PKD: Tolvaptan Study of Impact on Quality of Life

PKD Treatment

From healio.com

Tolvaptan showed no impact on QoL for patients with autosomal-dominant polycystic kidney disease

Treatment with tolvaptan did not appear to affect health-related quality of life for Swiss patients with autosomal-dominant polycystic kidney disease, according to study results.

“Recently, tolvaptan, an orally active, non-peptide selective arginine vasopressin V2R antagonist has been approved for the treatment of [autosomal-dominant polycystic kidney disease] ADPKD in many countries, including Switzerland,” Manuel A. Anderegg, MD, PhD, of Bern University Hospital in Switzerland, and colleagues wrote. “In two, randomized, double-blind, controlled phase 3 trials ... Tolvaptan lowered the increase in total kidney volume and kidney function decline compared to placebo.”

However, these benefits were coupled with a high frequency of aquaresis-related events including thirst, polydipsia, polyuria and nocturia, according to the researchers. Due to these adverse events, treatment guidelines have called for regular HRQoL assessment in patients treated with the drug. Researchers argued that despite these treatment recommendations, there remains knowledge gap on what impact, if any, tolvaptan has on HRQoL.

They initially included 121 patients from the Bern ADPKD registry, though the final analysis included 98 patients (treatment had to be discontinued in some of the study population due to aquaretic side effects or elevated liver enzymes; 30 patients with treatment, 68 patients without). All participants were asked to fill out the standardized kidney disease quality of life-short form (KDQoL-SF) questionnaire at the start of the study and after 1 year. The questionnaire assessed HRQoL with general measures (including physical functioning, role limitations caused by physical or emotional health problems, social functioning, bodily pain and vitality) and kidney-specific items (including effects of kidney disease, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep and patient satisfaction).

After adjusting for baseline scores, sex and age, researchers observed no difference between groups regarding general or kidney-specific HRQoL, except in patient satisfaction for which patients treated with tolvaptan rated as higher.

“The reasons for increased satisfaction in tolvaptan-treated patients can only be speculated,” they wrote. “Positive selection of patients that tolerated this novel disease-modifying drug in the analysis and close patient-physician relationship due to monthly visits for liver function tests are likely causes.”– by Melissa J. Webb

Portable Artificial Kidney Breakthrough Trials, Comparison of Dialysis Methods for Patient Survival

Dialysis 

From South China Morning Post, by Minghe Hu in Beijing and Coco Feng

Singaporean start-up’s portable ‘kidney’ could shrink dialysis machines, giving patients their freedom back

AWAK chief executive Suresha Venkataraya showcases the wearable artificial kidney in Beijing in December 2019. Photo: SCMP/ Coco Feng

For the past seven years, 70-year-old Singaporean Julia Lee has rarely travelled overseas. Her most recent trip was one night away, in neighbouring Malaysia.

Since being diagnosed with kidney disease, Lee has spent 10 hours each day hooked up to a 20-kilogram machine, making it difficult to move around.

Chronic renal disease results in a loss of kidney function, meaning the patient’s body is unable to clear the blood of waste and excess fluids. Dialysis – the treatment Lee goes through which involves machines removing excess water and toxins from the patient’s blood – is the only option for those whose kidneys are no longer able to perform their function, save for a kidney transplant. Some like Lee, whose heart problems make her unsuitable for a transplant, have to rely on the treatment permanently.

“If there was a portable device that could be carried around and used at home, it would be more convenient for me,” Lee said. “Maybe I would be able to travel more.”

But a Singaporean company is offering new hope with its work on a portable artificial kidney weighing just 2 to 3 kilograms, as advances in technology begin to drive more human and machine interaction in health care.

Founded in 2007, AWAK Technologies is among a group of start-ups worldwide – including Sweden's Triomed, US firm Wearable Artificial Organs and Dutch start-up Nanodialys – that are looking into ways to make wearable dialysis machines.

AWAK is the only one from Asia, and it has made some headway in gaining recognition from both regulators and investors.

A year ago, its portable artificial kidney was granted “Breakthrough Device Designation” by the US Food and Drug Administration (FDA), a qualification that could expedite the development and review of certain medical products.

The start-up also recently raised US$40 million in a series A1 fundraising round co-led by Vickers Ventures Partners and an unnamed global medical product company. Other investors include medical technology manufacturer Advanced MedTech and the investment arm of government agency Enterprise Singapore, SEEDS Capital.

The artificial kidney, worn externally, consists of a permanent pump and a disposable cartridge that acts as an advanced filter to clear toxins from the body.

Like the machine Lee uses, AWAK’s device carries out peritoneal dialysis (PD), one of two main types of dialysis. PD involves a solution being injected into the abdominal cavity to absorb waste products and toxins before being removed. The other main type of dialysis, haemodialysis (HD), involves extracting the patient’s blood, cleaning it and returning it to the body.

Despite its smaller size compared to regular PD machines, AWAK's device can be used for seven to 10 hours a day. It only holds 250 millimetres of fluid but the cartridge can clean the toxin-laden fluid after it is extracted from the patient's body and push it back repeatedly, processing about two litres of the solution each hour.

Although the company said it has not studied the efficiency of this system compared to conventional PD devices yet, the one Lee uses processes half a litre of solution per hour and has to hold a larger amount of fluid as it cannot be reused.

There is a large potential market for AWAK’s product: about 2.6 million people worldwide underwent dialysis in 2010, and the population is projected to double by 2030, according to a 2015 Lancet study.

To be sure, the new device still has some limitations. Although AWAK enables patients to work, attend school and go shopping more easily than before, possible contamination from the environment remains a concern.

As with conventional PD treatment, patients will need to find a clean place to reduce the risk of contamination, according to Sydney Tang, a professor of renal medicine at the University of Hong Kong.

However, as there are no more connections between the patient’s body to the device than conventional PD, “the risk of contamination should not be higher” theoretically, he said.

According to AWAK chief executive Suresha Venkataraya, the device tested safe in the most recent clinical trial in 2018, although this was conducted in a controlled environment in the Singapore General Hospital and patients were not allowed to leave the centre.

The company hopes to conduct further trials in about 12-18 months with the aim of getting government approval in Singapore, Venkataraya said, adding that one of its biggest challenges was recruiting patients for the trials.

