World Kidney Day 2024 focuses on raising awareness of the importance of kidney health and reducing the frequency and impact of kidney disease and its associated health problems.

The second Thursday of March each year is celebrated as World Kidney Day. It is a collaborative effort between the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF). It serves as a critical platform for educating the public, medical professionals and policymakers about risk factors and the need for accessible treatment options for treating kidney disease.

World Kidney Day focuses on preventive measures that can help curb the risk of kidney disease. Recently, kidney health advocacy groups and the healthcare industry have encouraged healthy lifestyle choices such as maintaining a balanced diet, regular physical activity, avoiding tobacco use and limiting alcohol consumption. To ensure the management of kidney disease progression with appropriate treatment, early detection through screening is especially encouraged for those at high risk.

Kidney Disease: Its Impact and Significance

The kidneys are responsible for the filtration of waste products from the blood and their excretion via urine. They also help regulate electrolyte levels and maintain fluid balance. The kidneys are known to play a major role in regulating blood pressure and producing hormones that influence the production of red blood cells (RBCs).

Chronic kidney disease (CKD) is known to affect millions of people worldwide; it is a condition that can gradually progress to end-stage renal disease (ESRD), which requires dialysis or kidney transplantation. Diabetes, hypertension, obesity and a family history of kidney failure are known risk factors for CKD.

Detecting kidney disease at an early stage can help slow down its progression and mitigate the associated health risks. Screening for kidney disease requires simple tests, such as blood and urine analyses, which can help detect early signs of kidney dysfunction and enable timely treatment and lifestyle adjustments to preserve kidney function.

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Facts and Statistics Related to Kidney Disease

Kidney disease, particularly CKD, has a significant global health burden and affects millions of people worldwide.

About 10 percent of the global population is known to be affected by CKD, which is also a major cause of morbidity and mortality worldwide.

Diabetes and hypertension are the leading causes of CKD and are contributing risk factors for about 66 percent of all cases. The other risk factors include obesity, smoking, cardiovascular disease and a family history of kidney failure.

CKD can considerably increase the risk of death from cardiovascular diseases and is ranked as the 12th leading cause of death globally.

In the US, kidney diseases are a significant health concern, with CKD affecting an estimated 15 percent of the adult population, or about 37 million people. Medicare spending for beneficiaries with CKD exceeded $114 billion in 2021, highlighting the need for effective management strategies and policies.

Latest Developments in Kidney Disease Therapeutics

The field of nephrology has witnessed considerable advancements in the last decade. Many promising areas of novel therapeutics are being explored to manage and treat various forms of kidney disease, particularly CKD and its complications. Here are some of the latest developments in this area:

• Sodium–glucose cotransporter-2 (SGLT2) inhibitors: These treatments were initially targeted for treating diabetes. However, SGLT2 inhibitors demonstrated considerable benefits in slowing the progression of CKD in both diabetic and non-diabetic patients. These inhibitors block the reabsorption of glucose in the kidneys, thus leading to its excretion in urine, and provide cardiovascular and renal-protective effects.
• Glucagon-like peptide-1 (GLP-1) receptor agonists: GLP-1 receptor agonists are primarily used for diabetes management but have shown promise in reducing the risk of CKD progression. They improve insulin secretion and demonstrate beneficial effects on weight, blood pressure and cardiovascular outcomes.
• Nonsteroidal mineralocorticoid receptor antagonists (MRAs): Unlike steroidal MRAs, these drugs have the potential to treat CKD by reducing fibrosis and inflammation in the kidneys without major known side effects. They provide cardiorenal protection, particularly useful for patients suffering from CKD and heart failure.
• Endothelin receptor antagonists: These drugs target the endothelin system, which is involved in blood pressure regulation and is also considered to play a role in kidney disease progression. These drugs are being investigated for their potential in slowing down CKD progression.
• Novel anemia treatments: Anemia is a well-known complication of CKD. To overcome this complication, novel treatments, such as hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), are being developed. These inhibitors stimulate RBC production by mimicking the body’s response to low oxygen levels. This approach can act as an alternative to the traditional erythropoiesis-stimulating agents (ESAs) and iron supplements.

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New Experimental Treatments for Kidney Disease

New experimental treatments for kidney disease include gene therapy and CRISPR technology, which hold promise for correcting genetic defects associated with kidney diseases and modulating gene expression. This approach is particularly exciting for addressing hereditary kidney diseases.

Moreover, stem cell therapy and regenerative medicine are being explored as potential methods for repairing or regenerating kidney tissue damaged by kidney disease. These experimental treatments offer hope for patients with conditions such as acute kidney injury (AKI) or CKD.

