RENAL1: The Decade of the Kidney - How Patients Voices can Bridge Oceans

The presently available Kidney Replacement Therapies (KRTs) are prolonging lives but need drastic improvements. Transplantation is by far the best & cheapest available KRT option, but: 1) there is a structural shortage of transplant kidneys, 2) many patients die, while still on the waiting list, 3) immune suppression drugs are needed to prevent transplant rejection, but also increase the risks of cancer and infections, 4) those that get a transplant still face an up to 25% shorter remaining life expectancy. Diaysis (either PD or HD) is the most widely used available KRT option, but: 5) it substitutes max 10-15% of kidney filtration function, 6) does not substitute all other kidney functions, 7) offers a significantly lower Quality-of-Life (QoL) than transplantation, 8) Is far more expensive and resource-heavy than transplantation, 9) comes with an up to 70% shorter remaining life expectancy. Dialysis is associated with a low QoL: Health-related QoL for dialysis patients is 27% – 49% worse than for the general population. It is resource-heavy, costing up to € 80,000 or $89,000 per patient per year, depending on the country and dialysis method. The annual death risk of dialysis patients is 10–100x higher than in the general population. The 5-year survival on dialysis is lower than for most cancer treatments, whereas worldwide 2/3 of patients do not even get treatment. They die without access to KRT, because they live in a country that either does not have sufficient infrastructure to offer the treatment, or the patients cannot afford the costs. World-wide the costs of treatment are rising, which is bound to become unsustainable. In 2016, $57.1 Billion/y was spent world-wide on chronic dialysis (note: that is excluding transplants and treatments for acute kidney failure). By 2030 this cost is expected to have risen to $110 Billion/y, while still 9.1 million out of 14.5 million patients will not have access to treatment (and those are even pre-Covid projections). The European Kidney Health Alliance (EKHA) and the American Association of Kidney Patients (AAKP) joined forces within the Decade of the KidneyTM framework to address these issues. We report on the rationale and vision of the EKHA Work Group “Breakthrough Innovation” which aims to disrupt the existing innovation paradox on KRT. We discuss how the concepts of international technological roadmapping and coopetition may leverage breakthrough KRT technologies, and present a map of the kidney innovation playing field, driven by patient advocacy groups, uniting patients, health professionals, policy makers, inventors, investors, engineers and entrepreneurs within the Decade of the KidneyTM.