If its upcoming trials are successful, AWAK could be the first to successfully launch a portable PD machine of this kind. But several of its competitors may also be close: a spokesman from Nanodialysis said that the company expects to launch its wearable PD device in 2022, first in Europe and then in Asian countries like Japan and China as well as the US, while Triomed completed a trial of wearable PD devices with five patients in 2018.

Lee said she would be excited about a portable dialysis device but price is a concern. The monthly cost of her current treatment, including machine rental and the dialysis fluid, is S$2,000 (US$1,480). This is mostly covered by national health care programmes as well as subsidies from the non-profit Kidney Dialysis Foundation, she said.

The price of the AWAK device has not been determined, although Venkataraya said the company wants to make sure that the cost can be covered by medical insurance in each market.

After launching in Singapore, AWAK hopes to introduce the device in Hong Kong, Australia, Europe and the US, Venkataraya said, adding that Singapore and the European regulators generally approve products faster than the US FDA. AWAK still does not have a clear timeline for the US market, where it can take an average of three to seven years for a medical device to clear regulatory scrutiny and launch.

On the company’s choice of its first market, Venkataraya said that while Singapore is not big, it does have high population density “where in one or two hospitals, you can find many patients and a lot of support”.

Government support was also a factor: “The National Medical Research Council gave us a grant for the trial and Enterprise Singapore also gave us early grants and funding which we really needed. So the whole ecosystem was very supportive,” he added.

From Eureka Press, UNIVERSITY OF LIMERICK

UL study reveals 'identical' survival for kidney dialysis patients using different treatments

Research carried out at University of Limerick has shown that life expectancy outcomes for two of the most common forms of kidney dialysis treatment are "virtually identical".

In the largest study of its kind, researchers from the Graduate Entry Medical School (GEMS) at UL compared the survival of patients with kidney failure that were treated with either peritoneal dialysis (PD) or haemodialysis (HD) at a dialysis centre, two of the most common forms of available treatments.

The researchers found that the survival of new patients with kidney failure was similar irrespective of treatment type - PD or in-centre HD - and have recommended that this new knowledge be incorporated into policy documents to enable patients and their providers make the best decisions on optimal treatments.

Prior to the study, questions had been raised by the scientific community as to whether one form of dialysis was superior to another in terms of survival benefit. This answer to this question is of "huge significance" according to Professor Austin Stack, Foundation Chair of Medicine and Lead Investigator for the Kidney Research Consortium at UL.

"There has been huge debate on this issue, as they are very different treatments for kidney failure," said Professor Stack.

"Defining whether one treatment confers a survival advantage over another for patients who develop kidney failure is of utmost importance. We have shown in this study that the life expectancy was virtually identical on either of these therapies. This is hugely important as it means that patients have a choice," he added.

The systematic review, a pooled meta-analysis of 17 cohort studies with over 113,000 dialysis patients between 1993 to 2014, was conducted by the research team at UL in association with the Departments of Nephrology and Internal Medicine at University Hospital Limerick, and the findings have just been published in the international journal Nephrology, Dialysis and Transplantation.

"Prior studies on this topic have yielded conflicting results," according to Dr Mohamed Elsayed, the primary author of the study, Research Fellow and Specialist Registrar in Nephrology.

"Indeed, when we looked at the available international literature, we found that the results tended to vary by country, and according to the year the study was carried out. One potential reason for this is that patients who are selected for PD differ from those who are selected for HD, and that practice patterns tend to vary across countries.

"The ideal method for comparing the survival of these two treatments would be a randomised controlled clinical trial but unfortunately due to logistical challenges and recruitment difficulties investigators have failed in the past to successfully complete such trials.

"The next best method is to use an approach that carefully considers the differences between PD and HD and conduct comparisons using what is called a propensity-score matched approach. Such a comparison allows us compare the treatments take into account baseline differences between the patient groups," he added.

The study pooled together the results from research that used a propensity-based approach and found that patients who began dialysis either with in-centre HD or PD experienced similar survival (Hazard Ratio 1.06, 95% Confidence interval 0.99 to 1.14). The findings were remarkably similar for patients with and without diabetes and were consistent across studies that included European, North American and Asian Cohorts.

Despite the overall similar survival between PD and HD, it did uncover important differences from country to country and across different time periods. Importantly, it also found that the survival of PD was better than that of HD in more recent time periods (after 2007).

These research findings have important implications, according to Professor Stack, on how we manage patients with imminent kidney failure approaching dialysis.

"All else being equal, both of these therapies are effective at extending patient survival, and thus the conversation with patients should revolve around which of these treatments is the most suitable treatment from a lifestyle and quality of life perspective," he explained.

"Globally, the rates of use of PD are substantially lower than those of HD, with less than 10% of dialysis patients receiving PD as a maintenance treatment. In the United States, around 10% of dialysis patients are receiving PD with the majority treated with HD. Similarly, in Ireland, the rates of PD use are remarkably low, with only 9.5% of patients utilising PD leaving room for improvement.

"Peritoneal dialysis is a form of dialysis that be provided in one's home, and lead to better quality of life and greater independence. Economically, PD is the cheaper form of therapy compared to in-centre HD with costs that are on average €20,000 lower.

"Given that PD has at least similar survival to HD, and the fact that PD is more cost effective, and leads to better preservation of lifestyle, we advocate that PD should be encouraged as a first-line therapy for many patients with approaching kidney failure," he added.

ADPKD Patients Needed for Study, New Kidney Donation Rules, Perfect Match, Medicare Drug Policy Creates Transplant Problem

Kidney Donation

From PKD Foundation, Blog, by Alexis Denny, Director of Government Affairs
Understanding new rules and regulations around kidney donation — Part One

In 2019, the U.S. Department of Health and Human Services (HHS) took major steps to increase the availability of organs for the 113,000 Americans on waitlists for lifesaving organ transplants — 20 of whom die each day. In the July Executive Order (EO) from President Trump, the Centers for Medicare & Medicaid Services (CMS) proposed changes in organ procurement and organizational accountability.

On December 18, 2019, Alex Azar, Secretary of Health and Human Services (HHS), announced new rules designed to alleviate some issues felt by the kidney community:
A Health Resources and Services Administration (HRSA) proposal to remove financial barriers to organ donation, specifically through adjustments to how the National Living Donor Assistance Center (NLDAC) administers reimbursements to living donors.
Changes to the way organ procurement organizations (OPOs) are held accountable for their performance by increasing regulation and oversight.

Proposed changes

Back in July, the EO promised change in three places: (1) prevention and dialysis; (2) transplant and living donation; (3) innovation and treatment. The new rules laid out in December will address number two from the EO — transplant and living donation.

