More than two-thirds of U.S. and European physicians believe there is a need for therapies to prevent kidney disease from diabetes becoming so severe that patients must go on dialysis to survive, according to a survey.

Sixty-six percent of American doctors and 70 percent of Europeans want to see therapies that can delay the onset of diabetes-related end-stage renal disease (ESRD), or kidney failure. The Decision Resources Group survey dealt with diabetic nephropathy (DN), the scientific name for kidney damage or failure from diabetes.

A report on the survey, “Diabetic Nephropathy Unmet Need,” also covered other needs that physicians believe should be addressed. One is therapies that can maintain patients’ glomerular filtration rate score, which measures how well kidneys can filter blood. Another is therapies that can reduce proteinuria, or excessive loss of proteins through urine.

Hallmarks of DNs include the kidneys leaking high levels of albumin protein into the blood, the development of diabetes-related kidney lesions known as diabetic glomerular lesions, and a drop in patients’ glomerular filtration rate score.

DN accounts for more than half of new kidney disease cases, making it the single most dangerous risk factor for end-stage renal disease.

Although most of the U.S. and European physicians who were surveyed identified unmet therapy needs, most said they were moderately satisfied with currently approved therapies. That response suggests they are satisfied with therapies that can control blood pressure and glucose levels, but want therapies that can prevent diabetes-related kidney failure.

Some of the other findings in the report:

• European physicians list DN as the kidney-disease area with the greatest unmet need, while U.S. physicians rank chronic kidney disease and obesity slightly higher. This likely reflects differences in the prevalence of the conditions in the two regions.
• U.S. and European physicians agree on the primary measures of a therapy’s ability to meet unmet needs, including reducing ESRD, proteinuria levels and blood pressure.
• Safety should be a primary concern in developing new therapies, and should take into account non-kidney health problems associated with kidney disease. For example, type 2 diabetes patients with kidney failure are at higher risk of having a heart attack or other cardiovascular problem. This means the medical community would likely appreciate a kidney therapy that offered cardiovascular protection as well.
• Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists, as well as Novo Nordisk’s Victoza (liraglutide) or Boehringer Ingelheim’s Jardiance (empagliflozin), do a better job of treating DN than loop diuretics.

“The emerging therapies, assuming approval, will be launching into a highly generic market in which physicians report some satisfaction with their current treatment options,” Caitlin Koris, an analyst from DRG, said in a press release. “In order to succeed, the drugs will need to demonstrate strong nephroprotective effects in their Phase 3 trials – or demonstrate enhanced safety. The first emerging therapy to receive an FDA-approved indication in DN will represent the first disease-modifying therapy for patients with kidney disease.”

Koris wrote a blog that offers additional perspective on the report. It’s titled “Hope at last! Activity in the Diabetic Nephropathy pipeline.”