Over 10% of the world’s population – or 850 million people – are estimated to have kidney disease, and the problem is growing rapidly. The vast majority lives in low-income or low-and-middle-income countries, and, without access to primary healthcare, may be unaware of the problem until it is too late – organ failure and early death follow. Only dialysis and organ transplant can prolong the life of patients with kidney failure, but neither is hugely scalable, particularly in low-resource settings.

Although asymptomatic until its later stages, kidney disease is easily diagnosed through urine and blood tests. In low-income countries, malnutrition, dehydration, infection and exposure to environmental toxins are important risk factors for kidney disease. In wealthy countries, kidney disease is often seen as a complication of other conditions, such as diabetes or high blood pressure. The treatments administered to patients reflect these lead-in indications – lowering blood sugar levels, lowering blood pressure and blockade of the renin-angiotensin-aldosterone system (which controls blood pressure and fluid balance) are all important interventions. The advent of newer classes, such as sodium/glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1(GLP-1) receptor agonists, and endothelin receptor antagonists have further improved the prospects of those patients who have access to them.

The cause of many cases of kidney failure remains unclear, however, although lowering inflammation and fibrosis are two additional approaches that have promise. Historically, kidney disease has not been a major focus of innovative biotechnology companies, although several large transactions in recent times indicate that that may be changing. Vertex Pharmaceuticals recently entered a $4.9 billion acquisition agreement with Alpine Immune Sciences, and Novartis acquired Chinook Therapeutics last year for $3.2 billion upfront. The focus of both deals is IgA nephropathy (or Berger’s disease), which arises from the damaging deposition of antibody complexes in the kidney.

Definitive data from large-scale phase 3 trials is still several years away. In the meantime, a recent consensus statement (Francis, A., et al., 3 Apr. 2024, Nat. Revs. Nephrol.) from several expert groups has called for the inclusion of kidney disease on the World Health Organization’s list of priority non-communicable diseases and the recognition of its varied causes and drivers in different regions and populations.

Companies mentioned in this episode:
Alpine Immune Sciences, Atara Biotherapeutics, Bayer, Boehringer Ingelheim, Chinook Therapeutics, CSL Vifor, GSK, Novartis, Sanifit, Travere Therapeutics, Renalys Pharma, Vertex Pharmaceuticals

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