These new rules are part of a larger effort by the kidney advocacy community to work with the Trump Administration to increase visibility, resources, and support for chronic kidney disease and kidney transplantation. The work over the past years to engage the President, Secretary Azar, and others and the receptivity we’ve received has been a long time coming. These new rules are concrete results of this effort.

From Calgary Sun, Canada

Man donates kidney to wife of 51 years after finding out he's a perfect match

Mike and Peggy Nipper. (St. David’s North Austin Medical Center photo)

If being married for half a decade isn’t enough to prove your love, maybe donating a kidney to your spouse will do it.

When Peggy Nipper’s diseased kidney began failing — she has polycystic kidney disease (PKD), a genetic condition that causes cysts to develop in the kidneys — and dropped to 14% functionality, requiring a transplant or dialysis, her husband of 51 years, Mike, was tested to see if there was a remote possibility he matched her, according to CNN.

Turns out, Mike Nipper was a perfect match for his 74-year-old wife, a shocking turn in a process that generally takes seven years to find a compatible donor.

The couple underwent the transplant in November at the Kidney Transplant Center at St. David’s North Austin Medical Center in Texas.

“It was quite a gift,” Peggy told CNN. “I don’t think he has to give me another gift for the rest of my life. This was the ultimate present.”

From Stat, By MATTHEW COOPER, M.D.

Medicare policy on antirejection drugs imperils kidney transplants

For people with failing kidneys — and there are thousands of them in the United States — a kidney transplant offers a new lease on life. But like every other type of transplant, its success depends on taking drugs for life to suppress the immune system. Otherwise, the body begins rejecting the transplanted organ.

That’s basic medical science. So it makes no sense that Medicare covers these drugs for just 36 months for the majority of people who receive new kidneys. Because of this, many patients find themselves back where they started in a risky and frightening place: on dialysis and in need of a new kidney that for many will never come.

Chronic kidney disease (CKD) is the ninth leading cause of death in the United States, claiming more lives than breast cancer or prostate cancer. More than 37 million Americans are living with CKD today. Individuals with irreversible kidney failure, known as end-stage renal disease, have only two choices to survive: undergo regular and frequent dialysis or be fortunate enough to receive a kidney transplant.

Since 1973, Medicare has covered the care for individuals with irreversible kidney failure, or end-stage renal disease. Dialysis does mechanically what the kidneys do naturally: removes waste products and excess fluid from the body. Most people undergo dialysis at a hospital or dialysis center, usually three times a week for about four hours each time. Medicare spends $86,300 a year per patient on dialysis, and there is no time limit on this coverage.

Kidney transplantation is a medical success story. It can dramatically improve the recipient’s quality and length of life. But not everyone who needs a donated organ receives one. There are currently more than 103,000 individuals on the kidney transplant waiting list, while just 23,000 kidney transplants were performed in 2019.

The upfront cost of a kidney transplant is about $110,000. Afterward, coverage of immunotherapy under Medicare Part B is approximately $2,300 per year. The savings to the government of providing immunosuppressive medications are clear.

As Medicare law currently stands, patients’ lives are at risk, donor kidneys are being neglected, and taxpayer money is being squandered. It’s time for change. That’s why I’m testifying before Congress Wednesday in support of lifetime Medicare coverage of immunosuppressive medications for kidney transplant recipients.

As a transplant surgeon for nearly 20 years, I have witnessed firsthand the impact of this shortsighted policy. Patients struggle to pay for the immunosuppressive drugs needed to maintain their transplants when their Medicare coverage ends, especially lower-income patients who lack group health insurance or who do not qualify for Medicaid or other assistance. These financial pressures force some patient into rationing their immunosuppressive drugs or forgoing them altogether, either of which generally results in the failure of the transplanted kidney.

I can recall several patients who had to choose between paying their mortgage or utility bills and paying for their transplant-saving medication. Many of my colleagues report that they encounter patients in similar situations. A 2012 New England Journal of Medicine article reported that nearly 70% of kidney transplant programs reported either a death or transplant loss due to patients’ inability to pay for their antirejection medications.

The 36-month limitation on coverage also has a detrimental effect on living kidney donations. Patients are reluctant to ask a friend or family member to be a living donor if they fear they will be unable to afford their antirejection medications long term. As an advocate for increasing kidney donation, I have trouble asking living donors or donor families to give the most amazing “gift of life” knowing that Medicare will cut off necessary immunosuppressive coverage after three years.

In May of 2019, the Department of Health and Human Services conducted an analysis that indicated potentially significant cost savings from extending immunosuppressive coverage for kidney transplant patients by averting future dialysis and re-transplantation. The Centers for Medicare and Medicare’s Office of the Actuary concluded that extending coverage could save Medicare up to $300 million over ten years.

In December 2019, Reps. Ron Kind (D-Wis.) and Michael Burgess (D-Texas) introduced the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534). This legislation would extend Medicare coverage of immunosuppressive medications for kidney transplant recipients for life.

By providing this coverage of last resort, Congress can help reduce the likelihood of the failure of transplanted kidneys, minimize the need for repeat transplants, enable more patients to pursue transplants, and save taxpayers money on the potential cost of re-transplantation. Most importantly, this measure also honors the gift of kidney donation for those who gave selflessly so others may have a second chance at life.

The current 36-month coverage policy for immunosuppressive drugs is not medically, economically, or ethically justified. Congress must fix it.

Matthew Cooper, M.D., is the director of kidney and pancreas transplantation at Medstar Georgetown Transplant Institute, professor of surgery at Georgetown University School of Medicine, and a board member of the National Kidney Foundation. He reports receiving consulting and research fees from several companies that manufacture immunosuppressive drugs. More information about H.R. 5534 is available at Honor the Gift, a patient-centered campaign for extending Medicare coverage of kidney transplant antirejection medications sponsored by CareDx, a precision medicine company focused on improving transplant outcomes.

PKD Research

From PKD Foundation

ADPKD Patients Needed for a New Research Study

We’re looking for patients who meet the following: 

• Males and females between the ages of 18 to 50
• Have been diagnosed with ADPKD
• Kidney function between 45 to 90 mL/min/1.73m2 eGFR
• Not currently taking Tolvaptan

Other eligibility criteria will apply.

Participation in STAGED-PKD is divided into two separate stages, each lasting up to 26 months and will include taking an oral study medication daily. The investigational drug, study-related procedures, and doctor visits will be provided at no cost.

