Pam Harrison

May 13, 2016

VIENNA — Big data will be in the spotlight here at the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) 53rd Congress as nephrologists look for ways to move beyond negative trial results and optimize treatment for patients with chronic kidney disease.

"We still use techniques developed many years ago, like glomerular filtration rate and proteinuria, but this information doesn't really tell us much about the pathophysiology that's giving rise to an individual patient's symptoms," said Gert Mayer, MD, chief of internal medicine at the Medical University Innsbruck in Austria, who is president of the congress.

"By not characterizing patients correctly, we end up lumping everybody together, and then we wonder why outcomes from these clinical trials are negative. But the drugs that are investigated probably only work in a subset of patients," he explained.

Dr Gert Mayer

The use of big data and a systems approach to better characterize patients might work, although "not everyone agrees that this is the right thing to do," he added.

Danilo Fliser, MD, from Saarland University Medical Centre in Homburg, Germany, and chair of the ERA-EDTA scientific committee, said he agrees.

"The problem with chronic kidney disease patients is that they are so different from all other groups of patients," he told Medscape Medical News. "You cannot take outcomes from standard trials and get the same effect in a CKD patient because of the inherent diversity of our patients."

To address this issue, big data experts will share their ideas on ways to modernize nephrology in a series of plenary sessions.

How the science of pharmacogenomics can be used by nephrologists to tailor drugs to individual patients will be examined by Andrew Kasarskis, PhD, from the Icahn Institute for Genomics and Multiscale Biology in New York City.

The use of genetic and environmental information to help pinpoint an individual's susceptibility to disease and anticipate response to a specific intervention will be discussed by Nicholas Schork, PhD, from the Scripps Research Institute in San Diego, in his lecture entitled Is it Time for One-Person Trials?

And the underpinnings of the immune system that can be tempered to induce immune tolerance will be looked at by Kathryn Wood, PhD, from the University of Oxford in the United Kingdom.

Shortage of Donor Organs

There will also be discussions on what to do about the growing shortage of donor organs.

One possibility is not to reject kidneys because of infection. Over the past decade in the United States, the demand for kidney transplants has almost doubled, yet 10% to 15% of all donor organs are discarded every year, often because of infection, Dr Kasarskis reported. About 80,000 kidneys are needed each year in the United States, but currently fewer than 20,000 are successfully transplanted, he said.

The challenge of managing the increasing number of elderly patients who are presenting to nephrology practices will also be addressed.

Dr Danilo Fliser

"The elderly have diabetes, they have vascular disease, and it doesn't matter if they have acute or chronic kidney disease, the proportion of patients over the age of 60 and 70 who are coming to our clinics with impaired kidney function is growing," Dr Fliser said.

The innovative and comprehensive SCOPE program — Screening for Chronic Kidney Disease Among Older People Across Europe — is a response to this problem, and will be featured at the meeting.

Another key area that will be covered is how to slow kidney disease progression in patients with common conditions, such as diabetic nephropathy.

For example, bardoxolone methyl, the first in a new class of antioxidant inflammation modulators, was effective in staving off progression to end-stage renal disease in a large trial of patients with diabetic nephropathy (N Engl J Med. 2013;369:2492-2503), Dr Mayer reported. However, significantly more patients in the bardoxolone methyl group than in the placebo group were hospitalized or died from heart failure, and the trial failed because of adverse effects.

"This is a good example of how we can use this or a similar drug if we correctly classify patients," Dr Mayer explained, and could be another area in which personalized medicine might improve outcomes.

Dr Mayer reports relationships with Alexion, Amgen, Teva, Fresenius, CosmoFer, Novartis, Roche, and Sandoz. Dr Fliser reports relationships with Amgen, Daiichi-Sankyo, FMC, and Roche.

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