CKD Treatment in India: From Current Care to Emerging Therapies

Why is the Treatment Moving Beyond Disease Control?

Chronic kidney disease (CKD) accounts for kidney function decline. Often, the condition requires management of blood pressure, blood glucose, medication, dialysis, or transplantation depending on the damage. In the larger perspective, the focus remains on preserving or replacing the kidney. The least focus goes on repairing the damaged kidney tissue. 

Researchers and clinicians have widely recognized the gap in the treatment regimen, which makes them look beyond conventional treatment. The evolving regenerative medicine is addressing the aspect of tissue repair and rejuvenation. The changes occur intrinsically and address the underlying problems, including inflammation and immune response modulation.  

The future of  CKD Treatment in India is evolving with stem cell treatment for Chronic Kidney Disease and other regenerative approaches. The current article provides a clear overview of existing gaps with conventional treatment and how regenerative medicines are addressing these gaps. 

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What Does Current CKD Treatment in India Achieve?

The current CKD treatment in India focuses on slowing down disease progression and managing complications. The key focus remains on introducing lifestyle changes, management of co-morbid conditions, boosting kidney function, dialysis, or transplantation. The treatment includes:

Lifestyle Modification

• Quit smoking, alcohol, or substance use
• Dietary intervention, intake of a balanced diet
• Restriction of salt intake (<6g/day)
• Regular physical activities and weight management
• Avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen

Medication

• SGLT2 inhibitors (dapagliflozin) for diabetic patients
• ACE inhibitors (ramipril, lisinopril, enalapril) to counter hypertension
• Statins (atorvastatin, simvastatin) for hyperlipidemia
• Limit potassium supplement intake to prevent hyperkalemia
• Diuretics (furosemide) to combat oedema
• Management of iron deficiencies or anemia, which is very common in advanced chronic kidney disease stage

Dialysis

• At advanced stage, the kidney stops working efficiently
• Dialysis removes waste products or excessive fluid from the blood; based on the patient’s condition, dialysis is recommended
• Haemodialysis involves diversion of blood into external machines. The blood gets filtered and returns to the body. The frequency remains approx. 3 times a week, and the procedure requires a hospital visit
• Peritoneal dialysis, where dialysis fluid is pumped into the tummy, which draws waste products from blood when it passes through the vessels inside the body. The procedure can be performed at home several times a day

Kidney Transplantation

• In advanced kidney disease where kidneys have stopped functioning
• Donor can be a living or deceased individual
• However, there is a shortage of donors, which can take several months to years as waiting time

Where Conventional CKD Treatment Has Limits?

CKD Treatment in India Significantly Focuses on Disease Progression and Managing Complications. However, There are Significant Challenges Including:

• Kidney Disease Progresses Silently: Chronic kidney disease is accompanied by substantial loss of kidney function. By the time the symptoms become noticeable and the patient is diagnosed, the structural damage in the kidney tissue is already done
• Kidney Function Does Not Restore Damaged Tissue: Medicines control various co-morbid conditions like hypertension, hyperlipidemia, inflammation, or hyperglycemia. However, they do not replace nephrons. The medications have frequent side effects including headache, muscle or joint pain, constipation, diarrhoea, fatigue, etc.
• Progressive Fibrosis Limits Chances of Repair: Persistent kidney damage triggers fibrosis, that is, replacement of healthy tissue with scarred tissue. Extensive fibrosis limits the kidney’s capacity for functional recovery
• Dialysis Replaces Certain Functions: Dialysis only removes waste products and excessive water. However, the procedure requires constant repetition
• Transplantation: Access to kidney donors is quite challenging. Medical eligibility, compatibility, 

*The Unmet Need: The existence of these serious complications makes regenerative medicine an important area of research. The intent is to address the underlying cause. Protecting tissue injury, reducing maladaptive fibrosis, promoting repair, or preserving kidney function is the key focus.

   

How Regenerative Medicine Combats CKD?