Link to More Information about this study.

Clinical Studies webpage link at PKD Foundation.

Take part in clinical research!


Local doctors are currently conducting a Phase 3 trial of an investigational oral therapy for individuals at risk of rapidly progressive Autosomal Dominant Polycystic Kidney Disease (ADPKD); the purpose of the trial is to determine if GZ/SAR402671, an investigational medication, is as safe and effective as a possible treatment for ADPKD.


ABOUT THIS STUDY The Phase 3 trial, known as the STAGED-PKD study, will be run in 2 parts and aims to enroll 640 people across approximately 80 international sites located in the Americas, Europe and Asia-Pacific. The company expects to complete the trial by 2023. The study is divided into 2 separate stages. Each stage will consist of a 30-day screening period, a 2-week period where placebo is taken, a 24-month study treatment period, and a 4-week post-study treatment follow up period. The total length of participation and treatment in the study will be the same in Stage 1 and Stage 2 (up to 26 months participation for each stage). Stage 1 of the study enrollment is currently ongoing. Participants are randomly assigned to 1 of 3 study groups and will take the oral study medication GZ/SAR402671 (8mg or 15mg), or matching placebo, once daily over the duration of approximately 24 months. After Stage 1 of the study finishes, Stage 2 will start. Patients in Stage 2 will receive either placebo or GZ/SAR402671at the highest dose determined in Part 1 to be safe and effective.

PKD Treatment: Octreotide-LAR, Kidney Swaps Revolution, Artificial Kidneys Milestone, Dialysis Patients Panic, Organ on a Chip Testing

PKD Treatment

From MDMag, by Kenny Walter

Octreotide-LAR Delays Cyst Growth in ADPKD Patients

Octreotide-LAR treatment could be beneficial to patients suffering from autosomal dominant polycystic kidney disease (ADPKD).

In a poster presented at the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., investigators, led by Satyanarayana Vaidya, MD, Emory School of Medicine, evaluated the efficacy of Octreotide-LAR on disease progression based on a meta-analysis of published literature across all stages of chronic kidney disease due to ADPKD.

The team identified all placebo-controlled randomized trials of Octreotide-LAR through a literature search and analyzed the efficacy—rate of cyst growth and kidney function decline—as well as safety outcomes.

Ultimately, they found 4 trials that fulfilled the requirements, with a total of 445 patients.

The results showed were positive for Octreotide-LAR.

“Compared to placebo, Octreotide-LAR showed a significant reduction of total kidney volume, standard mean difference -.41[ 95% CI, -.69--0.12], P =.005 but a comparable mean reduction in glomerular filtration rate standard mean difference .01 [95% CI, -.17-.20], P =.90 and rate of adverse events RR, 1.46 [0.82-2.61], P =.20,” the authors wrote.

Participants in the trial were adults with a clinical and ultrasound diagnosis of ADPKD with glomerular filtration rate of ≥15 ml/min/1.73 m2, with the exclusion of diabetics and patients with poorly controlled hypertension (BP> 180/110 mmHg).

The outcomes included mean total kidney volume and decrease in glomerular filtration rate, compared using a standard mean difference.

ADPKD is the most common hereditary kidney disease, characterized by tubular epithelial cell proliferation (ECP) and fluid secretion leading to cystic kidney enlargement and progressive renal failure in the majority of cases.

The cyclic adenosine monophosphate (cAMP) pathway has been found in the past in both epithelial cell proliferation and fluid secretion.

Somatostatin and its synthetic analogues have shown in the past to inhibit invitro adenyl cyclase activity and slow cyst growth in both underpowered studies in either early or more advanced stages of ADPKD.

However, the study could yield better outcomes for patients with ADPKD.

“Octreotide-LAR delays the cyst growth across all stages of kidney disease in ADPKD, without a clear beneficial effect on kidney function, or a significant difference in adverse outcomes,” the authors wrote. “Longer follow-up is required to elucidate a potential beneficial role of Octreotide-LAR on kidney function.”

Kidney Transplant

From Time, BY LISA EMMOTT

Kidney Swaps Are Revolutionizing a Broken Organ-Donation System in the U.S.

2017 ended as a banner year for my family, but things didn’t look great at the start. A death sentence met us in a boxing ring, and we had to school ourselves on fighting to live. I never thought much about the 37 million American adults who suffer from kidney disease until my husband Neil became one of them.

Celebrating our first year of marriage in 2001, we learned by accident through an unrelated medical exam that my husband has polycystic kidney disease, an illness which causes the kidneys to fill with cysts over time, rendering the organs unable to function properly. There is no cure. There was nothing to do but wait for my husband’s kidney function to decline below 20%, the point at which either dialysis or a transplant would be considered to prolong life.

It would be 16 more years before Neil would enter end-stage renal failure, the final, permanent phase of chronic kidney disease where the organs no longer function, and in early 2017, he joined the waitlist for a transplant, alongside some 100,000 others in the U.S. Those on the waitlist face a three-to-10 year wait for a deceased donor kidney, and the statistics are grim. Kidney disease is the ninth most common cause of death in the U.S., and while Medicare covers the cost of dialysis for kidney failure, it is an exhausting treatment process with low survival rates. America’s kidney shortage kills 43,000 people per year, as those on the waitlist sit hoping for “the call” that an organ has become available.

Much hope was given to kidney disease patients in July when the federal government announced an executive order aimed at overhauling the care of kidney disease. The move aims to reduce the number of kidney failures by early monitoring and preventative care, and to make more kidneys available for transplant by examining the rate of discarded kidneys from deceased donors. The administration also plans to address disincentives to living donation such as financial hardship during time off work.

While this call to action is long overdue, continued education is needed to empower patients to navigate the transplant process. We were bombarded with a plethora of medical information during my husband’s extensive transplant evaluation, but we received no guidance about his best shot at a long and healthy life: a kidney from a living donor. Determined not to watch my husband deteriorate on the deceased donor waitlist, I went to work finding a living kidney donor, a challenging job that typically falls on the patient or family members. I quickly learned that having a willing donor is a far cry from having an approved donor.

