Speaker calls current moment ‘positive sweet-spot’ for precision medicine in kidney care
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Though contending the care currently provided to patients is “poor,” a speaker at ASN Kidney Week said society is at a “uniquely positive sweet-spot” in which vascular access care, as well as kidney care as a whole, can be transformed.
In his presentation, Prabir Roy-Chaudhury, MD, PhD, of the University of North Carolina Kidney Center, told the audience that patients presently receive low-quality care despite spending an estimated $5 billion per year on vascular access care. The outcomes achieved, according to Roy-Chaudhury, are “dismal,” with a 50% patency rate at 1 year for most forms of arteriovenous access.
“This does not include any mention at all about quality of life,” he added.
To do better, Roy-Chaudhury recommends the vascular access community adopt a precision medicine approach, which calls for the use of demographic, clinical, imaging and molecular predictors to stratify patients into different risk groups to determine the therapy that will “suit them best.”
He said an essential element of precision medicine is addressing what matters most to the patient.
“Things that are important to patients are often different than the things that are important to physicians and industry partners, regulators and payers,” he said, citing a study published in the American Journal of Kidney Diseases that found patients who received hemodialysis most valued the ability to travel, dialysis free time and “not feeling washed-out at the end of dialysis.” On the other hand, physicians placed greater importance on survival, hospitalization and drops in blood pressure.
Although this study did not specifically look at vascular access priorities of patients, Roy-Chaudhury suggested it is likely patients care most about pain on cannulation, the wait times after pulling needles, the absence of physical disfigurement, as well as the number of procedures and interventions.
Acknowledging there are many steps involved in developing a precision medicine approach — moving from initial ideation and investment to the identification of targets to clinical trial infrastructure to regulation and reimbursement — he argued that due to actions taken by both public-private partnerships (eg, Kidney Health Initiative and Kidney Innovation Accelerator [KidneyX]) and federal agencies, like the FDA and HHS, precision medicine is attainable.
“As we look to the future, I would argue strongly that this sort of precision medicine approach when applied to population health — to all patients with vascular access — is perhaps the only way that we can add value to vascular access care and also take better care of our patients,” he concluded.
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Roy-Chaudhury P. Biology to personalize vascular access selection and treatment: A myth or reality? Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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