Moving The Needle: The Future of Kidney Care

There is not enough innovation for renal patients? I strongly disagree — and I believe we are on the brink of more breakthroughs that will radically improve our patients’ lives.

As the CEO of a healthcare company, I’m often asked about the future: “Will it get better?”, our patients want to know. They ask me because the company I work for, Fresenius Medical Care, is the top kidney specialist in the world. We care for hundreds of thousands of dialysis patients, have manufactured over half of all dialysis machines, perform around 48 million dialysis treatments a year and operate research and development sites across the globe. And this is just within our walls – we also spend hundreds of millions to participate in the science and innovation that goes on beyond them. So when I’m asked about the future, I’m not playing a guessing game: It’s my job to know the future of healthcare, to invest and bet on it – and then put myself on the line to really make it happen.

But this is not about me; it’s about the 37 million Americans (and hundreds of millions of others in the world) suffering from chronic kidney disease. The majority of them are unaware they even have it. That seems oddly fitting: Despite being the ninth leading cause of death in the United States, kidney disease is rarely a big issue in the media. This changed in July, when the administration presented the “Executive Order on Advancing American Kidney Health” – a large and ambitious vision for the future that gives a very positive answer to the question “Will it get better?”. I would like to seize this opportunity to add my two cents and talk about how I see the future of kidney care, speaking from the insights my position has to offer. 

1.      Kidney care is improving continuously, already

Only a few decades ago, losing your kidneys was a death sentence. Since then we’ve learned to replicate their function using dialysis or replace them altogether with transplants. And in this industry, we at Fresenius Medical Care have long been on the forefront of innovation. It’s true, we haven’t found a ‘miracle pill’ to cure kidney disease with a single stroke – but we’ve come up with a whole series of inventions and improvements, ranging from new drugs and medical devices to improved standards for patient care, which have made the lives of thousands of patients longer and better. If you’re interested to see what we’ve been up to lately, check out my posts about our new industry-leading approach to care and our push to bring dialysis to our patients’ homes. 

2.      We will get much better at preventing kidney disease

At this very moment, medicine is going through some dramatic changes. As our capacity to acquire and process data increases, there is a shift from reactive to preventive healthcare – from seeing patients only after they get sick to proactively keeping them healthy. Kidney disease has long been particularly data rich. By looking at more than 1000 real-life clinical data points, we at Fresenius Medical Care can already predict which of our dialysis patients is at increased risk of being hospitalized, so that our clinical staff can take special care to prevent it. And the better we get at making such predictions, the earlier we are able to intervene.

Today, ninety-six percent of Americans with light kidney damage don’t know they have it. We usually don’t get to see them until they’re very sick and “crash into dialysis” ending up at the emergency room. This is a worst-case scenario — both physical and psychological — that unfortunately occurs far too often. Dialysis patients with a smooth start into dialysis treatment have a much higher life expectancy. If in the future, people will be able to give us consent to see their data much earlier this could give us the opportunity to detect signs of kidney disease at an earlier stage. And once we detect it, we can accompany our patients and enable a smooth transition phase into dialysis or are able to slow its progression.   

3.      We need to find new ways to treat kidney disease in the future

Kidneys are a true miracle of the human body: They cleanse the blood 300 times a day, regulate the body’s water levels, maintain its acid-base balance, control mineral levels, and produce hormones. You can imagine how hard it is to replace these intricate organs. Today, around 100,000 Americans are waiting for a transplant — with an average waiting time of between three to seven years. About a third of them will receive one from a living donor. Ten years further down the line, even if they stick to their immunosuppressant medications, only about half of these transplanted kidneys will still be working. Now imagine an alternative world in which we can heal injured or damaged kidneys or replace them with one grown from a patient’s own cells, thereby eliminating the possibility of rejection. It seems like a far-fetched idea — but our researchers in the field of regenerative medicine are already going there. Our strategic partner Humacyte, a U.S.-based biotechnology start-up, grows blood vessels in a bioreactor. They can be implanted without the risk of rejection and, compared to synthetic transplants, result in fewer complications for our dialysis patients, who can use them for vascular access. Then there is our independent affiliate Unicyte, which has managed to restore in a pre-clinical model the kidney function in mice suffering from a specific kind of kidney disease. It’s progress like this that is making us optimistic.

With ten percent of the world‘s population affected by chronic kidney disease, the amount of research focused on the subject is less than you would expect: The funding of clinical trials by the National Institutes of Health for renal-related issues is lower than for almost all other major medical specialties. At Fresenius Medical Care, the need for our patients to live full, productive lives challenges us to do more. We are highly dedicated to renal research and have put the infrastructure in place to do it. Why? Because we believe that the opportunities for innovation are limitless — and it is our mission to improve the quality of life of every one of our patients, every day. I don’t have a crystal ball, but I would say things are about to get much better for kidney patients.