Living-donor criteria are very stringent in order to protect the donor’s long-term health. While each transplant center has its own specific criteria, being overweight, having uncontrolled hypertension, diabetes, cancer, or a serious mental health condition can all rule a person out from donating a kidney. During my medical evaluation, I was diagnosed with fibromuscular dysplasia, a progressive twisting and beading of the renal arteries. All the other willing potential donors in our family were also deemed medically ineligible. With this devastating news, we went public with our search for a donor. I spoke about my husband’s plight at local community groups, we printed signs and cards to post in local businesses, and campaigned on social media. Eventually, a number of people came forward to donate and in the end, two teachers at our daughter’s school were approved.

Read More

From MedicalXpress, University of California, San Francisco

Implantable artificial kidney achieves preclinical milestone

The Kidney Project, a national effort to develop an implantable bio-artificial kidney that could eliminate the need for dialysis, will announce a key milestone in a November 7, 2019 presentation at the American Society of Nephrology Kidney Week 2019 conference in Washington, DC.


The team will report that UC San Francisco scientists have successfully implanted a prototype kidney bioreactor containing functional human kidney cells into pigs without significant safety concerns. The device, which is about the size of a deck of cards, did not trigger an immune reaction or cause blood clots in the animals, an important milestone on the road to future human trials.

"This is the first demonstration that kidney cells can be implanted successfully in a large animal without immunosuppression and remain healthy enough to perform their function. This is a key milestone for us," said Kidney Project co-lead Shuvo Roy, Ph.D., a faculty member in the Department of Bioengineering and Therapeutic Sciences, a joint department of the UCSF Schools of Pharmacy and Medicine. "Based on these results, we can now focus on scaling up the bioreactor and combining it with the blood filtration component of the artificial kidney."

UCSF-Vanderbilt Kidney Project Aims to Eliminate Dialysis

Nearly 750,000 Americans—and two million people around the world—are treated for end-stage renal disease (ESRD), and rates of kidney disease are growing rapidly, leading to an urgent shortage of kidneys for transplant. As of 2016 there were only 21,000 donor kidneys available for transplant in the U.S. on a waiting list of nearly 100,000 and extending five to ten years.

Most patients awaiting a kidney transplant survive by undergoing long and cumbersome dialysis treatments multiple times a week to clear toxins from their blood, but dialysis does not replace many essential kidney functions and on average, only 35 percent of dialysis patients remain alive after five years. Dialysis and other treatments for ESRD, which are universally covered by Medicare, cost $35 billion in 2016, representing seven percent of Medicare's annual budget.

The Kidney Project [pharm.ucsf.edu/kidney] is led by Roy and Vanderbilt University Medical Center nephrologist William H. Fissell, MD, who for more than a decade have been working to develop an implantable bio-artificial kidney with the goal of eliminating dialysis and easing the shortage of donor kidneys.

The implantable device being developed by The Kidney Project consists of two components: an blood filtration system called the hemofilter, which removes toxins from the blood by passing it through silicon membranes fabricated with precisely shaped nanometer-scale pores; and a bioreactor, which contains cultured human kidney cells intended to perform other kidney functions, such as maintaining adequate fluid volume and blood pressure, adjusting salt levels, and producing essential hormones.

Following promising studies in large animals, The Kidney Project's hemofiltration system is currently awaiting FDA approval for an initial clinical trial to evaluate its safety. The bioreactor technology has been tested in laboratory experiments but so far had not been implanted into animals.

Bioreactor Containing Human Kidney Cells Implanted in Pigs Without Immune Reaction or Blood Clots

In The Kidney Project's November 7 Kidney Week presentation, Rebecca Gologorsky, MD, a UCSF Surgical Innovations Fellow on the team, will show how silicon membranes inside the implanted bioreactor protect the enclosed human kidney cells from the host immune system by keeping blood-borne immune cells and proteins out of the device.

"It has been a holy grail of transplant therapies to find ways to avoid the need for lifelong immunosuppressive drugs that are often required to prevent immune rejection," Roy said. "These drugs not only expose patients to infection and other harmful side-effects but have been shown to directly harm transplanted cells and organs, eroding the therapeutic benefit of transplants over time."

Another key benefit of avoiding immunosuppression is its cost to patients, Roy says: "Medicare currently covers dialysis for life, but immunosuppressive drugs are covered for just the first three years following transplant. Many patients who receive kidney transplants ultimately lose the new organ because they weren't able to afford the immunosuppressive drugs needed to keep it healthy."

Roy's team also carefully engineered the prototype bioreactor to avoid triggering blood clots that could lead to pulmonary embolism or stroke, a major challenge faced by all patients with long-term medical implants. They achieved this by coating the silicon membrane filters that contact the blood with biologically friendly molecules and engineering the device to avoid the turbulent blood flow that can also trigger clotting.

"We couldn't use the standard blood-friendly coatings that have been developed for heart valves, catheters, and other devices because they are so thick that they would completely block the pores of our silicon membranes," Roy said. "One of our accomplishments has been to engineer a suitable surface chemistry on our silicon membranes that makes them look biologically friendly to blood."

The results, Roy says, demonstrate progress towards The Kidney Project's hoped-for clinical "trifecta": a heart-powered device that runs without batteries or other external connections that could introduce infection risk, and which can clean the blood without anti-rejection drugs or blood thinners.

The researchers now aim to scale up the prototype bioreactor to contain more cells in order to test whether the implanted device can supplement kidney function in animals with kidney failure, with the ultimate goal of eventually moving the device to human safety trials.

"Advancing a complex cell therapy like this into the clinic will not be a trivial task—for instance, it will require substantial investments in cell production and characterization in controlled GMP facilities to avoid any possibility of contamination," Roy said. "Now we've confirmed that we're on the right track to move forward with these efforts."

From Bio-IT World, By Deborah Borfitz

Will Organ-On-A-Chip Models Be Viable Alternatives to Animal Testing?

Organ-on-a-chip models could fundamentally change the way drugs make their journey to clinical trials and reduce the need for animals in laboratory experiments. The new testing technology is of great interest to pharmaceutical companies looking to better understand the effects of medicines—especially the unintended consequences of their administration—and will facilitate study of not only toxicity, but also the mechanism by which drugs work and the timing of their delivery and physiological response, according to Vanderbilt University professor John Wikswo, a biological physicist and founding director of the Vanderbilt Institute for Integrative Biosystems Research and Education.

As Wikswo defines them, organs-on-chips are microfluidic devices that are populated with living cells, most often human, to create two-dimensional (2D) or three-dimensional (3D) microphysiological systems that recapitulate human physiology better than cells grown on flat plastic. They’re in the same class with, but more complex than, either spheroids (typically formed from cancer cell lines or tumor biopsies) and organoids (self-organized, organ-specific cultures typically derived from stem cells). The coupling together of different organ-on-chip models allows researchers to mimic human physiology better than any single chip could do individually.

