From scientific research comes great news for nephropathic patients: drugs initially developed for the treatment of diabetes will soon be used also in chronic kidney disease patients to improve their conditions while the latest frontiers of cell therapy promise to make transplants even more effective and lasting . Unfortunately, 4000 kidneys are missing for as many in need of transplantation.
These are just two examples of the innovations that will be discussed during the 62nd Congress of the Italian Society of Nephrology (SIN RENI), which will take place from 6 to 9 October in Rimini.
The SIN wanted to take stock of the Covid-19 and vaccinations issue, on why it was necessary to rethink the vaccination scheme for renal patients and start the third doses.
Finally, particular attention was paid to the so-called “green nephrology”: “nephrology has a double link with the environmental issue that we can no longer ignore. On the one hand, climate change has a negative impact on the health of the kidneys, on the other hand nephrological therapies, especially dialysis ones, are particularly impacting from an environmental point of view. We are victims and perpetrators at the same time. It’s time to look for solutions, ”said Piergiorgio Messa, President of SIN, Director of the Complex Operational Unit of Nephrology, Dialysis and Kidney Transplantation at the Milan Polyclinic and Full Professor of Nephrology at the University of Milan.
Covid-19 vaccination and its effects on nephrological patients
“The effects of the Sars-Cov-2 epidemic on nephrological patients were particularly serious: as shown by a survey conducted by the SIN, among dialysis patients there was a mortality 10 times higher than that estimated to date in the general population during the second phase of the pandemic (26% vs 2.4%) ”, said Mario Salomone, Secretary of SIN. For this reason SIN had clamored for the inclusion of these patients among the categories that first had to access the anti Covid-19 vaccination and has now welcomed the indication for a third dose in renal patients.
“From the data collected, it is evident that in dialysis patients the antibody response to vaccination is 20-30% lower than in the general population, a decrease that reaches 60% or more in transplant recipients. These data suggest that our patients may still be susceptible to contracting the infection, suggesting that a third dose, which has been shown to double the level of antibodies, may also allow renal patients a suitable antibody response to increase. the defenses against the virus ”, added Messa.
New therapies available to nephropathic patients
Several congress sessions dedicated to therapeutic innovations. The first is related to the use of drugs initially studied for the treatment of type 2 diabetes, SGLT-2 inhibitors (sodium-glucose cotransporter 2) which decrease blood sugar levels by increasing the excretion of glucose in the urine. Numerous recent studies have shown a clear benefit of these drugs in renal and cardiovascular protection not only in patients with type 2 diabetes, but also in non-diabetic patients with renal or cardiological pathology. Specifically, these drugs, significantly slowing down the evolution of chronic kidney disease, reduce both the risk of death from kidney causes and the risk of getting to dialysis treatment.
“This is a very important therapeutic option that allows us to add a new product to the few drugs available to slow down the often inexorable evolution of chronic kidney disease towards the terminal phase of dialysis, and to improve the cardiovascular prognosis of these patients. explained Sandro Mazzaferro, Full Professor of Nephrology at the Sapienza University of Rome and Director of the UOC of Nephrology – Policlinico Umberto I in Rome.
Another novelty concerns anemia, one of the main complications of chronic kidney disease: an inhibitor of prolyl hydroxylase, a drug that stimulates erythropoiesis and regulates iron metabolism, has been shown to increase hemoglobin levels in renal patients in a manner comparable to the action of epoetin alfa, the standard of care, with the advantage of being an oral therapy.
New strategies to improve the transplant program
The congress will also be an opportunity to discuss kidney transplantation, chronic organ scarcity and new therapeutic perspectives. According to the latest data from the National Transplant Center, there are over 6000 people waiting for a kidney transplant, while the kidneys available are around 2000 every year: therefore more than 4000 kidneys are missing. “This is why it is extremely important to increase the culture of living transplantation, which today represents only 10% of donations: the only way to significantly reduce waiting lists”, explained Messa. “In the meantime, scientific research also comes to our aid: techniques such as CAR-T could in fact be” declined “also in the field of nephrology, to induce tolerance and therefore decrease toxicity and increase the duration of the transplant”. In fact, 15-20% of the people on the waiting list are patients who have already undergone a transplant.