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Expert panel recommends new approaches to management of autosomal dominant polycystic kidney disease

January 29th marks the publication of a report by the European ADPKD Forum (EAF), an international, multidisciplinary panel of experts from the fields of nephrology, hepatology and genetics, as well as patient group representatives, dedicated to improving the health and quality of life of people with (ADPKD) – a chronic, progressive, inherited disease in which fluid-filled cysts grow in the kidneys and liver.1

The report, entitled ‘Translating Science into Policy to Improve ADPKD Care in Europe’, details the important role of healthcare professionals to improve the development and delivery of ADPKD care, and provides a comprehensive overview of the current management of ADPKD throughout Europe.

The publication highlights the variation of clinical standards throughout Europe2 and identifies the need for greater education and support for non-specialist healthcare professionals to ensure the accurate and appropriate diagnosis and treatment of ADPKD and ADPKD-related symptoms. These include pain, infections of cysts and the urinary tract, kidney stones, blood in the urine, and abdominal distension.3-8 ADPKD patients may also present with cardiovascular symptoms as they are at high risk of developing hypertension and cardiovascular disease.1 The report also highlights that polycystic kidneys cause kidney failure in the majority of patients,2,9 and that delaying the progression of the disease would improve patient outcomes and cost efficiencies for health services.

Commenting on the publication of the report, Dr. Richard Sandford, Consultant Clinical Geneticist at Addenbrooke’s Hospital, Cambridge, and co-chair of the EAF, said: “The management of ADPKD is currently based on the general management of declining renal function and the symptoms associated with the condition. Disease specific treatments are not currently available. Care pathways are fragmented across the EU and specialist knowledge of the disease itself remains limited. Innovative, long-term solutions should be sought to improve patient outcomes, and meet the financial and societal challenges that ADPKD represents.”

The EAF Report is endorsed by two leading patient organisations PKD International and the Patients Network for Medical Research and Health (EGAN). The following recommendations, captured in the ‘Brussels Declaration on ADPKD’ which is being launched today alongside the report as a stand-alone ‘EU policy action plan’, aim to help address the existing unmet needs and to promote access to high-quality care for all patients with ADPKD in Europe:

  • The implementation of tiered care: Governments should support the development of a nationally co-ordinated, tiered approach to ADPKD care in collaboration with experts, patient advocacy organisations and other stakeholders, in line with the European Commission (EC) policy priority to address health inequalities
  • The establishment of specialist ADPKD centres: An expanded European Reference Network of specialist ADPKD centres should be established to facilitate further research and harmonised, integrated, patient-centred care pathways, ensuring best practice and consistency of care
  • Supporting therapeutic innovation: The EC and national governments should support research to develop disease-modifying treatments with the potential to maintain quality of life, delay renal decline and improve life expectancy among patients, and to reduce the economic impact on healthcare systems
  • Prioritisation of prognosis: Governments and healthcare providers should support the routine implementation of methods to assess prognosis in ADPKD to inform clinical decision making, research and innovation
  • Empowering patients: All stakeholders, including the European Commission, national governments and healthcare providers, should support efforts to better inform individual patients and families affected by ADPKD, and to involve patient organisations in policy making regarding healthcare planning and delivery related to ADPKD
  • Engaging patients in health technology assessment: Health Technology Assessment (HTA) organisations should seek to engage ADPKD patient organisations in their assessments in order to consider their unique knowledge about the impact of living with ADPKD, and their aspirations for new treatments, according to the HTA International Quality Standards for Patient Involvement in HTA