The human body has roughly 200 organs and they don’t yet all have a chip counterpart, says Wikswo. Around two dozen of them have been micro-engineered to date—including the blood-brain barrier, gut, kidney, lung, parts of the female and male reproductive systems, the mammary gland, bone marrow, cardiac and skeletal muscle, and the bone-cartilage interface—as well as multiple liver-on-a-chip models.

Wikswo holds 18 patents and has multiple patents pending related to the instrumentation and control of cells and the support hardware for organs-on-chips. These include the MicroFormulator, an innovative platform for controlling the concentration of drugs in each well of a multiwell plate commonly used in biomedical and clinical research. Organs-on-chips, at their core, are all microfluidic cell culture devices.

The organ chips themselves are transparent and roughly the size of an AA battery, each with its own instrumentation and software. They vary by purpose as well as size, shape and what they grow on, says Wikswo. One of the new economy models coming out of Vanderbilt is shaped like a puck, and others have been engineered to resemble bendy posts or curling levers.

Read More.

Dialysis

From California HealthLine, By Ana B. Ibarra

Dialysis Patients Panic As Financial ‘Life Raft’ Becomes Unmoored

Russell Desmond received a letter a few weeks ago from the American Kidney Fund that he said felt like “a smack on the face.”

The organization informed Desmond, who has kidney failure and needs dialysis three times a week, that it will no longer help him pay for his private health insurance plan — to the tune of about $800 a month.

“I am depressed about the whole situation,” said the 58-year-old Sacramento resident. “I have no clue what I’m going to do.”

Desmond has Medicare, but it doesn’t cover the entire cost of his care. So, with assistance from the American Kidney Fund, he pays for a private plan to cover the difference.

Now, the fund, which helps about 3,700 Californians pay their premiums and out-of-pocket costs, is threatening to pull out of California because of a new state law that is expected to cut into the dialysis industry’s profits — leaving patients like Desmond scrambling.

The letter portrayed the fund as helpless. “We are heartbroken at this outcome,” it read. “Ending assistance in California is the last thing we want to do.”

But supporters of the new law are calling the threat a scare tactic. State Assemblyman Jim Wood (D- Healdsburg), the author of AB-290, said there is nothing in the measure that prohibits the fund from continuing to provide financial assistance to patients.

“AKF has simply made a conscious decision, without merit, to leave the state despite the many accommodations I made by amending the bill in the Senate to ensure that it can continue to operate in California,” Wood said in a written statement.

What’s behind this dispute is the tight relationship between the American Kidney Fund and the companies that provide dialysis, which filters the blood of people whose kidneys are no longer doing the job.

People on dialysis usually qualify for Medicare, the federal health insurance program for people 65 and older, and those with kidney failure and certain disabilities. If they’re low income, they may also qualify for Medicaid, which is called Medi-Cal in California.

But dialysis companies can get higher reimbursements from private insurers than from public coverage. And one way to keep dialysis patients on private insurance is by giving them financial assistance from the American Kidney Fund, which helps nearly 75,000 low-income dialysis patients across the country.

The fund gets most of its money from DaVita and Fresenius Medical Care, the two largest dialysis companies in the country. The fund does not disclose its donors, but an audit of its finances reveals that 82% of its funding in 2018 — nearly $250 million — came from two companies.

Insurance plans, consumer advocacy groups and unions have accused the American Kidney Fund of helping dialysis providers steer patients into private insurance plans in exchange for donations from the dialysis industry. Wood said his bill is intended to discourage that practice.

American Kidney Fund CEO LaVarne Burton denied the accusations and said her group plays no role in patients’ coverage choices.

Starting in 2022, the new law will limit the private-insurance reimbursement rate that dialysis companies receive for patients who get assistance from groups such as the American Kidney Fund to the rate that Medicare pays. The rate change won’t apply to patients who are currently receiving assistance as long as they keep the same health plans. The bill will also address a similar dynamic in drug treatment programs.

To determine which patients receive financial aid, the law will require third-party groups to disclose patients’ names to health insurers starting July 1, 2020.

Read More

this link is to an external site that may or may not meet accessibility guidelines.

close dialog

INTRODUCTORY OFFER

12 WEEKS FOR $12

When you subscribe today

REDEEM MY OFFER

ADPKD Patients Needed: ACT Alert, Preventing Blood Clots During Dialysis, Cost of Kidney Transplant Surgery

Accelerating Clinical Trials

From PKD Foundation

ADPKD patients needed for pravastatin study

We are conducting a research study in adults with ADPKD to determine if treatment with a statin (pravastatin) will decrease cyst growth and slow renal function decline. 

The study plans to enroll up to 200 people, age 25-60 years, over the next 2 years. Other criteria for the study include: 

•  a diagnosis of autosomal dominant polycystic kidney disease (ADPKD) 
• GFR >45 mL/min/1.73 m2 
• controlled blood pressure 
• no current tobacco use 
• no other clinical indication for a statin 
• women must not be pregnant, trying to become pregnancy, or lactating 

Participation involves taking either pravastatin or placebo one a day for two years. Testing, which includes blood draws, vitals, MRI of the kidneys, and the GLOFIL-125 procedure to measure kidney function will be done at the University of Colorado Anschutz Medical Campus at the beginning and end of the study. There will also a local visit at 6 weeks for safety labs, and monthly phone calls/emails. 

If traveling from out-of-state, your airfare and hotel will be arranged and paid for by the study. 

For more information or to see if you qualify, please contact Diana George, at diana.george@cuanschutz.edu or (303) 724-1684. 

You can find more information about the study at www.clinicaltrials.gov.

Dialysis

From Healio

FDA grants breakthrough device designation to dialysis system that prevents blood clots

Fresenius Medical Care has received breakthrough device designation from the FDA for its hemodialysis system, which was designed to prevent blood clotting without the use of blood thinner medication.

“We are hopeful this new system will help eliminate the reliance on heparin during dialysis to improve treatments for most patients,” Robert Kossmann, MD, chief medical office for Fresenius, said in a press release. “The work to achieve this breakthrough has been years in the making and we are excited that the FDA has recognized the importance of bringing this technology to the market as quickly as possible.”