Notable Phase II/III Clinical Trials for Kidney Disease

Numerous investigational drugs are currently progressing through Phase II/III clinical trials, offering promising treatment options for kidney diseases. These candidates are specifically designed to target the underlying mechanisms of kidney damage or enhance kidney function while minimizing adverse effects.

Boehringer Ingelheim’s BI 690517, for instance, inhibits aldosterone production, a hormone that can accelerate the progression of kidney disease when in excess. At the Phase II trial stage, the findings demonstrated a notable decrease in albuminuria, an indicator of kidney damage, by as much as 39.5 percent when BI 690517 was administered alongside empagliflozin, an SGLT2 inhibitor, compared to a placebo. In this study, empagliflozin was used as background therapy to mitigate the risk of hyperkalemia, a potential side effect of inhibiting aldosterone.

Novartis’ atrasentan is being studied for its potential to reduce proteinuria in patients with IgA nephropathy (IgAN), a condition known to lead to progressive loss of kidney function. The Phase III ALIGN study successfully achieved its primary objective, establishing the superiority of atrasentan over placebo in reducing proteinuria during the 36-week interim analysis. Furthermore, the safety profile of atrasentan remained consistent with previously documented data.

React (rilparencel), a cell therapy developed by ProKidney, is undergoing Phase III trials targeting moderate to high-risk diabetic CKD patients. This therapy aims to preserve kidney function, with a focus on patients exhibiting an estimated glomerular filtration rate (eGFR) between ≥ 20 ml/min/1.73m² and ≤ 35 ml/min/1.73m².

Each of these drugs are targeted towards different aspects or types of kidney disease. Owing to the complexity and variety of kidney-related conditions, many therapeutic approaches are being explored and tested to observe their effect on kidney disease.

New FDA-Approved Treatments for Kidney Disease

The US Food and Drug Administration (FDA) has recently approved several treatments for kidney disease.

Bayer’s Kerendia (finerenone) tablets have been granted FDA approval for reducing the risk of kidney function decline, kidney failure, non-fatal heart attacks, cardiovascular death and hospitalization due to heart failure in adult patients diagnosed with CKD associated with type 2 diabetes.

Farxiga (dapagliflozin), originally approved for diabetes management, has also received FDA approval for treating CKD due to its demonstrated ability to protect kidney function and reduce the risk of kidney failure. Farxiga was developed by AstraZeneca and Bristol Myers Squibb (BMS).

The FDA granted approval for Jardiance (empagliflozin) to mitigate the risk of sustained decline in eGFR, end-stage kidney disease, cardiovascular death and hospitalization in adults diagnosed with CKD at risk of progression. Jardiance was developed by Boehringer Ingelheim and Eli Lilly.

Last year, the FDA approved GlaxoSmithKline’s (GSK) Jesduvroq (daprodustat), a novel once-daily oral treatment for anemia linked to CKD. The approval is limited to adult patients who have been receiving dialysis for a minimum of four months.

New Technologies Under Investigation for Kidney Disease Treatment

Many innovative technologies are under development and aimed at transforming care for patients undergoing kidney disease treatment. Here is an overview of some of these technologies:

• Waterless artificial kidney: This prototype of the world’s first tabletop artificial kidney is aimed at creating a device that fits on a desktop and can be used at work or placed on a bedside table while sleeping. It simulates the filtration and important ion transport functions of the nephron such as ultrafiltration, nanofiltration, electrodeionization for ion transport requirements and reverse osmosis for urine concentration and water excretion control​​.
• Implantable bioreactor: Researchers at UC San Francisco are developing an implantable device, referred to as an implantable bioreactor, to house kidney cells that can survive within the human body and can replicate many important kidney functions. This approach aims to free patients from dialysis or immunosuppressive drugs after transplants and quietly work in the background (similar to a pacemaker) without triggering any response from the immune system.
• Regeneration of diseased kidney cells: The targeting of the IL-11 pathway with anti-IL11 therapy has been reported to potentially reverse established CKD and restore kidney function by promoting regeneration. This therapy has led to the restoration of renal function in preclinical models and has the potential to reverse the effects of renal tubular cell damage and fibrosis.

World Kidney Day 2024 highlights the significance of kidney health and the urgency to address kidney disease — a condition affecting millions worldwide. It also helps identify the critical gaps between current knowledge and its implementation in healthcare practices. With each passing year, advancements in treatment and a growing awareness of the importance of early detection offer new hope to millions affected by kidney disease worldwide. By bridging the gap between knowledge and practice, advancing research and fostering global collaboration, the quality of life for millions worldwide affected by kidney disease can be improved.