Chronic Active Antibody-mediated Rejection: Opportunity to Determine the Role of Interleukin-6 Blockade

Chronic active antibody-mediated rejection (caAMR) is arguably the most important cause of late kidney allograft failure. However, there are no US Food and Drug Administration (FDA)-approved treatments for acute or chronic AMR and there is no consensus on effective treatment. Many trials in transplantation have failed because of slow and/or inadequate enrollment, and no new agent has been approved by the FDA for transplantation in over a decade. Several lines of evidence suggest that interleukin-6 is an important driver of AMR, and clazakizumab, a humanized monoclonal antibody that neutralizes interleukin-6, has shown promising results in phase 2 studies. The IMAGINE trial (Interleukin-6 Blockade Modifying Antibody-mediated Graft Injury and Estimated Glomerular Filtration Rate Decline) (NCT03744910) is the first to be considered by the FDA using a reasonably likely surrogate endpoint (slope of estimated glomerular filtration rate decline >1 y) for accelerated approval and is the only ongoing clinical trial for the treatment of chronic rejection. This trial offers us the opportunity to advance the care for our patients in need, and this article is a call to action for all transplant providers caring for patients with caAMR.

A National Registry for People With All Stages of Kidney Disease: The National Kidney Foundation (NKF) Patient Network

RATIONALE & OBJECTIVE

The National Kidney Foundation (NKF) launched the first national US kidney disease patient registry, the NKF Patient Network, that is open to patients throughout the continuum of chronic kidney disease (CKD). The Network provides individualized education and will facilitate patient-centered research, clinical care, and health policy decisions. Here, we present the overall design and the results of a feasibility study that was conducted July through December 2020.

STUDY DESIGN

Longitudinal observational cohort study of patient-entered data with or without electronic health care record (EHR) linkage in collaboration with health systems.

SETTING & PARTICIPANTS

People with CKD, age≥18 years, are invited through their provider, NKF communications, or national outreach campaign. People self-enroll and share their data through a secure portal that offers individualized education and support. The first health system partner is Geisinger.

EXPOSURE

Any cause and stage of CKD, including dialysis and kidney transplant recipients.

OUTCOME

Feasibility of the EHR data transfer, participants' characteristics, and their perspectives on usability and content.

ANALYTICAL APPROACH

Data were collected and analyzed through the registry portal powered by the Pulse Infoframe healthie 2.0 platform.

RESULTS

During the feasibility study, 80 participants completed their profile, and 42 completed a satisfaction survey. Mean age was 57.5 years, 51% were women, 83% were White, and 89% were non-Hispanic or Latino. Of the participants, 60% were not aware of their level of estimated glomerular filtration rate and 91% of their urinary albumin-creatinine ratio.

LIMITATIONS

Challenges for the Network are lack of awareness of kidney disease for many with CKD, difficulty in recruiting vulnerable populations or those with low digital readiness, and loss to follow-up, all leading to selection bias.

CONCLUSIONS

The Network is positioned to become a national and international platform for real-world data that can inform the development of patient-centered research, care, and treatments.

Wisconsin's health department-university partnership model for comprehensive cancer control

Cancer causes substantial morbidity and mortality every year in the United States. To address cancer prevention and control in Wisconsin, the Wisconsin Division of Public Health and the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center forged a unique partnership. Using funds from the state legislature, the university, and the Centers for Disease Control and Prevention, the Wisconsin Comprehensive Cancer Control Program was created. This health department-university partnership model has allowed both institutions to contribute their distinct strengths to projects that neither organization would have been able to complete on its own. Some challenges also have arisen during development and execution of the program, but overall, this collaborative partnership has brought diverse groups together to develop and implement evidence-based cancer control programs and policies in Wisconsin.