According to the release, an antithrombogenic additive is being incorporated into the manufacturing process of dialyzers and bloodlines to reduce clot risk and increase hemocompatibility.

“Harnessing out innovational expertise, we continuously strive to make significant advances in our products and provide new solutions for people with chronic kidney disease worldwide,” Olaf Schermeier, PhD, CEO for global research and development at Fresenius, said. “Receiving this designation, we are right on track with a new dialysis system that will directly benefit our patients’ well-being.”

Research supportive of the system will be presented at the American Society of Nephrology’s Kidney Week in November, from which Healio/Nephrology will be providing live coverage.

Kidney Transplant Surgery

From The Richest, BY REBECCA KNAUSS

The 10 Most Expensive Surgeries In The USA

7KIDNEY TRANSPLANT ($414,800)

It's possible to live life with only one kidney, but when both of them stop working you will be required to have a kidney transplant. This chronic failure is usually caused by things like diabetes, high blood pressure, polycystic kidney disease, and chronic glomerulonephritis.

The decision ultimately comes down to whether you want to go through with a transplant or stay on dialysis for the rest of your life. It is obvious that most people choose to pay the $414,800 fee for a transplant instead of spending chunks of their days hooked up to a dialysis machine.

PKD Treatment: Diet Maybe the Key, PKD Diagnosis: Urinary BioMarkers, Walk for PKD Home Stretch

PKD Treatment

From University of California, Santa Barbara

Reversing polycystic kidney disease

Hereditary and relatively common, polycystic kidney disease (PKD) has long been thought to be progressive and irreversible, condemning its sufferers to a long, slow and often painful decline as fluid filled cysts develop in the kidneys, grow and eventually rob the organs of their function.

Once their kidneys fail, PKD patients often require dialysis several times a week or must undergo a kidney transplant. To make matters worse, a host of other PKD-related conditions and complications add to the patients’ health burden, including high blood pressure, vascular problems and cysts in the liver. And that doesn’t take into account the medical costs and the reduced quality of life.

Progress toward finding a cure has been sluggish, with only one drug proven to slow — but not stop — the progression of PKD.

But now, thanks to research conducted by UC Santa Barbara biochemist Thomas Weimbs, postdoctoral researcher Jacob Torres and their team, a solution may be no farther than the end of your fork. Diet, they discovered, could hold the key to treating PKD.

“It’s surprisingly effective — much more effective than any drug treatment that we’ve tested,” Weimbs, whose work focuses primarily on the molecular mechanisms underlying polycystic kidney disease and related renal diseases, said of his group’s discovery. Their work appears in the journal Cell Metabolism.

A fast(ing) response

Postdoctoral researcher and lead author Jacob Torres, left, and biochemist Thomas Weimbs.
Credit: Sonia Fernandez

In previous studies, the research team found that reducing food intake in mouse models slowed the growth of polycystic kidneys; but at the time, they did not know why. In their new paper, the scientists have identified the specific metabolic process responsible for slowing the progress of the disease.

The best part? It’s a process many of us already know well.

“There’s a way of avoiding the development of the cysts through dietary interventions that lead to ketosis,” Weimbs said.

You heard that right: Ketosis, the underlying metabolic state of popular diets such as the ketogenic diet, and, to a lesser extent, time-restricted feeding (a form of intermittent fasting), has been shown in the Weimbs group’s studies to stall and even reverse PKD.

“The cysts appear to be largely glucose-dependent,” Weimbs explained. In people with the predisposition toward PKD, the continuous supply of sugar in the high-carbohydrate, high-sugar diets of modern culture serve to feed the growth and development of the fluid-filled sacs.

“Ketosis is a natural response to fasting,” Weimbs said. “When we fast, our carbohydrate reserves are very quickly used up. In order to not die, our bodies switch over to a different energy source and that comes from our fat reserves.” The fat reserves, he continued, are broken down into fatty acids and ketones which then take the place of glucose in providing energy to the body. The Weimbs team found that the presence of ketones in the blood stream in particular inhibits the growth of the kidney cysts. And with a steady supply, ketones actually acted to reverse the condition in their animal studies.

The problem with typical Western diets is that we almost never go into ketosis: we eat high-carb, high-sugar foods almost continuously throughout the day, securing for ourselves a continuous supply of glucose. In the ketogenic diet, the body’s typical “go-to” source of energy — glucose — is taken away as ketogenic dieters focus on non-carbohydrate foods, eventually forcing their bodies to mimic the fasting response. Time-restricted feeders, meanwhile, reach that state by limiting the window of time they eat to a small part of the day, leaving the remaining 16-20 hours of their day for the body to use up the carbs and sugars and switch over into ketosis.

Ketones are actually a class of three different naturally occurring molecules, said Weimbs. Of particular interest and effectiveness is one called BHB (beta hydroxybutyrate), which has been shown “to affect numerous signaling pathways that are implicated in PKD,” according to the study. The team found that by just feeding that ketone to rats with PKD, they were able to create the beneficial effects of ketosis, no special diet restriction needed.

“Which makes this really amazing,” Weimbs said. “On top of a normal high-carb diet, which they can eat all day long, if we give them BHB, they’re fine.” After five weeks of treatment with BHB in the drinking water, rat polycystic kidneys were “nearly indistinguishable” from normal ones.

In fact the researchers were so surprised by their result they thought they had made a mistake. “I was so surprised by the effect of BHB treatment that I had to go and double-check all the genotypes of the animals to make sure they had PKD to start with,” said Torres, the paper’s lead author. “The effect was really unlike anything I had encountered before.

“The impact of this research has huge implications on the field of PKD,” Torres continued. It provides a framework, he said, for understanding the pathology of PKD from a metabolic viewpoint and adds another disease to the list that a ketogenic diet can be used to treat. “Our discovery also has implications for understanding cellular metabolism at a fundamental level as we learn more about what has gone wrong in our disease models. I am really looking forward to the future of research in this field as we explore this new space and uncover even more about what is really going on in PKD.”

An assist with ketosis

It’s quite possible to reach ketosis just by avoiding carbs or by fasting for a period of time. “It’s a very natural way to have your own body produce BHB,” Weimbs said. “So something like a time-restricted diet is feasible.”

But the key to success with diet-related issues is consistency. Ask virtually any dieter and they’ll tell you that staying on track is the difficult part.

