The Advantages of Precision Medicine for Kidney Health

Recognizing the limitations of these practices, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) launched a kidney precision medicine effort in 2016. One key purpose of their initial workshop (and their follow up work) is clearly stated as: “To recognize the heterogeneity of acute and chronic kidney disease and the importance in differentiating such heterogeneity so that precise treatments can be developed and provided to individual patients.”

In pointing to the diverse nature of kidney disease, the NIDDKD emphasized the need for scientific research and changes in medical practice to better address individual patients’ health conditions. Through more precise diagnosis and personalized treatment, there is great potential to slow down or stop the progression of kidney disease. By taking a more individualized approach, healthcare professionals can provide tailored treatment plans that consider patients' unique circumstances, ultimately improving their quality of life.

Precision Medicine Promises Better Health Outcomes

Precision medicine is an approach to medical treatments and disease prevention that is based on an exact understanding of an individual's state of health, including differences in their genes, environment, and lifestyle. Precision medicine promises better health outcomes compared to the traditional one-size-fits-all approach, which bases its diagnosis and treatment practices on modeling the “average” patient.

One patient's experience highlights the benefits of precision medicine in managing kidney disease. Through a kidney biopsy, the patient learned that hypertension, rather than diabetes, was the primary cause of their kidney disease. Understanding the underlying mechanisms of their disease was a “revolutionizing experience” and provided the patient with insight into their past health experiences, informed their self-care going forward, and allowed them to prioritize which treatments to focus on.

While sometimes referred to as personalized medicine, we should think of that personalization at the level of subgroups identified by specific characteristics and not every single individual patient.

The Path to Precision Medicine Varies

As medicine evolves, the focus on precision medicine has become increasingly important. This approach seeks to gain a more nuanced understanding of a patient's state of health by examining various aspects of bodily functions. In the case of kidney health, precision medicine involves a multi-layered mapping of how the kidneys can both function and fail.

There are currently three primary approaches to applying precision medicine to kidney health:

1. Deep analysis of tissue samples

The Kidney Precision Medicine Project (KPMP), hosted at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD), utilizes deep analysis of kidney biopsies to better understand kidney health. Biopsies are ethically collected from individuals experiencing Acute Kidney Injury (AKI) or Chronic Kidney Disease (CKD) to create a kidney atlas, define disease subgroups, and identify critical cells and pathways. This work aims to develop targets for novel therapies to improve kidney health.

2. Genetic Analysis

Genetic analysis has provided a more precise understanding of kidney disease risk levels by examining an individual's genetic makeup or the genetic makeup of tumors, organs, or bodily tissue. By identifying genetic variations, healthcare professionals can make more precise diagnoses, treatments, and gain a deeper understanding of the patient's overall health. One study at the Perelman School of Medicine identified 182 genes potentially linked to kidney function. Through this work, researchers have begun mapping out inherited genetic factors that increase CKD risk and distinguishing genes impacting related conditions such as hypertension.

3. Biomarker Analysis

Biomarker analysis is a valuable tool in precision medicine for identifying a person's risk level for developing disease and the most effective approaches for treatment. Researchers have used biomarkers to identify whether bodily tissue is healthy or damaged, as well as exposure to environmental toxins.

A research group at the University of Michigan is investigating lipid biomarkers and has identified some that predict the progression of kidney disease in people with type 1 and type 2 diabetes along with how these indicators differ between the two groups. 

Paul J. Beisswenger, MD — Chief Scientific Officer at Journey Biosciences — has been instrumental in investigating advanced glycation end products (AGEs) in the blood as a predictive biomarker for kidney disease. His latest research, published in Diabetes Care, confirmed the predictive relationship between AGEs and the development of kidney disease in type 2 diabetes.

NaviDKD® Brings Precision Medicine to Diabetes and Kidney Care

NaviDKD enables a tailored and proactive approach for the management and prevention of diabetes-related kidney disease (DKD). By analyzing a blood sample, the screening accurately assesses an individual's risk level for developing DKD, well in advance of clinical signs or symptoms. This timely insight empowers both healthcare professionals and individuals with diabetes to implement effective interventions, which can delay or even halt disease progression.

Precision medicine holds great promise for managing kidney health, and ongoing research is making progress in identifying, managing, and preventing kidney disease. By analyzing individuals' genes, environments, lifestyles, etc., precision medicine can develop personalized treatments that lead to better health outcomes. NaviDKD is playing a role in these advancements by providing early warning signs and enabling proactive measures to preserve kidney health. We are encouraged by the momentum and the dedicated work of researchers and healthcare professionals, and we hope to see positive change for those affected by kidney disease.