“Dialysis and transplantation result from a failure in nephro prevention”, Dr Eric Magnant, Aix en Provence, France
I happened to be involved in exchanges with a French senior nephrologist, a specialist in kidney diseases, management and implementation of dialysis. What can be done in “nephro prevention” (prevention of kidney diseases), for patients and MDs? Testimonials (patient family perspective).
Mylène Farmer: “fates are intertwined”
Off to a rough start… This is me in 2011, telling myself that it was time to stop investigating a subject with no way out, where the irreconcilable edges would always clash in the whirlwind of words, powerless to reach the Truth for All and the Universal appeasement. The French expression “avoir la moutarde qui monte au nez” translates literally to “to have mustard climbing up to the nose”. The idiom is a metaphor for getting angry and indeed I was getting angry.… After all, I had only investigated a subject that was none of my concern (neither me nor my relatives), after having worked with surgeons to “implement” robotically assisted mini invasive surgery in Europe (US company Intuitive Surgical Inc). in the early 2000s. For me, the story ended there, in 2011. My blog about transplant ethics on Blospot would no longer be updated. Would Progress happen in my lifetime, or would “gate keepers” block innovation? (lots of money in transplantation, especially kidney. And in anti-rejection drugs. Huge public health problem). Either way, I couldn’t do much about it. Even today, my former mentor, a biologist and geneticist from Bordeaux who worked in California and orchestrates the medicine and genomics program in Abu Dhabi, just wrote to me: “Visited an HLA genotyping laboratory in Jeddah, transplantation in increase, here .” Speaking of nephroprevention…
Until recently, whatever the venue — congresses, medical or surgical conventions, patient association gatherings — you kept hearing that non-acute kidney damage was insidious, asymptomatic, discovered too late, irreversible, and that diabetes and hypertension were the main culprits of this mess… Sure enough, dialysis and transplants exist. But having interviewed many caregivers and relatives of patients between 2005 and 2011 for my blog “Ethics and organ transplantation”, plus a good number of biomedical chronicles posted on Agoravox (same subject, same period), one thing is pretty much straightforward: dialysis makes it possible to survive, and kidney transplantation is a victim of its own success (major shortage of grafts, living kidney donation remains to be developed in France), not to mention that very often, “transplantation does not cure, it prolongs the disease”, with heavy drugs (immunosuppressive therapy) that can give cancer-type side effects, etc. “A transplant is not a cure”, told me once a British nurse who was working in the field. Her daughter needed a heart transplant. Says it all, doesn’t it? You understood it well, it is difficult to summarize such a delicate field on the medico-ethical level, involving donors and recipients, populations of different religions, values, beliefs…
About a year and a half ago, a loved one, following COVID contracted very early into the pandemic (no vaccine was yet available, we were just starting to have masks and tests!) deteriorated his kidney function, while he already has type 2 diabetes (under control) and hypertension (also under control). He ends up in stage 3a CKD (chronic kidney disease), at just 60 years old. High speed internet is fun if you want to spend your free time as a retiree, say, in the metaverse; instead, for my loved one, I was considering a (not so) high-speed-dialysis-retirement process. Way less funny.
A small revolution: the combined Farxiga-Irbesartan treatment, which might “turn the transplant and dialysis landscape upside down” Dr Eric Magnant, Aix en Provence
It was then that Dr. Magnant informed us of a novelty: a “repurposed drug”, or a combination thereof, that might help “turn the landscape of dialysis and transplantation upside down”. A small revolution, like he puts it. In the midst of a pandemic, it feels like going back 15 years ago, when I was putting together information for my blog “ethics and organ transplantation” (blogspot). In the meantime, studied genomics and bioinformatics at the Massachusetts Institute Of Technology (MIT, Boston) between 20011 and 2016. The lure of medical novelty, I guess… For fun and out of curiosity, I start to investigate, asking around: how many patients with CKD have started on this Farxiga + Irbesartan therapy (or bi-therapy)? A lot, I soon discovered, by asking pharmacists, general practitioners, etc., in several regions of France. When a treatment works so efficiently, when it comes to restoring renal function and, in turn, improving the cardiac one, it is used widely, even in cases, I am told, where the renal function is very degraded.
Gone are the days when “non-acute kidney damage was insidious, asymptomatic, discovered too late, and above all irreversible”? Very careful patient follow-up (exhaustive blood tests, scanners, ultrasounds, etc.), as my loved one is among the first French patients to have benefited from this treatment. Kidney function returns to stage 2 (phew!), but after a year and a half: back to stage 3a (grrr). Dr. Magnant explains that the nephro prevention continues, that is to say that we will NOT dis-continue the treatment, in order to prevent a deterioration, more or less slow but certain, of the renal function, if nothing is done ( which would pretty much amount to the fact that, like the cow, we would just watch the trains go by). So the patient will carry on fluctuating between stage 2 and 3a of CKD, or might even remain in stage 3a, but this shouldn’t be bad news, as CKD patient data (lab results, medical imaging) will be monitored, and as long as the clinical picture remains good (diabetes and hypertension under control, etc.), there is no danger of dialysis…
Pyrénées Atlantiques, in the southern France, teleworking in the midst of a pandemic. Cows are curious. The lure of novelty, I guess…
A new molecule. Thanks to it, the CKD patient should fare off even better…
… Kérendia Finérénone (Bayer)
“…And,” adds Dr. Magnant, “I’m monitoring a new molecule, developed by a team of researchers in Chicago. Based on very solid studies, cardiac and renal. Green-lit by FDA for the US market; pending approval for the European one.” I understand that by the end of the year, my loved one could well benefit from this new treatment, which would do even better than the Farxiga-Irbesartan combination, which would still have caused a small revolution “in the dialysis and transplant landscape”, admittedly quite recent…
The cover of Dr. Magnant’s Bayer-Kerendia-Finérénone folder
Study published by Springer, 2018. It brings together an impressive team of researchers from many countries.
Although I am neither a caregiver nor a patient, I see this embryo of revolution growing a little more each day, and with hindsight I tell myself that Steve Jobs, with his famous “connecting the dots”, wasn’t wrong. I will have taken more than 15 years to do so, but it must be recognized that medical innovation is somewhat the red thread of my little story. Maybe I’m not the only one in this case? It is in this spirit that I have written this short biomedical chronicle, dedicated:
- to my loved one, at risk during the pandemic, but who had come to help his father who contracted covid on dialysis. And of course in memory of my step-dad, whom I adored.
- to my former bosses at Intuitive Surgical Inc., who passed away during COVID: Dr. Maurice Soustiel and Dr. Adrian Lobontiu, pioneers in minimally invasive computer-assisted surgery.
One of my twitter handles…
… and another one…
OK, I will spare you the details of my Mastodon accounts ;-) I’m just trying to tell you that my job is not in medicine. I’ve been a teacher for decades. It seems that I prefer teenagers to adults, as my job is “Creative Writing Teacher” at the Elon Musk school in California. For 10 years, with French-speaking students, we have been studying and writing science-fiction… which, by the way, doesn’t happen on twitter ;-)
(French version of this biomedical chronicle here.)
