Expert Suggests Precision Medicine is a Highly Desirable Goal for Dialysis Patients

Applying the principles of precision medicine to peritoneal dialysis could improve the flexibility and personalization of care for dialysis patients.

Precision medicine considers the environment, lifestyle, and genetics (or biological characteristics), of a patient to personalize care. This treatment may create more flexibility and individualization for patients on peritoneal dialysis (PD), Rajnish Mehrota, MD, MS, FASN, University of Washington School of Medicine, said on November 4 during a session at the American Society of Nephrology Kidney Week conference.

In precision medicine, also considered to be the same as personalized medicine, the health care provider works with the patient and their unique experience to create a health care plan that breaks away from the “one size fits all” model of many treatment options.

The hope is that “people are dialyzing to live, rather than living to dialyze,” Mehrotra said during his session. “It would allow people to live the life they want to live.”

There can be different value propositions that come with each type of treatment, specifically home dialysis vs center hemodialysis. At home, Mehrotra suggests that patients value privacy, freedom, and flexibility, whereas center patients may look for planned schedules, socialization, and to work with health care professionals who understand their therapy and have had experience with it.

“Not only do different people weigh these issues differently, how they weigh them can also change over time,” Mehrotra said.

Mehrotra discussed past initiatives that propelled personalized medicine into the mainstream, which includes All of Us, an initiative that was part of the 2015 Precision Medicine Project under former president Barack Obama. This program had a goal of enrolling 1 million genetically diverse US participants to collect data on their environment, lifestyle, and health.

The Kidney Precision Medicine Project was later created to redefine/reclassify common kidney diseases and identify the pathways, critical cells, and targets needed to create novel therapies for genetically diverse people. Mehrotra also stressed the importance of understanding the burden of different dialysis modalities in precision medicine, as is the burden of the disease itself.

“There are numerous dietary restrictions, frequent hospitalizations, IV solutions...It’s an extremely high burden and [I] acknowledge the high burden of treatment,” Mehrotra said in the session. “I do not know any other chronic condition…[that] requires such long, sustained changes in people’s lifestyles—I do not know of another disease.”

When prescribing PD, there should be many considerations, of which he suggests flexibility is an important one. Though there are inflexible factors, such as the concentration of electrolytes or bag storage, patients have flexibility in choosing the type of bag, the hours connected to dialysis, the time of day, and where they want to receive it.

In a study done by Bio-PD, it was determined that genetics also play an important factor in precision medicine. The findings suggest that genes can influence creatinine, the peritoneal solute transport rate, and ultra-filtration capacity.

"We have the tools to offer flexibility in personalized medicine," Mehrotra said

Reference

Mehrotra, Rajnish, MBBS, MD, MS, FASN. Developing Personalized Medicine for Dialysis Patients. American Society of Nephrology. November 4, 2022. ASN Kidney Week.