Ames Gross, Pacific Bridge Medical
Ameing for Asia

Diseases of the Kidney on Rise Across Asia

By Ames Gross
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Ames Gross, Pacific Bridge Medical

The need is growing for life-saving treatments.

Kidney disease, a growing public health problem around the world, is on the rise with particular ferocity across Asia, ramping up the need for pharmaceuticals, dialysis treatments, cutting-edge kidney technologies and drugs.

Diseases of the kidney are broadly classified into two types: Acute kidney injury and chronic kidney disease. Acute kidney injury is defined by sudden damage to kidney tissue, usually caused by a drug, severe infection or obstruction to urine leaving the kidney from kidney stones, an enlarged prostate, or a severe accident. Chronic kidney disease entails the kidney function worsening over a number of years, and is more common than acute kidney injury. High blood pressure can damage blood vessels to the kidneys, diabetes can attack kidney tissue, and cysts can form, which do irreparable harm to this critical organ. When the disease progresses to end stage kidney disease, dialysis or a kidney transplant are required.

Causes and Prevalence of Kidney Diseases in Asia

In Asia, the incidence of kidney disease of all types is ballooning. The incidence of chronic kidney disease, in which the kidney slowly loses function and fails, stands at about 10% across the globe—but in Asia, the disease afflicts more than 14% of the population. According to recent Global Burden of Disease (GBD) estimates, chronic kidney disease currently ranks 19th among diseases for years of life lost globally, rising from 36th in 1990. In Asia, the disease ranks even higher at 14th. China alone has 119.5 million chronic kidney disease patients.

The incidence of kidney disease in Asia is growing even more due to increasing rates of diabetes and hypertension. The demand for dialysis in India, for example, is growing at a rate of about 30% each year. The value of the dialysis market there has increased from $100 million in 2007 to more than $200 million today. Across the continent, the population of end-stage renal disease patients requiring dialysis is growing at an annual rate of more than 12%.

In China and Japan, the increased prevalence of kidney disease is tied to growing incidences of obesity and diabetes, and to aging populations. In less developed South Asian countries, kidney function loss is driven by high rates of tuberculosis, diarrheal diseases, and vector-borne infections. In these nations, access to dialysis treatments is limited, nephrologists are scarce, and pharmaceutical remedies oftentimes are not available.

The rapid growth of kidney diseases in Asia is proving costly. Chronic kidney disease is often untreated in its earliest stages and is expensive to manage as it progresses to end stage renal failure.

Treatment Options and Market Opportunities in Asia

The increased prevalence of kidney disease in Asia has given rise to the need for a host of therapies, including sophisticated devices to enhance treatment. Chief among traditional treatments are hemodialysis and peritoneal dialysis. Hemodialysis removes wastes and water by circulating blood outside the body through an external semipermeable membrane filter, while peritoneal dialysis removes wastes and water from the blood inside the body using the peritoneal, or abdominal, membrane as a natural semipermeable membrane. While those therapies are widely available in well-developed countries such as Singapore, Hong Kong, Japan and Korea, they are much more rare in countries on the other end of the income scale such as Nepal, Bangladesh, Vietnam and Cambodia.

In some Asian countries, with the exception of the most affluent and well developed, continuous ambulatory peritoneal dialysis is more desirable than hemodialysis for the simple reason that it requires less electricity. In China alone, over 100,000 patients are treated with continuous ambulatory peritoneal dialysis today.

Technologies that can remove potentially cancerous renal masses without surgery are also in high demand in Asia. Existing techniques use radiofrequency waves or freezing techniques. But a relatively new technique, High Intensity Focused Ultrasound (HIFU), is drawing particular interest. It uses high frequency sound waves to kill cancer cells and obliterate kidney masses laparoscopically, without damage to surrounding tissues.

The market is also growing for devices to test kidney function. Urine dipstick analysis, which allows medical professionals to collect samples more easily and with less risk of infection than by drawing blood, are increasingly sought after.

For some patients in Asia as elsewhere, a kidney transplant is ultimately the only chance for survival. But kidney transplant waiting lists are long, and only one in three dialysis patients survive for more than five years without a transplant.

Although still more goal than reality, implantable artificial kidneys, which have been in development for more than 20 years, may go into clinical trials later this year. The device, developed by a team of academic researchers in the United States and funded with government grants, could prove revolutionary for patients across the globe—and a goldmine for the company that develops it.

Across Asia, demand is growing for a broad range of kidney disease treatments—which are still largely imported to the region from Western manufacturers. The opportunities for expansion are greatest in dialysis care, continuous renal replacement therapy, and HIFU technologies, and the market is expected to grow fastest in Japan, Korea, Singapore and other countries with more affluent and aging populations. Companies like Baxter and Fresenius already have large renal businesses in the region.

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Ames Gross, Pacific Bridge Medical

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