Regenerative medicine targets the underlying cause of the disease. In chronic kidney disease, regenerative medicine focuses on working of extracellular vesicles and paracrine signaling to influence injured kidney environments.  Researchers are widely exploring mesenchymal stem cells (MSCs) for their regenerative potential and paracrine signaling. Stem Cell Treatment for Chronic Kidney Disease undertakes key mechanisms including:

• Regeneration: MSCs potentially differentiate into renal tubular cells, podocytes, and other kidney cells. They promote regeneration and repair of dead or damaged cells
• Repair: MSCs release various cytokines and growth factors that promote cellular communication. They boost the body’s natural repair mechanism and create a supportive kidney microenvironment. This aids in improving kidney function and supports other conventional treatments
• Anti-Inflammation: MSCs release various anti-inflammatory molecules; they neutralize the effects of pro-inflammatory molecules
• Immunomodulation: MSCs modulate immune response, they mitigate the risk of immune-mediated kidney damage. This enables acceptance of other treatments to combat kidney disease [1,2]

What are the Current Challenges and Future Direction?

Currently, preclinical and clinical investigations have reported the potential of stem cell treatment for kidney disease. They aid in slowing disease progression, improving renal function, and reducing fibrosis. Besides, the safety and tolerance profile remains intact in most of the studies. Yet, the therapy is at an early stage of development. The current challenges involve:

• Cell Quality and Source: Optimization of the stem cell source is crucial to ensure treatment outcome consistency and efficacy. The stem cell quality is crucial for treatment efficacy
• Administration: Standardization of the administration method is crucial for efficient delivery of the stem cells and maximization of the therapeutic benefits
• Safety and Efficacy: Establishing long-term safety and efficacy of the stem cell therapy for kidney disease is crucial. A stringent large-scale clinical trial is required to establish long-term efficacy, tolerance, and safety of the procedure’
• Patient’s Factor: Stem cell treatment for kidney disease has a distinct outcome among different individuals. Standardization of the therapeutic parameters can reduce the risk of treatment failure and increase efficacy [2]

*Advancells, India is a leading stem cell supplier for various chronic health conditions including chronic kidney diseases. The cells undergo stringent quality control. The product comes with a Certificate of Authentication (CoA). 

What Does Regenerative Medicine Add to the CKD Treatment Landscape?

The Key Focus Areas Remain:

• Reduction of maladaptive inflammation
• Renal fibrosis modulation
• Support damaged renal cell repair
• Preserve the existing cells and support a healthier microenvironment
• Delay disease progression, improve the efficacy of conventional treatment

*NOTE: Stem cell therapy for kidney disorder is yet at an early stage of clinical application. One considering stem cell therapy must consult a renowned clinic and experienced nephrologist. Rely on evidence-based practice and set clear expectations before opting for the treatment. 

Conclusion 

Chronic kidney disease marks a high health burden in India. The conventional treatments are well-established and aid in combating symptoms. However, the emerging Stem Cell Therapy for Kidney Disorder intends to target the underlying cause at the cellular level. The focus must remain on establishing large-scale clinical trials to ensure safety and efficacy.

References

1. Wang Y, Luo P, Wuren T. Narrative review of mesenchymal stem cell therapy in renal diseases: mechanisms, clinical applications, and future directions. Stem Cells International. 2024;2024(1):8658246. 
2. Salybekov AA, Kinzhebay A, Kobayashi S. Cell therapy in kidney diseases: advancing treatments for renal regeneration. Frontiers in Cell and Developmental Biology. 2024 Dec 11;12:1505601. 

FAQ’s

Q- Can Stem Cell Treatment for CKD be Considered as a Standard Treatment?

No, currently stem cell treatment for chronic kidney disease is at an early stage of development. Clinicians globally are introducing SCT as supportive treatment along with conventional treatment for better long-term outcomes. 

Q- How Could Stem Cells Potentially help in Kidney Disease?

Preclinical and clinical evidence marks the potential of stem cells to differentiate into distinct cells. They also support paracrine signaling, including anti-inflammatory activities, immunomodulation, and activation of repair pathways.

Q- Why is Regenerative Medicine Being Explored for CKD?

The current CKD treatment helps slow down disease progression and manage complications. They create supportive microenvironments that boost conventional treatment efficacy. 

Q- Can Stem Cell Therapy Replace Dialysis or Kidney Transplantation?

No, currently stem cell therapy for kidney disorders cannot replace dialysis or transplantation. The approach is still evolving, and it acts as supportive treatment.