progression of ADPKD could substantially reduce the economic burden of ADPKD.
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Affiliation(s)
| | | | | | | | - Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ USA
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