For those with polycystic kidneys who could use an assist with ketosis, whether or not they need to lose weight or wish to change their diets, the Weimbs lab is developing a dietary supplement to add BHB to their regular intake. This patent-pending nutritional supplement would be similar to commercially available ketone products being offered as energy boosters, but formulated specifically for supporting kidney health.

“We want to make sure we don’t put anything harmful into the bodies of people with potentially compromised kidney function,” Weimbs said. “And some of the ketone products already out there are high in potassium and other ingredients that could be detrimental.”

In addition, the supplement being developed is combined with another nutrient the Weimbs Lab has recently shown to inhibit cyst formation in PKD by a completely different mechanism from BHB, thereby approaching the problem from two directions. While not a drug — and therefore less expensive and essentially free of serious side effects — the supplement is nevertheless intended for use by those under medical supervision. Members of the Weimbs team are planning to conduct a clinical trial to test their supplement mixture in people with PKD. Assuming all goes well, they are planning to launch a company to make it available.

“We’re really excited that we can actually provide a supplement that potentially could help many more people than dietary intervention alone,” Weimbs said.

Research in this study was conducted also by Samantha Kruger, Caroline Briderick, Tselmeg Amarlkhagva and Shagun Agrawal at UC Santa Barbara; John R. Dodam and Leslie A. Lyons at the University of Missouri and Michal Mrug at the University of Alabama.



PKD Diagnosis 

From MD Linx

Rapid progression of autosomal dominant polycystic kidney disease: Urinary biomarkers as predictors

Among participants of a study evaluating the therapeutic effectiveness of lanreotide in autosomal dominant polycystic kidney disease (ADPKD), researchers assessed tubular damage and inflammation markers as predictors of kidney function decline. They used 24-h urine samples of patients to measure albumin, immunoglobulin G, kidney injury molecule 1, β2 microglobulin (β2MG), heart-type fatty acid-binding protein, neutrophil gelatinase-associated lipocalin, and monocyte chemotactic protein-1 ­(MCP-1), at baseline. They used mixed-model analysis, considering 13 estimated glomerular filtration rates (eGFRs) (chronic kidney disease EPIdemiology) per patient, to compute individual alteration in eGFR during follow-up. They found that ADPKD patients with rapidly progressive disease could be selected via measurement of urinary β2MG and MCP-1 excretion, which displayed a predictive value comparable to or even higher than that of total kidney volume or PKD mutation. Hence, the potential promising value of easy and inexpensive to measure urinary markers was suggested for predicting prognosis in ADPKD.

Walk for PKD

From PKD Foundation

We’ve held 31 Walks and raised over $1 million since our September 7 kick-off. There are Walks remaining – will you help us reach our $2 million goal?

The Walk for PKD is your chance to make a difference in the lives of everyone impacted by polycystic kidney disease. Our signature fundraising event puts 100% of the funds raised toward PKD research.

We’re closing in on the finish line but there’s still plenty of time to hit our goal!

Fundraise today

PKD Alert: Participate in Accelerating Clinical Trials, Paying to Live: Transplant Costs

ACT Alert (Accelerating Clinical Trials)

From PKD Foundation

ADPKD patients needed for curcumin study

Help play a key role in PKD research! Patient participation in clinical studies is essential to discovering treatments and a cure for PKD.

Are you or someone you know interested in participating? There is a new research study being conducted to understand if the dietary supplement, curcumin, improves the function of blood vessels in children and young adults with autosomal dominant polycystic kidney disease (ADPKD).

Study Details:

• Participants must be between the ages of 6 to 25 and diagnosed with ADPKD.
• The study involves a physical exam and medical history, blood draw, non-invasive testing of blood vessel function and an MRI of your kidneys.
• A travel stipend is available

Kidney Transplants

From WRDW-TV Channel 12, Augusta, GA

Paying to Live: Pricey transplants put spotlight on cost of living with disease and recovery

The organ transplant list at Augusta University currently had 891 people waiting for vital organs. While they wait, those people are crunching the numbers for what their health will cost them.

That gift comes with a high price even with insurance.

If Shelia Reeves had one wish, it would be for more time. Reeves has lupus and it's attacking her kidneys. She's been on the waiting list for a kidney for over four years.

“I went through the surgery for dialysis and was on dialysis for like a month and a half until my body just couldn't take the surgeries and dialysis,” Reeves said.

So now, she has to get rid of all the dialysis supplies she bought. They can't be returned or even donated.

Reeves’ only option is now a transplant. Since she's running out of time, her family started looking at options for a living donor and found her daughter is a match.

“The biggest surprise was the money that's involved,” Reeves said. “I thought once you have a donor, it's pretty much, when does this process start? But, it's not a fast process.”

Take Medicare for example. With most plans, you pay your deductible, then you pay 20 percent of the costs. But 20 percent is a lot when you're talking about hundreds of thousands of dollars.

In 2017, Kaiser Health estimated the average cost for a kidney transplant, the pre-care, the post-care, the drugs -- all said and done – at over $400,000. If you need a new liver? Over $800,000. And if you need more than one organ, the priciest surgeries, like heart and lung transplants can cost up to $2.5 million. Twenty percent of that is $500,000.

“I worry about the money,” Reeves said. “You still have to do daily living, household expenses.”

Once you get a transplant, patients have to take anti-rejection drugs -- typically for life. Those can run up to $2,500 a month. If you can't prove you'll be able to pay for them, transplant hospitals can deny your surgery. You'll get a letter like a patient up in Michigan received that said, “You are not a candidate for a heart transplant at this time due to needing a more secure plan for immunosupressive medication coverage. The committee is recommending a fundraising effort of $10,000.”

Shelia's Medicare will cover some but not all of the cost for those pricey drugs, which is why her doctors referred her to a non-profit that will help match what she raises if she can raise $10,000.

But raising that kind of cash when some days you can barely raise yourself out of bed, can feel like an impossible task.

“I miss working,” Reeves said. “A lot of people just say, ‘I wish I didn't have to work and could just stay home.’ Never. I was never that type of person. I've been working since I was 15.”

It brings the reality into focus. You have to pay to live. It's a hard pill to swallow -- even harder than all the pills needed to maintain care as someone with Lupus.

“My family, my grandkids, my husband -- we've been married over 25 years,” Reeves said. “I want a little more time to be with them.”

We haven't found any transplant program that accepts uninsured patients. Here's a surprising twist: we found if your kidney problems are what allowed you to qualify for Medicare in the first place, you are booted off of Medicare three years after your transplant.

But remember pricey those drugs are usually for life.